非HIV患者播散性马尔尼菲篮状菌感染并溶骨性破坏1例

Osteolytic lesion caused by disseminated Talaromyce marneffei infection in a HIV negative patient

马尔尼菲篮状菌(Talaromyce marneffei,T.marneffei)是一种温度依赖性双相真菌,HIV阴性患者感染播散性T.marneffei并溶骨性破坏国内报道少见,我院收治了1例非HIV患者感染播散性T.marneffei,广西人,既往体健,无免疫受损基础疾病,临床表现为发热、肩关节疼痛、体重下降、溶骨性破坏,HIV阴性,左肩关节脓液和外周静脉血均培养出T.marneffei,给予两性霉素B脂质体抗真菌治疗1个月后好转出院,但该患者出院后2年内又因其他原因住院3次,最后1次住院临床诊断为脓毒血症休克。该患者出院后6个月死亡,死亡原因很可能是鸟-胞内分枝杆菌合并马尔尼菲篮状菌感染。

Talaromyce marneffei(T.marneffei)is a dimorphic fungal.There were rare reports of T.marneffei caused osteolytic destruction in non-HIV-infected cases.A patient who came from Guangxi Zhuang Autonomous Region,presented with fever,shoulder pain,weight loss,osteolytie lesion.He was HIV-negative,physical health,and did not merge the underlying disease with immune impairment.Pus of left shoulder joint and blood culture were positive for T.marneffei,His clinical status was improved and discharged after a month of amphotericin B treatment.The patient had 3 readmissions for other reasons within 2 years later.The last admitting diagnosis was septic shock.He died 6 months later due to co-infection of Mycobacterium avium-intracellulare complex(MAC)and T.marneffei probably.