A Rare Case of Mycobacterium Avium Combined with Penicillium marneffei (PM) Infection Involving Multiple Bone Joints throughout the Whole Body: A Case Report

Background: Mycobacterium avium complex (MAC) infection case which involves bones and joints are rare scenarios. Here, we report a rare case of Penicillium marneffei (PM), lung infection and systemic multi joint damage reported with positive anti-interferon-gamma at the same time. Case Presentation: A 55-year-old woman with fever for 10 days due to repeated multiple joint pain for more than one month was admitted to our hospital on September 19th 2020. During hospitalization, the patient was confirmed with mycobacterium avium combined with Penicillium marneffei (PM) infection involving multiple bone joints. Antifungal therapy and immunity regulatory agent were given during hospitalization. Following pharmocol-therapy, symptoms gradually improved, and the patient was discharged. Conclusions: The patient was considered disseminated and refractory non-tubercular mycobacterium (NTM) combined with Penicillium marneffei infection. In addition, we found that anti IFN-γ autoantibodies are closely related. Although the current incidence of this patient is related to anti IFN-γ, there is a strong correlation between autoantibody-mediated immunodeficiency in adults.

Marneffei青霉致病性动物实验研究

通过５批动物实验首次证明Ｍａｒｎｅｆｅｉ青霉的致病性是１、Ｍａｒｎｅｆｅｉ青霉是条件致病菌；２、在不同条件下该菌可以引起（１）局限性自愈性良性型Ｍａｒｎｅｆｅｉ青霉病（或感染）；（２）进行性播散型Ｍａｒｎｅｆｅｉ青霉病，可致死；３、该菌在体内易早期播散全身；４、菌株变色仍能致病；５、要证明所分离出的菌株是否是Ｍａｒｎｅｆｅｉ青霉较敏感的实验动物是小白鼠、罗赛鼠、褐家鼠、幼龄板齿鼠，接种菌量要多，以酵母样型为好，剖验的最适宜时间是接种后第１４±７天，否则可因动物自身免疫力增强自愈而失败。

Clinical characteristics and risk factors of Talaromyces marneffei infection in human immunodeficiency virus-negative patients: A retrospective observational study

BACKGROUND: To investigate the clinical characteristics and risk factors of human immunodeficiency virus(HIV)-negative patients with Talaromyces marneffei(T. marneffei) infection.METHODS: We retrospectively collected the clinical information of HIV-negative patients with T. marneffei infection from January 1, 2010 to June 30, 2019, and analyzed the related risk factors of poor prognosis.RESULTS: Twenty-five cases aging 22 to 79 years were included. Manifestations of T. marneffei infection included fever, cough, dyspnea, chest pain or distress, lymphadenopathy, ear, nose, and throat(ENT) and/or skin lesions, bone or joint pain, edema and pain in the lower extremities, digestive symptoms, icterus, malaise, and hoarseness. Two cases had no comorbidity, while 23 cases suff ered from autoimmune disease, pulmonary disease, cancer, and other chronic diseases. Sixteen cases had a medication history of glucocorticoids, chemotherapy or immunosuppressors. Pulmonary lesions included interstitial infiltration, nodules, atelectasis, cavitary lesions, pleural effusion or hydropneumothorax, bronchiectasis, pulmonary fibrosis, pulmonary edema, and consolidation. The incidence of osteolytic lesions was 20%. Eight patients received antifungal monotherapy, and 11 patients received combined antifungal agents. Fifteen patients survived and ten patients were dead. The Cox regression analysis showed that reduced eosinophil counts, higher levels of blood urea nitrogen(BUN), alanine aminotransferase(ALT), aspartate aminotransferase(AST), lactic dehydrogenase(LDH), myoglobin(Mb), procalcitonin(PCT), and galactomannan were related to poor prognosis(hazard ratio [HR]>1, P<0.05).CONCLUSIONS: Bone destruction is common in HIV-negative patients with T. marneffei infection. Defective cell-mediated immunity, active infection, multiple system, and organ damage can be the risk factors of poor prognosis.

Penicillium marneffei chylous ascites in acquired immune deficiency syndrome:A case report

Penicillium marneffei （R marneffei） infection usually occurs with skin, bone marrow, lung or hepatic involve- ment. However, no cases of P. mameffei infection with chylous ascites have been reported thus far. In this re- port, we describe the first case of acquired immune de- ficiency syndrome （AIDS） which has been complicated by a P. marneffei infection causing chylous ascites. We describe the details of the case, with an emphasis on treatment regimen. This patient was treated with am- photericin B for 3 mo, while receiving concomitant ther- apy with an efavirenz-containing antiretroviral regimen, but cultures in ascitic fluid were persistently positive for P. marneffei. The infection resolved after treatment with high-dose voriconazole （400 mg every 12 h） for 3 too. R marneffei should be considered in the differential di- agnosis of chylous ascites in human immunodeficiency virus patients. High-dose voriconazole is an effective, well-tolerated and convenient option for the treatment of systemic infections with R marneffei in AIDS patients on an efavirenz-containing antiretroviral regimen.

Association between specific proteins and dimorphic growth of penicillium marneffei

Objective： To investigate the difference of proteome between yeast form and mould form of Penicillium mameffei, and to investigate the association of specific proteins expressed with biochemical properties, susceptibility of antifungal agent with dimorphic growth. Methods： Biochemistry identity plates were used to test the assimilation of carbohydrates and E-test strips were used to detect the minimum inhibitory concentration （MIC） of mould form and yeast form 16 P. mameffei. Surface enhanced laser desorption/ionization （SELDI） mass spectrometry with ProteinChip WCX2 was performed to compare the expressed proteins in yeast form and mould form. Protein profiles were read by PBSⅡ proteinchip reader and the proteome database was analyzed by proteincbip software 3.2.0. Results： Mould form assimilated lactose, melibiose significantly stronger （ P 〈0.01）, while yeast form assimilated sorbinose significantly stronger （ P 〈 0.05）. The mean MIC of fluconazole against mould form increased significantly （ P 〈 0.01 ） compared with yeast form. Seventy-five distinct proteins were found in yeast form and mould form of P. mameffei, in which proteins of 2900Da and 3151Da were specifically expressed in yeast form and other two proteins of 13151Da and 13285Da were specifically expressed in mould form （ P 〈 0.01 ）. Conclusion： The assimilation of carbohydrates and drug susceptibility of P. mameffei may change partly due to the morphogenetic conversion and different texture. Specific proteins may he involved in the regulation, the change of biochemical reaction and drug susceptibility during dimorpbic growth.

Nursing Experience of an Elderly Patient with Systemic Disseminated <i>Penicillium marneffei</i>

Elderly patients with systemic disseminated Penicillium marneffei are generally more seriously ill with high mortality. In addition to clear diagnosis and timely treatment, careful nursing throughout the hospitalization is particularly important for the patient’s recovery. Psychological nursing and family emotional support, the treatment of adverse drug reactions, systemic infection wound care, the prevention of pressure sores in long-term bedridden patients, antithrombotic nursing, disinfection isolation and the standard prevention of nosocomial cross infection all play decisive roles in the patient’s prognosis. After one month treatment and medical care, the patient was cured and was discharged from hospital. After discharge, the patient follow-up was carried out up to one year. This patient had completely recovered. In this paper, we report a successful nursing experience of an elderly patient with systemic disseminated Penicillium marneffei. With the summary of nursing key points, it could play a reference in the treatment and rehabilitation of similar patients.

Penicillium marneffei infection involving liver

Penicillium marneffei(P.marneffei)is a pathogenic fungus that can cause fatal infections in humans,particularly immunocompromised hosts.It is prevalent only in the Southeast Asian region.A 5-year-old boy was presented with diagnosed Acute Lymphoblastic Leukemia undergoing chemotherapy and suffering from high-grade fever for 15 days positively responded to antibiotics on the initial day,but later he became unresponsive.He was found negative for blood cultures of bacterial growth.Ultrasound of the abdomen showed a borderline enlarged liver with multiple small hypoechoic areas of variable sizes seen scattered in both lobes of the liver.Morphological and microscopic analyses of liver tissues showed multiple septate hyphae of P.marneffei.Amphotericin B was found to be effective in treating the child.Appropriate identification is essential to treat the pathogen-causing disease,especially in immuno-compromised conditions like a leukemic patient,and determine underlying mechanisms behind the pathogenesis.

Comparison of Talaromyces marneffei Infection in Human Immunodeficiency Virus-positive and Human Immunodeficiency Virus-negative Patients from Fujian, China

Background： Talaromyces （Penicillium） marneffei （TIM） is an emerging dimorphic human pathogenic fungus that is endemic to Southeast Asia. TM mostly occurs as an opportunistic infection in patients with human immunodeficiency virus （HIV）. The objective of this study was to compare the clinical and laboratory parameters of patients with TM infections who were HIV-positive and HIV-negative and to assess therapies and outcomes. Methods： This was a retrospective analysis of 26 patients diagnosed with disseminated TM infection from September 2005 to April 2014 at Fujian Provincial Hospital, China. Results： Patients with TM infection tend to present with fever, weight loss, and anemia. The time from symptom onset to confirmed diagnosis was greater for HlV-negative patients （n 7; median： 60 days, range： 14-365 days） than for HIV-positive patients （n = 19; median： 30 days, range： 3-90 days, Mann-Whitney U= 31.50, P = 0.041）. HIV-negative patients were more likely to have dyspnea （57.1% vs. 5.3%, Z： = 8.86, P = 0.010）, low neutrophil count （Mann-Whitney U = 27.00, P = 0.029）, high CD4 count （Mann-Whitney U= 0.00, P 0.009）, and high lymphocyte count （Mann-Whitney U = 21.00, P = 0.009）. There were no significant differences in other demographic, clinical, or biochemical characteristics. Among all the patients, 12 HIV-positive patient and 1 HlV-negative patient received amphotericin and fluconazole treatment, 9 of whom improved, l died, 2 had kidney damage, 1 had hypokalemia due to exceeded doses. Conclusions： HIV-negative patients with TM infections tend to have a longer diagnostic interval, a higher percentage of dyspnea, higher levels of CD4 and lymphocytes, and lower neutrophil counts than TM infection in HIV-positive patients. Treatment programs with amphotericin and fluconazole are mostly effective.

Determinants of prognosis in Talaromyces marneffei infections with respiratory system lesions

Background: Little study has investigated the differences between Talatomyces marneffei (T. marneffei) respiratory infection and tuberculosis and the prognostic factors of such infection. This study investigated the characteristics and prognostic factors of T. marneffei infections with respiratory lesions and the causes of misdiagnosis. Methods: Clinical characteristics and prognoses of patients with T. marneffei infections with respiratory system lesion were investigated. T. marneffei diagnosis followed isolation from clinical specimens using standard culture, cytology, and histopathology. Survival curves were estimated by using Kaplan-Meier analysis, with log-rank test to compare differences in survival rates between groups. Univariate and multivariate Cox regression analyses were also performed to assess significant differences in clinical characteristics of overall survival. Results: Of 126 patients diagnosed with T. marneffei infections, 63 (50.0%) had T. marneffei respiratory system infections;38.1%(24/63) were misdiagnosed as having tuberculosis. Human immunodeficiency virus (HIV) infection, CD4/CD8 < 0.5, percentage of CD4+ T cells <42.8%, and length of time from onset to confirmation of diagnosis >105 days were potential risk factors for poor prognoses. Length of time from onset to confirmation of diagnosis persisted as an independent predictor of all-cause mortality in multivariate analysis (odds ratio: 0.083, 95.0% confidence interval: 0.021–0.326, P < 0.001). However, the size of the lung lesions, dyspnea, thoracalgia, mediastinal lymphadenopathy, and pleural effusion did not significantly predict overall survival. There was no significant difference in prognosis according to the type of treatment. Conclusions: T. marneffei infections involving the respiratory system are common. The critical determinants of prognosis are HIV infection, CD4/CD8, percentage of CD4+ T cells, type of treatment, and the time range from onset to confirmation of diagnosis. Rapid and accurate diagnosis is crucial for improving prognosis.

Genetic diversity analysis of Penicillium marneffei isolated from AIDS patients in Guangdong, China using randomly amplified polymorphic DNA

Background Penicillium mameffei （P. marneffe~） is an emerging pathogenic fungus that can cause invasive mycosis in patients with AIDS. The epidemiological features of P. marneffeiinfection in AIDS patients in Guangdong province remain unclear so far. This study aimed to investigate the genetic diversity within a population of 163 P. mameffei isolates obtained from AIDS patients and search for the dominant clinical strains in Guanqdong province.

Disseminated Penicillium marneffei infection in acquired immunodeficiency syndrome: a case report

P enicillium marneffei ( P. marneffei ) is a facultative intracellular pathogen and the only thermally dimorphic fungus. This fungal infection is commonly found in Southeast Asian, Hong Kong, south China, and especially in acquired immunodeficiency syndrome (AIDS) patients. 1-4 We reported a patient with AIDS in whom infection due to P. marneffei was demonstrated. CASE REPORT A 34-year-old man with human immunodeficiency virus (HIV) infection (diagnosed before 6 months), living in Guangzhou of south China, was admitted to the hospital because of prolonged fever, cough, and weight loss. Initial examination revealed permanent high-grade fever (39-40℃) with chill and cough. Laboratory findings revealed haemoglobin concentration at 80 g/L, CD 4 lymphocyte count at 7×10 6/L, and viral load at 1.3×10 5 copies/ml. Blood and urine culture revealed no bacterial growth. Sputum culture was negative for mycobacterium. Chest X-ray film revealed left upper lobe ill-defined parenchymal opacities and widening of the superior mediastinum with left lung hilum prominence (Fig. 1). Abdominal B ultrasound showed hepatoplenomegaly and coeliac enlarged lymph nodes. On physical examination, the patient was found to have facial papula, cervical and superclavicular multiple lymph nodes.

艾滋病合并马尔尼菲篮状菌感染的临床特征和预后因素研究

目的探讨艾滋病(AIDS)合并马尔尼菲篮状菌(Talaromyces marneffei,TM)感染的临床特点和预后因素研究。方法选取我院2017年1月至2021年12月收治的85例AIDS合并TM感染患者。根据预后情况分为生存组和死亡组。对两组患者的临床和实验室指标进行比较分析。并对死亡组影响预后因素进行Logistic回归分析。结果AIDS合并TM感染患者病死率为18.8%。最常见症状体征为发热(94.1%)、咳嗽(54.1%)、消瘦(54.1%)、皮肤损害(34.1%)、肝脾肿大(38.8%)和淋巴结肿大(80.0%)。最常见的实验室指标异常是贫血(78.8%)、血小板减少(45.9%)和谷草转氨酶升高(70.6%)、乳酸脱氢酶升高(80.0%)。Logistic回归筛选出血红蛋白(OR=0.922;95%CI 0.858,0.991)、尿素氮(OR=1.612;95%CI 1.084,2.399)、呼吸衰竭(OR=348.538;95%CI 5.374,22606.322)3个有统计学意义的预后因素。结论呼吸衰竭和血红蛋白减少、尿素氮升高是AIDS合并TM感染预后不良的危险因素。

(1-3)-β-D葡聚糖联合降钙素原、CD4^(+)T淋巴细胞多指标在艾滋病患者马尔尼菲篮状菌感染早期诊断临床研究

目的探讨(1-3)-β-D葡聚糖联合降钙素原(procalcitonin,PCT)、CD4^(+)T淋巴细胞多指标在艾滋病患者马尔尼菲篮状菌感染早期诊断临床研究。方法回顾性选取我院2020年1月—2022年6月住院的120例艾滋病患者为研究对象。依据实验室结果,将其分为马尔尼菲篮状菌感染确诊组(血或组织液培育养出马尔尼菲篮状菌),简称A组(62例),及马尔尼菲篮状菌感染临床诊断组[根据临床症状、体征、血常规及(1-3)-β-D葡聚糖、PCT、CD4^(+)T淋巴细胞多指标诊断],简称B组(58例)。检测患者(1-3)-β-D葡聚糖、PCT、CD4^(+)T淋巴细胞的表达水平,采用受试者工作特征(receiver-operating characteristic,ROC)曲线下面积(area under the curve,AUC)评估上述指标联合检测对艾滋病患者感染马尔尼菲篮状菌的诊断效能。结果A组的(1-3)-β-D葡聚糖和PCT水平均高于B组,CD4^(+)T淋巴细胞个数低于B组(P<0.05);(1-3)-β-D葡聚糖、PCT、CD4^(+)T淋巴细胞联合检测的AUC为0.933,(1-3)-β-D葡聚糖单独检测的AUC是0.812,PCT单独检测的AUC为0.883,CD4^(+)T淋巴细胞单独检测的AUC是0.810,(1-3)-β-D葡聚糖、PCT和CD4^(+)T淋巴细胞联合检测的AUC皆优于三项单独检测,表明(1-3)-β-D葡聚糖、PCT和CD4^(+)T淋巴细胞联合检测的诊断价值皆优于单一指标诊断,且联合检测的特异度、约登指数分别为92.43%和0.580,均高于三项单独检测。结论(1-3)-β-D葡聚糖联合PCT和CD4^(+)T淋巴细胞多指标对艾滋病马尔尼菲篮状菌感染具有非常高的临床诊断价值,能够帮助医生分析出高危风险患者,及时制定治疗方案,同时也承担预后效果的判断依据,对治疗艾滋病马尔尼菲篮状菌感染具有非常重要的研究价值。

非HIV相关儿童马尔尼菲篮状菌感染9例临床分析

目的探讨非HIV相关儿童马尔尼菲篮状菌(TM)感染的临床特点、治疗和预后。方法回顾性分析2015年10月至2023年10月广州医科大学附属第一医院儿科收治的9例HIV阴性TM感染患儿的临床资料,包括临床表现、肺部影像学、病原检测、组织病理特点、治疗和预后等。结果9例非HIV相关TM感染患儿以男性为主,中位年龄为40(3~164)个月。主要临床表现为发热、咳嗽、浅表淋巴结大,皮疹、肝脾肿大、腹痛或腹泻少见。大部分患儿C反应蛋白、降钙素原以及血沉升高,伴有血红蛋白降低。8例TM患儿免疫球蛋白G、免疫球蛋白A有不同程度降低。胸部CT显示肺部弥漫性或实质性病变。痰/血培养TM阳性8例。6例经支气管镜肺组织病理活检(1例同时行淋巴结活检),其中2例肺组织病理为肉芽组织形成,1例淋巴结及肺组织细胞质内可见圆形或腊肠状伴有横隔的孢子样物质,其余3例肺组织病理为非特异性炎性病变组织。8例患儿行基因全外显子测序,5例检出明确致病基因。9例患儿初始均采用伏立康唑治疗,4例预后良好,2例改用两性霉素B治疗后好转,3例因病情进展死亡。结论非HIV相关TM患儿起病隐匿,病程长,需注意原发病的追踪。血、肺泡灌洗液培养有助于尽早诊断TM感染,尽早进行抗真菌治疗有助于改善预后。

国产两性霉素B脂质体不同加量方案在艾滋病合并马尔尼菲篮状菌感染患者中的安全性

目的探索国产两性霉素B脂质体临床应用中不同加量方案的安全性、常见不良反应及其影响因素。方法收集2017年1月—2022年12月我院收治的使用国产两性霉素B脂质体的艾滋病合并马尔尼菲篮状菌感染的病例,收集患者的基本资料、对比两性霉素B脂质体不同加量方案对血常规、肝肾功能及低钾血症的影响,统计发生的药品不良反应并使用多重线性回归法对用药后钾离子浓度的影响因素进行分析。结果共纳入50例患者,快速加量法(n=23,≤4d)与慢速加量法(n=27,>4d)对血常规、肝肾功能及钾离子浓度的影响均差异无统计学意义(P>0.05)。低钾血症(76.0%)是两性霉素B脂质体最常见不良反应,多重线性回归分析显示用药前钾离子浓度(P=0.008)是用药后钾离子浓度的重要影响因素。结论国产两性霉素B脂质体可安全使用快速加量法以尽快达到治疗剂量,该药临床应用中最常见不良反应为低钾血症,用药前钾离子浓度是用药后钾离子浓度的重要影响因素。

以马尔尼菲篮状菌肺炎起病的X连锁高IgM综合征婴儿1例

X连锁高IgM综合征(X-linked hyper-immunoglobulin M syndrome,XHIGM)是罕见的原发性免疫缺陷病,该病以反复感染为特征,易感染机会致病微生物。临床上以马尔尼菲篮状菌肺炎起病的XHIGM更为罕见。该文回顾性分析1例以马尔尼菲篮状菌肺炎起病的X连锁高IgM综合征婴儿的临床资料,实验室、影像学检查结果和诊疗经过并探讨其基因型,结合最新文献复习,以提高对该疾病的认识。

AIDS并发脾脏马尔尼菲篮状菌病及脾结核临床及腹部CT表现特征分析

目的探讨AIDS并发脾脏马尔尼菲篮状菌病(Talaromycosis marneffei,TSM)与AIDS并发脾结核(splenic tuberculosis,STB)的临床特征及CT表现特点,以提高对两者的诊断及鉴别诊断能力。方法回顾性分析南宁市第四人民医院2019年1月至2023年12月间确诊的22例AIDS并发脾脏TSM以及31例AIDS并发STB患者的临床及腹部CT资料,比较两组患者年龄、性别、CD4+T淋巴细胞计数、贫血、发热、腹胀、腹痛、皮疹等临床特征以及脾脏大小、脾脏病灶分型及强化方式、腹腔腹膜后淋巴结受累及强化方式、脾脏有无梗死等CT表现。结果脾脏TSM患者通常具有更低的CD4+T淋巴细胞计数且以CD4+T淋巴细胞计数小于20个/μl多见。与脾脏STB患者相比,脾脏TSM患者更常观察到皮疹和腹胀。两组患者性别、年龄分布比差异无统计学意义;贫血、发热、腹痛发生率差异无统计学意义。脾脏TSM患者CT表现以脓肿/肿块型多见,而STB患者CT表现以粟粒型、结节型多见。两组患者脾大、脾梗死差异无显著统计学意义。脾脏TSM通常增强扫描以无强化多见,STB以环形强化多见。两组患者均较常累及腹腔、腹膜后淋巴结,TSM相关性淋巴结肿大以均匀强化多见,淋巴结结核以环形强化为主。结论AIDS并发脾脏TSM与STB患者的临床及CT表现具有一定特征性,CT增强扫描对两者的诊断与鉴别诊断具有较大的价值,加深对AIDS并发脾脏STM与STB患者的临床和CT特点的认识,有助于诊断和鉴别诊断。

以腹泻为主要症状的新生儿播散性马尔尼菲篮状菌感染1例

报道1例以腹泻为主要起病症状的新生儿播散性马尔尼菲篮状菌病。患儿,男,生后25 d,因“发热伴腹泻8 d”入院,血培养及痰培养均提示马尔尼菲篮状菌,外周血IgG水平明显降低,进一步对患儿、患儿父母及姐姐进行免疫缺陷病相关基因检测,提示患儿存在CD40LG基因突变所致X连锁高IgM综合征,患儿母亲及姐姐为该位点杂合变异,父亲正常。确诊后给予伏立康唑静滴治疗症状好转,复查血培养及痰培养阴性出院,出院后继续口服伏立康唑片巩固治疗,随访患儿未再发病。

多指标单独或联合检测在艾滋病合并马尔尼菲篮状菌感染的诊断价值

目的探讨多个指标单独或联合检测在艾滋病合并马尔尼菲篮状菌感染诊断中的应用价值。方法回顾性分析我院2018年10月—2021年12月期间住院的艾滋病患者临床资料,经纳排标准筛选得到789例患者资料。依据马尔尼菲篮状菌分离培养和鉴定以及临床诊断等结果,将157例确诊为艾滋病合并马尔尼菲篮状菌感染定义为TM组;632例无马尔尼菲篮状菌感染的艾滋病患者定义为非TM组。采用Mann-Whitney U检验,比较两组之间降钙素原(Procalcitonin);腺苷脱氨酶(Adenosine deaminase);乳酸脱氢酶(lactate dehydrogenase);半乳甘露聚糖(Galactomannan);(1,3)-β-D-葡聚糖[(1,3)-beta-D-glucan]和CD3^(+)、CD8^(+)、CD4^(+)T淋巴细胞计数的差异;利用ROC曲线分析PCT、ADA、LDH、GM和G在CD4^(+)T淋巴细胞计数≤50个/μL的AIDS合并TM感染患者诊断中的应用价值;分析GM、ADA和G试验联合检测在CD4^(+)T淋巴细胞计数≤50个/μL的AIDS合并TM感染患者中的应用价值。结果与非TM组相比较,TM组的PCT、ADA、LDH、GM和G水平明显增高,差异有统计学意义(P<0.0001),TM组的CD3^(+)、CD8^(+)、CD4^(+)T淋巴细胞计数明显低于非TM组,差异有统计学意义(P<0.0001);经ROC曲线分析综合得出GM、ADA和G三个指标在CD4^(+)T淋巴细胞计数≤50个/μL的AIDS合并TM感染患者中的诊断价值较高;在所有联合检测的方案中ADA、GM和G串联的特异性(99.53%)和阳性预测值(98.15%)最高;ADA和G串联的诊断准确率最高(77.26%);ADA、GM和G并联的灵敏度(96.03%)和阴性预测值(94.17%)最高。结论AIDS合并TM感染主要发生在CD4^(+)T淋巴细胞计数≤50个/μL的患者;GM、ADA和G检测在CD4^(+)T淋巴细胞计数≤50个/μL的AIDS合并TM感染患者中的诊断价值较高;在所有联合检测的方案中GM、ADA和G三者联合检测诊断效能最好,可有效提高疾病检出率。

艾滋病合并肠道马尔尼菲篮状菌感染1例

小肠出血是较为常见的临床问题,且诊断具有一定的挑战性。本文报道了1例艾滋病合并肠道马尔尼菲篮状菌感染患者,表现为发热、腹痛、血便,CT提示空肠上段活动性出血,内镜提示空肠上段黏膜病变,血培养及内镜下活检提示马尔尼菲蓝状菌感染,行抗真菌治疗后,病情好转。这提示马尔尼菲蓝状菌可感染肠道,引起肠道出血等并发症,应用多种检查方法积极寻找出血部位,诊断明确后有效的抗真菌治疗,可取得良好疗效。