马尔尼菲青霉菌病致溶骨性破坏1例报告及文献复习

目的提高对马尔尼菲青霉菌病(penicilliosis marneffei,PsM)的认识和诊断水平,以便及时治疗,减少病死率。方法回顾分析1例PsM致关节炎及溶骨性破坏患者的临床及病理特点,并复习相关文献。结果马尔尼菲青霉菌(penicillium marneffei,PM)是深部条件致病菌,感染多见于AIDS等免疫功能受损的患者,健康人感染少见。PM可引起局限性感染或多脏器受累,常见肺、皮肤和肝损害。骨关节炎并溶骨少见。临床表现包括发热、贫血、淋巴结炎、肝脾肿大、皮肤传染性软疣样损伤及肺炎等。病理类型有肉芽肿样型、化脓型及变应性缺失/坏死型。结论PM可引起局限性感染或多脏器受累。对于用结缔组织病等无法解释的多系统损害,又有东南亚PM流行区生活史的患者,要高度怀疑PsM。

A report of one case of osteolytic lesion caused by penicillionsis marneffei and related literature review

Objective To improve the diagnostic level and understanding for Penicilliosis marneffei (PsM) so that it could be treated timely and the mortality could be decreased.Methods The clinical and pathonological characteristics of one cases of osteolytic lesion and arthritis caused by progressive yeast fungus infection were retrospectively analyzed,and related literatures were reviewed.Results Penicillium marneffei(PM) was progressive opportunistic pathogen,which was often found in AIDS patients with immunodeficiency and was hardly found in healthy subjects. PM could result in limited infection or damage of multiple organs including lung,skin and liver.Osteolytic destruction and arthritis were seldom found.Clinical manifestations were fever,anemia,lymphadenitis,hepatolienomegaly,molluscum contagiosum of skin and pneumonia, etc.The lesion could be classified into the granuloma type,suppurative type and anergy/necrosis type histologically.Conclusion PM can cause limited infection or damage of multiple organs.When multisystem damage couldn't be explained for connective tissue disease and the patients have the life history in epidemic region of Southeast Asia,PsM should be paid much attention to.