马尔尼菲青霉病不同类型病变中免疫反应观察

选用２组病变类型不同的６例马尔尼菲青霉病人病变组织，采用免疫组化ＰＡＰ法，观察病变组织中ｌ８淋巴细胞、巨噬细胞、ＩｇＧ、ＩｇＭ、乙等免疫指标。结果发现马尔尼菲青霉病的病变类型取决于机体的免疫功能状态，人体抗马尔尼菲青霉免疫以细胞免疫为主，组织中Ｔ细胞的存在对于杀灭真菌、局限病变具有积极意义；体液免疫特别是特异性抗体的出现除具有促进细胞免疫功能外，可能也是脓肿成因之一。     

Clinical characteristics and imaging manifestations of AIDS complicated with disseminated Penicillium marneffei infection

Objective To investigate the clinical characteristics and imaging manifestations of AIDS complicated with disseminated Penicillium marneffei （PM） infection. Methods A total of 12 patients with AIDS complicated with disseminated PM infection were collected and the symptoms, signs, laboratory examination results and image manifestations of these patients were analyzed retrospectively. Results （1） The diagnosis of PM infection in all the 12 cases were confirmed by peripheral blood culture. All the 12 cases （100%） had irregular fever （38-41℃） and enlarged lymph nodes, 8 cases （66%） had skin rashes; 8 cases （66%） had hepatomegaly; 9 cases （75%） had splenomegaly while 8 cases （66%） had anemia. （2） Imaging manifestation： Five cases manifested bilateral pulmonary disseminated miliary nodular shadows or lattice signs; 1 case showed enlarged hilar lymph node and 2 cases showed patchy shadow with pleuritis. One case presented sub-pleural curve line shadow at the posterior part of the right lower lung, and adhesion between the intestinal wall and intestinal mesentery in mass form in the abdomen by CT examination. Conclusion Patients suffering from AIDS （CD4 T lymphocytes 〈50/μ L） with impaired immunity might be susceptible to complication of disseminated PM infection, which presents mainly damage of multiple organs and symptoms such as fever; enlargement of liver, spleen and lymph nodes, as well as specific skin maculopapular rashes. Imaging manifestations in the lungs were revealed as miliary nodular shadows and lattice-like shadows. Intensified abdominal CT might reveal presence of several enlarged postperitoneal lymph nodes and intestinal adhesion in shape of ＂cakes＂.     

HIV阴性儿童马尔尼菲篮状菌病2例临床分析并文献复习

 目的 总结2例人类免疫缺陷病毒（HIV）阴性儿童马尔尼菲篮状菌病（TSM）患儿的临床特征。方法 分析某儿童医院收治的2例HIV阴性TSM患儿的临床特点及实验室资料、存在的基础疾病,并复习相关文献,总结TSM感染患儿的临床特征及诊治经验。结果 2例HIV阴性TSM患儿中病例1以右下肢肿块为首发症状,1个月余后才出现发热及咳嗽,误诊为结核感染;病例2以发热、三系减少及肝脾、淋巴结大等表现起病。病例1行基因检测为STAT1基因突变,病例2有反复灰指甲及口腔溃疡病史,均行血、骨髓培养及淋巴结活检确诊。病例1先后予以伏立康唑、两性霉素B脂质体静脉滴注,伊曲康唑口服维持治疗,共治疗1年后停药;病例2一直予以伏立康唑治疗（先静脉滴注后口服）,共7个月后停药,均无复发。结论 TSM可发生在HIV阴性儿童,且可存在STAT1基因突变。对于治疗效果差的患儿,应尽早行培养或组织活检以明确诊断,并积极查找TSM可能存在的基础疾病,以到达早期诊断、早期治疗和改善预后的目的。     

竹鼠马尔尼菲青霉菌感染的病理学研究

目的 研究马尔尼菲青霉菌感染竹鼠的组织病理学方法。方法 应用ＨＥ,Ｇｒｏｃｏｔｔｅ,免疫组化染色及电镜观察。结果 马尔尼菲青霉菌引起竹鼠各脏器的组织病理学改变为化脓性病变及肉芽肿性病变,病变轻微。结论 竹鼠为马尔尼菲青霉菌的天然储库,主要侵犯竹鼠的肺和单核巨噬细胞系统。     

艾滋病合并马尔尼菲青霉病江西首例报告

目的 分析艾滋病并发马尔尼菲青霉病的发病情况、临床特征、诊断要点。方法 对艾滋病合并马尔尼菲青霉病患者的临床资料进行总结。结果 艾滋病并发马尔尼菲青霉病的患者临床症状呈现多样性，但以马尔尼菲青霉病的表现为主。结论 艾滋病且易并发马尔尼菲青霉病，应引起临床高度重视。     

儿童马尔尼菲青霉菌感染2例临床和病理分析

目的　探讨儿童马尔尼菲青霉菌感染的临床特点和病理特征。方法　通过淋巴结活检和尸体解剖的肺、肝、脾、淋巴结的病理片观察真菌的形态 ;用酶免疫法和免疫印迹法检测病例 1患儿血清人类免疫缺陷病毒 (HIV)抗体 ;用流式细胞仪检测病例 1患儿的CD3、CD4、CD8和CD1 5 5 6。结果　例 1为艾滋病合并马尔尼菲青霉菌感染 ,例 2为播散型马尔尼菲青霉菌感染。例 1的CD4显著降低 ,HIV ELISA、免疫印迹法检测阳性 ,淋巴结活检可见马尔尼菲青霉菌的腊肠状细胞和桑葚小体。对例 2进行尸体解剖 ,肝、脾、淋巴结和双肺中均发现青霉菌的典型的腊肠状细胞和桑葚小体。结论　儿童马尔尼菲青霉菌感染是机会性感染 ,主要继发于先天性免疫缺陷和艾滋病 ,早期诊断、早期治疗对预后的影响很大。     

五种抗真菌药物对马尔尼菲青霉菌的体外抗菌活性观察

目的 了解两性霉素B(AMB)、酮康唑(KET)、氟康唑(FCA)、5-氟胞嘧啶(5-Fc)和伊曲康唑(ICA)5种抗真菌药物对马尔尼菲青霉菌体外抗菌活性,为临床用药提供参考依据.方法 采用浓度梯度法(E-test)测试AMB、KET、FCA、5-Fc、ICA 5种抗真菌药物对52株从不同AIDS患者骨髓、血液、皮肤损害标本中分离的马尔尼菲青霉菌酵母相和菌丝相的体外抗菌活性.数据采用U检验.结暴 AMB、KET、FCA、5-Fc、ICA的90%酵母相马尔尼菲青霉菌的最低抑制浓度(MIC90)分别为0.250、0.160、24.000、4.000和0.006 mg/L,最低抑制浓度(MIC)范围分别为0.004～0.500、00002～0.016、1.000～256.000、0.002～32.000和0.002～0.008 mg/L;对90%菌丝相马尔尼菲青霉菌的MIC90分别为1.500、0.125、256.000、24.000和0.012 mg/L,MIC范围分别为0.064～4.000、0.006～0.940、1.000～256.000、0.125～32.000和0.002～0.064 mg/L.不同抗真菌药对双相马尔尼菲青霉菌的体外抗菌活性不同,以ICA最强,其次为KET.酵母相和菌丝相的马尔尼菲青霉菌对同一药物的MIC比较差异有统计学意义(AMB、KET、FCA、5-Fc和ICA的U值分别为4.221 9、1.912、28.798、6.43、7.21,均P＜0.05).结论 进行马尔尼菲青霉菌体外抗真菌药物敏感实验对临床有重要参考意义.     

Bioinformatic analysis of the pathogenic mechanism of talaromyces marneffei infection

Background:Talaromyces marneffei (T marneffei), known as a significant pathogen in patients with AIDS in Southeast Asia, is a dimorphic fungus, which can cause deadly systematic infection in immunocompromised hosts. What is more, the dimorphic phase transition has been reported as a conspicuous process linked with virulence. Interestingly, the yeast form was found in infected individuals, representing the pathogenic phase. However, few researches were found to study the mechanism of dimorphic transition. Thus, a diverse insight into the dimorphic switch mechanism, is urgently needed and we are the first one to research the mechanism of dimorphism.Methods:Firstly, we investigated the microarray of T. marneffei in the Gene Expression Omnibus database (GEO) for differentially expressed genes (DEGs). Then Database for Annotation, Visualization and Integrated Discovery (DAVID) v6.8 was employed to analyze the underlying enrichment and pathway in biological process of DEGs. Meanwhile, protein-protein interaction (PPI) network was constructed using STRING database. On the strength of the theory that similar amino acid sequences share similar structures, which play a decisive role on the function of protein, three dimensional structures of hub-genes were predicted to further investigate the likely function of hub-genes.Results:{"type":"entrez-geo","attrs":{"text":"GSE51109","term_id":"51109"}}GSE51109 was elected as the eligible series for the purpose of our research, including {"type":"entrez-geo","attrs":{"text":"GSM1238923","term_id":"1238923"}}GSM1238923 ({"type":"entrez-geo","attrs":{"text":"GSM23","term_id":"23"}}GSM23), {"type":"entrez-geo","attrs":{"text":"GSM1238924","term_id":"1238924"}}GSM1238924 ({"type":"entrez-geo","attrs":{"text":"GSM24","term_id":"24"}}GSM24), and {"type":"entrez-geo","attrs":{"text":"GSM1238925","term_id":"1238925"}}GSM1238925 ({"type":"entrez-geo","attrs":{"text":"GSM25","term_id":"25"}}GSM25). PMAA_012920, PMAA_028730, PMAA_068140, PMAA_092900, PMAA_032350 were the most remarkable genes in all of the three PPI networks, thus, were viewed as hub-genes. With regard to the three-dimensional construction, except that there was no significant prediction structure of PMAA_092900 with the criterion seq identify > 30%, GMQE: 0-1, QMEAN4: -4-0, the parallel templates for four structures were Crystal structure of Saccharomyces cerevesiae mitochondrial NADP(+)-dependent isocitrate dehydrogenase in complex with isocitrate, Organellar two-pore channels (TPCs), Yeast Isocitrate Dehydrogenase (Apo Form) and Crystal Structure Of ATP-Dependent Phosphoenolpyruvate Carboxykinase From Thermus thermophilus HB8 in order.Conclusion:The dimorphic transition of T. marneffei was viewed as a pathogenic factor and DEGs were observed. In-depth study of the function and pathway of DEGs revealed that PMAA_012920, PMAA_028730, PMAA_068140, PMAA_092900, PMAA_032350 were most likely acting as the hub-genes and were likely taking effect through regulating energy metabolism.     

粗针穿刺确诊马尔尼菲篮状菌感染性淋巴结炎的临床病理分析

目的 分析马尔尼菲篮状菌(TM)感染性淋巴结炎的临床病理特点。方法 回顾性分析15例TM感染性淋巴结炎的临床资料、病理形态特点、病原体检查、治疗情况等。结果 15例TM感染性淋巴结炎中,男14例,女1例,年龄26~67岁,平均(49.1±11.87)岁,包括13例艾滋病和2例糖尿病患者,伴有颈部、锁骨上、腋窝、腹股沟等部位浅表淋巴结肿大。粗针穿刺的条索状淋巴结组织,其结构全部或部分被炎性病变所取代,8例显微镜下形态以吞噬病原体的组织细胞弥漫性浸润为主;5例以广泛凝固性坏死为主伴散在少量病原体及核碎屑;2例以成纤维细胞小结节状增生,形成肉芽肿结构的改变为主,多核巨细胞少、散在分布。病原体大小、形态较一致,呈圆形、椭圆形或腊肠状,团聚成簇,如桑葚样,淀粉酶消化后过碘酸希夫及六胺银染色可见包含横隔的菌体结构。15例患者血液、肺泡灌洗液、痰液或者淋巴结抽出液真菌培养均查见TM生长。临床及时抗真菌治疗,15例患者病情好转后出院。结论 TM感染性淋巴结炎往往是全身侵袭性TM病晚期阶段的突出表现之一,容易被临床误诊,通过淋巴结粗针穿刺活检及早明确诊断,以免延误治疗,从而提高治愈率。     

艾滋病合并马尔尼菲青霉病的胸部CT表现

目的：探讨艾滋病合并马尔尼菲青霉菌病的胸部CT表现特点。方法回顾性分析2014年1月至2016年1月经临床病理证实的12例艾滋病合并马尔尼菲青霉菌病患者的胸部CT表现。结果肺门增大8例,纵膈淋巴结增大9例,磨玻璃密度影5例,实变影4例,结节影4例,小叶间隔增厚3例,支气管血管束增粗3例,胸腔积液3例。结论艾滋病合并马尔尼菲青霉菌病胸部CT主要表现具有一定特点,对于早期诊断具有一定意义。