PAS联合六胺银染色诊断局限性马尔尼菲青霉菌感染的应用

目的探讨建立快速诊断局限性马尔尼菲青霉菌感染的方法，以期早期诊断，降低死亡率。方法采用高碘酸一无色品红（PAS）染色联合六胺银染色对4例非AIDS马尔尼菲青霉菌感染者活检组织进行马尔尼菲青霉菌的特殊染色，分析感染者的临床表现和病理组织学诊断特点。结果患者均为广东本地居民，属局限性马尔尼菲青霉菌感染。除1例有发热外，临床上未见以发热、失重、贫血、白细胞增高为主的马尔尼菲青霉菌感染症状以及多器官损害症状。HE染色显示病理组织学类型为肉芽肿型和化脓型。病变组织经PAS染色与六胺银染色后，在油镜下增生的泡沫状巨噬细胞胞浆内，呈现大量红色或黑色的卵圆形及腊肠状酵母样青霉菌孢子。无荚膜，在腊肠状菌体中可见马尔尼菲青霉菌特有的裂殖时出现的横隔膜。结论PAS联合六胺银染色清晰显示组织中马尔尼菲青霉菌的特征性结构和形态，结合病理组织学特点、中国南方地区生活或旅游史，可以快速诊断局限性马尔尼菲青霉菌感染。

Rapid diagnosis of local Penicillium marneffei infection by PAS and GMS

Objective To develop a rapid method for early diagnosis of local Penicillium marneffei infection in non-AIDS patients for the purpose of decreasing the mortality. Methods Periodic acid-Schiff （PAS） and Grocott methenamine silver （GMS） staining methods were used in the histopathologic staining and examination of biopsy specimens from four patients with PeniciUium marneffei infection. Analysis of clinical and histopathological characteristics was performed. Results Patients were residents of Guangdong, and were infected with Penicillium marneffei. Except for one patient with fever, common clinical features included fever, weight loss, anemia, leukocytosis and multiple organ lesions were not observed. Granulomatous and suppurative reactions were seen in the infected tissues. Large numbers of red or black yeast-like fungus were found in the cytoplasm of hyperplastic macrophages after PAS or GMS staining. Oval or ＂sausage＂ shaped yeast cells with characteristic transverse septum that occurs during fission of Penicillium marneffei was clearly seen under microscope. Conclusions The characteristic structure and morphology of PeniciUium marneffei could be visualized in tissue sections stained with PAS and GMS. PAS and GMS staining is a rapid method for the diagnosis of local infection with PeniciUium marneffei.