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.

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.

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.

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.

广西银星竹鼠与人马尔尼菲青霉病关系的研究

目的 探讨动物与人马尔尼菲青霉病的流行病学关系。方法 收集 16只广西银星竹鼠进行真菌学研究。结果 从 15只竹鼠体内分离出与人类马尔尼菲青霉病的病原菌一致的马尔尼菲青霉菌 ,阳性率达 93 .2 %。结论 野生竹鼠自然携带马尔尼菲青霉菌 ,但无病态 ,其可能为该菌的贮存宿主。其分泌排泄物可通过呼吸道、消化道、皮肤等途径致人感染马尔尼菲青霉菌 。

艾滋病合并播散性马尔尼菲青霉菌胸部感染的CT诊断

目的探讨艾滋病合并播散性马尔尼菲青霉菌胸部感染的CT表现及其诊断价值。方法回顾性分析经临床确诊的6例艾滋病合并播散性马尔尼菲青霉菌感染患者的胸部CT扫描的资料。结果肺部片状实变影4例;结节影3例;支气管壁增厚3例;支气管血管束增粗2例;弥漫性粟粒小结节影1例;纵隔及肺门淋巴结肿大3例;胸膜炎4例。结论艾滋病合并播散性马尔尼菲青霉菌胸部感染胸部CT主要表现为肺部片状实变影、结节影、纵隔淋巴结肿大、胸膜炎性反应。胸部CT检查有利于本病临床诊断及治疗。

免疫健全者播散性马尔尼菲青霉菌病一例及文献复习

目的总结播散性马尔尼菲青霉菌病的特征,以提高临床医生对播散性马尔尼菲青霉菌病的认识。方法通过对1例非免疫受损者播散性马尔尼菲青霉菌病例的临床、影像学及细菌学分析,并复习播散性马尔尼菲青霉菌病的相关文献,从而总结其特征。结果患者男性,32岁,广东人,以发热、咳嗽及肺部、气道黏膜、皮下等多系统结节病变或脓性包块为主要临床表现;实验室检查显示血常规白细胞明显升高,心、肝、肾多脏器损害;曾多次包块活检显示炎症表现,但脓肿分泌物培养阴性;广谱抗生素治疗无效。纤维支气管镜下见气道黏膜灰白色结节,最后在细菌学专家床边指导下皮下肿块脓性分泌物真菌培养及纤维支气管镜深部痰真菌培养确诊马尔尼菲青霉菌病。结论播散性马尔尼菲青霉菌病可发生于免疫功能正常患者,对于用结缔组织病及普通化脓性感染等无法解释的多系统损害、多发化脓性皮下包块,又有南方流行区生活史的患者,应警惕马尔尼菲青霉菌感染,并尽早确诊和治疗。

马尔尼菲青霉对巨噬细胞模式识别受体TLR-2、TLR-4、Dectin-1的表达及TNF-α分泌的影响

目的研究马尔尼菲青霉对巨噬细胞模式识别受体TLR-2、TLR-4、Dectin-1的表达及促炎因子TNF-α分泌的影响。方法马尔尼菲青霉酵母相菌液与小鼠腹腔巨噬细胞共培养24h,采用流式细胞技术检测巨噬细胞TLR-2、TLR-4及Dectin-1的平均荧光强度;共聚焦显微镜观察荧光染色的受体;ELISA法测定培养液上清中TNF-α的浓度;Real time PCR检测不同时间段TNF-α的mRNA表达。结果马尔尼菲青霉可使巨噬细胞TLR-2、TLR-4、Dectin-1的平均荧光强度均增高,并激活巨噬细胞产生TNF-α。结论马尔尼菲青霉上调了巨噬细胞模式识别受体TLR-2、TLR-4及Dectin-1的表达,巨噬细胞的激活与TLR-2、TLR-4及Dectin-1的表达上调相关。

双抗原夹心ELISA法检测马尔尼菲青霉Mp1p抗体

目的建立一种检测马尔尼菲青霉特异性抗体的双抗原夹心ELISA方法。方法利用毕赤酵母系统表达重组马尔尼菲青霉特异性甘露糖蛋白Mp1p,并利用改良过碘酸钠法标记Mp1p,经棋盘滴定法建立一种可检测马尔尼菲青霉Mp1p特异性抗体的双抗原夹心ELISA法,并检测100例健康人群对照血清、21例血培养确诊其他真菌感染病人血清和15例血培养确诊马尔尼菲青霉病人血清,联合本实验室前期建立的马尔尼菲青霉抗原检测方法评价其临床应用价值。结果成功建立一种检测马尔尼菲青霉Mp1p特异性抗体的双抗原夹心ELISA法,经健康人群对照及其他真菌感染病人血清评价特异度为100%(121/121),检测15例马尔尼菲青霉病人血清,Mp1p特异性抗体2例阳性,Mp1p特异性抗原12例阳性,Mp1p抗体与抗原联合检测可明显提高灵敏度,达到93.3%(14/15)。结论双抗原夹心ELISA法检测马尔尼菲青霉Mp1p特异性抗体具有高度的特异性,联合抗原检测可提高马尔尼菲青霉感染诊断率。

原位杂交技术鉴定马尔尼菲青霉

目的 探讨原位杂交技术 (ISH)特异性检测马尔尼菲青霉 (Pm)感染组织标本的可行性。方法 以Pm的rDNA区间种特异性序列作为特异性探针 ,通过聚合酶链反应 (PCR)扩增合成并以地高辛标记 ,与 12例临床确诊的Pm感染组织标本中的靶DNA杂交。结果 12例Pm感染标本中全部阳性 ,其它种属真菌感染组织均为阴性。结论 ISH技术可以灵敏、特异地检测出组织中的Pm ,适用于今后临床组织标本中Pm感染的检测。

9例非HIV感染患者马尔尼菲蓝状菌播散感染的回顾性分析报告

目的通过回顾性分析非艾滋病患者感染马内菲蓝状菌病的临床特点提高对非HIV患者马内菲蓝状菌病的认识。方法分析并总结9例马内菲蓝状菌感染患者的临床表现及实验室检查各项指标。结果 6例无基础疾病,3例有基础疾病,6例患者接受免疫抑制剂治疗。5例患者有骨损坏,2例有皮疹,淋巴结肿大7例,贫血7例,脾增大7例,肝大5例,体重下降5例,6例患者接受抗结核或非结核治疗。最后有6例患者治愈或好转,3例死亡。结论激素或免疫抑制剂的使用是非艾滋病患者感染马内菲蓝状菌的主要原因。非艾滋病患者感染马内菲蓝状菌无特异性的临床表现,易误诊,早期诊断困难,尤其需与结核病等疾病相鉴别。抗真菌治疗与患者的预后有密切的相关性。

艾滋病合并马尔尼菲青霉病的临床分析

【目的】探讨艾滋病合并马尔尼菲青霉病的临床及实验室特征。【方法】回顾分析2002年11月至2005年12月本院收治明确诊断为艾滋病合并马尔尼菲青霉病的53例临床及实验室资料。【结果】艾滋病合并马尔尼菲青霉病以发热、消瘦、咳嗽、皮疹、贫血等为主要临床特点,皮损主要表现为坏死性丘疹、脐凹状丘疹、溃疡、结节、血痂;外周血CD4+细胞显著减少;在沙氏琼脂培养基中马尔尼菲青霉呈酵母相(37℃)或菌丝相(25℃);药敏结果显示伊曲康唑、酮康唑对马尔尼菲青霉的MIC值最低,两性霉素B、5-氟胞嘧啶次之,氟康唑最高;病理组织六胺银染色见圆形、椭圆形或腊肠样病原体,部分有横隔。【结论】艾滋病合并马尔尼菲青霉病临床表现复杂,主要发生于CD4+计数少于50细胞∕μL的患者,真菌培养鉴定结合组织病理检查是确诊的关键,治疗上建议使用伊曲康唑、两性霉素B。

马尔尼菲青霉菌感染病例报告

目的 探讨马尔尼菲青霉菌的鉴定及临床表现 ,为早期诊断、治疗提供经验 ,降低死亡率。方法 取淋巴结穿刺液、血液进行真菌培养鉴定。结果 氢氧化钠涂片和革兰染色能检出马尔尼菲青霉菌所特有的孢子。结论 氢氧化钠涂片和革兰染色能早期发现真菌孢子 ,是一种快速、可行的方法 ,此外 ,组织病理学也可作为诊断马尔尼菲青霉病的一种很重要的方法 ,但需做过碘酸雪夫染色与荚膜组织胞浆菌病作鉴别。

酵母相马尔尼菲青霉菌体外抗真菌药敏试验研究

目的 用 Ｅ-test法测定马尔尼菲青霉菌（penicillium marneffei,PM)酵母相的药物敏感性，指导临床合理用药。方法 采用Ｍ２７－ｐ方案中的Ｅ-test法测定６株ＰＭ的酵母相（ｙeast）对伊曲康唑、酮康唑、氟康唑、５－氟胞嘧啶、二性霉素Ｂ的ＭＩＣ值。结果 伊曲康唑ＭＩＣ值范围０．００２～０．016μg/ml，无耐药株；酮康唑ＭＩＣ值范围０．０１６～０．１６０μg/ml，耐药株１株；５－氟胞嘧啶ＭＩＣ值范围０．０３２～０．３８０ μｇ／ml，耐药株１株；氟康唑ＭＩＣ值范围１．５００～６．０００μｇ／ml，无耐药株；二性霉素 Ｂ ＭＩＣ值范围 ０．０４７～１．５００μｇ/ml，耐药株２株。结论 伊曲康唑敏感性最强，其次是酮康唑和 ５－氟胞嘧啶，二性霉素Ｂ敏感性相对较弱，酵母型ＰＭ对５种抗真菌药物敏感性存在差异。

获得性免疫缺陷综合征合并血流感染143例临床及病原菌分析

目的了解获得性免疫缺陷综合征(AIDS)合并血流感染(BSI)的临床特点、病原菌分布及其耐药性。方法回顾性分析广西钦州市第一人民医院2013—2014年住院的143例AIDS合并BSI的临床和病原学资料。结果 AIDS患者BSI患病率为22.1%。真菌性BSI的特征性皮疹、贫血貌、肝脾肿大及淋巴结肿大发生率高于细菌性BSI(P均<0.05);真菌性BSI的CD4^+细胞计数、白细胞计数、中性粒细胞计数、红细胞计数、血小板及血红蛋白下降较细菌性BSI更明显(P均<0.05),而天冬氨酸转氨酶和肌酐升高较细菌性明显(P均<0.05)。143株病原菌中,马尼菲青霉84株,占58.7%;大肠埃希菌10株,占7.0%;新生隐球菌9株,占6.3%;肺炎克雷伯菌7株,占4.9%;沙门菌属6株,占4.2%;白念珠菌和气单胞菌属各3株,各占2.1%。分离的菌株多对常用抗菌药物敏感。结论 AIDS患者BSI患病率较高;真菌性BSI更容易出现特征性皮疹、贫血貌、肝脾肿大及淋巴结肿大、血液系统异常及肝肾功能损害。病原菌构成以真菌为主,尤其是马尼菲青霉;多数菌株对常用抗菌药物敏感。

艾滋病合并播散性马内菲青霉病1例

报告1例艾滋病合并播散性马内菲青霉病。患者女,31岁。因发热、咳嗽、乏力伴消瘦2个月入院。入院前半个月患者面部、躯干、上肢出现中央有凹陷或坏死的传染性软疣样皮损。入院后查人免疫缺陷病毒(HIV)抗体阳性。骨髓涂片、组织病理检查见细胞内外有大量酵母样细胞,部分中央有横隔(裂殖);骨髓、皮损及淋巴结真菌培养均阳性(25℃和37℃双相培养),经鉴定为马内菲青霉,25℃条件下培养为菌丝相,且有红色色素产生,37℃条件下培养为酵母相。诊断:艾滋病合并播散性马内菲青霉病。确诊后予以静脉滴注伊曲康唑,2周后发热消退、皮损缓解。

儿童马尔尼菲青霉菌感染的鉴定及该菌酵母相的体外药敏分析

目的确定患儿体内所感染的病原体为马尔尼菲青霉菌(PM),并用E-test法测定该菌酵母相的药物敏感性,指导临床合理用药。方法取患儿血液、骨髓涂片染色镜检和真菌双相培养,观察真菌生长情况及菌落形态,显微镜下观察菌体特征。并采用M27-p方案中的E-test法测定6株PM的酵母相(yeast)对伊曲康哇、酮康哇、5-氟胞嘧啶、氟康唑、两性霉素B的MIC值。结果PM为双相性真菌,于25℃为青霉相,于37℃为酵母相,并均有典型的菌落形态特征。瑞氏染色可见菌体呈圆形、椭圆型或腊肠样,大小不一,直径2～8μm,胞壁染紫色且清楚连续,在腊状的细胞内可见一明显的横隔。该菌37℃酵母相时伊曲康哇、酮康哇、5-氟胞嘧啶、氟康唑、两性霉素B的MIC范围分别为0.002～0.016μg/mL、0.012～0.125μg/mL、0.032～0.380μg/mL、1.500～6.000μg/mL、0.047～2.000μg/mL,对酮康唑、5-氟胞嘧啶出现耐药株各1株,对两性霉素B耐药株2株。结论马尔尼菲青霉菌的特征性菌落形态和骨髓及外周血发现的真菌孢子对该菌有诊断价值,而药敏结果显示该菌对伊曲康唑敏感性最强,其次为5-氟胞嘧啶、氟康唑、酮康唑,两性霉素B敏感性最弱。

马尔尼菲青霉菌的实验室诊断

目的明确并检出患者体内的病原菌为马尔尼菲青霉菌。方法取患者血液、骨髓、皮损分泌物等直接涂片染色镜检,同时做真菌培养,分别置25℃和35℃孵育,观察真菌生长情况及菌落形态,并涂片、固定、染色,显微镜下观察菌体特征。结果培养出双相性真菌,于25℃为青霉相,产生具有特征性的红色色素,镜下可见典型的帚状枝;于35℃为酵母相,无色素产生,镜下可见酵母样细胞,形似腊肠。结论从患者体内分离出的致病菌可排除荚膜组织胞浆菌,鉴定为马尔尼菲青霉菌。