艾滋病合并马尔尼菲青霉病11例临床分析

目的 探讨11例艾滋病合并马尔尼菲青霉病患者的临床特征.方法 对2002-2004年来我院住院和门诊就诊的11例艾滋病合并马尔尼菲青霉病患者的一般资料、临床表现、体征、实验室检查进行分析.结果 11例患者中男9例,女2例,临床症状除非特征性的表现如发热、消瘦、贫血、肝脾淋巴结肿大外,8例合并有皮疹;3例有消化道症状,其中2例腹痛,1例腹泻、排红色湖状便:1例吞咽困难,进食梗阻感;5例有呼吸系统症状;1例关节痛;2例合并口腔念珠菌感染、4例骨髓、1例痰、1例血涂片、8例皮疹刮片或分泌物涂片、2例淋巴结和皮肤病理活检切片中可见成堆的PAS染色阳性的圆形或腊肠形分隔孢子.11株分离株经形态学、培养皆证实为马尔尼菲青霉,其中4株分离株经DNA分析证实为马尔尼菲青霉.结论 艾滋病患者机会性感染中马尔尼菲青霉病的临床表现多样,且多伴有皮疹.

Penicilliosis marneffei in 11 cases of AIDS: clinical analysis

Objective To investigate the clinical features and laboratory findings of Penicilliosis marneffei in 11 cases of AIDS.Methods Clinical data of 11 patients with AIDS who were evaluated in our hospital between 2002 and 2004 were analyzed.Laboratory findings for Penicillium marneffei infection were also assessed.Results Of the 11 patients,9 were male and 2 were female.In addition to nonspecific manifestations such as high fever,weight loss,anemia,hepatosplenomegaly,generalized lymphadenopathy,8 patients had skin lesions,3 had gastrointestinal symptoms (2 had abdominal pain,1 had diarrhea with red and mushy stool),1 had difficulty in swallowing and obstructive feeling in taking food,5 had respiratory symptoms,such as cough and chest pain,I had arthralgia,2 had oral candidal infection.PAS staining-posi tive yeast-or sausage-like clumped septate spores were found in direct smear of 4 bone marrow specimens,1 sputum specimen and 1 peripheral blood specimen,in 8 scrapings from skin lesions or smears from dis- charges from the skin,and in 2 cases of lymph node and skin biopsy specimens.The 11 isolates from differ- ent patients were all identified to be Penicillium marneffei by microscopic examination and fungal culture, and 4 of them were also confirmed by DNA sequence analysis.Conclusion The clinical manifestation of Penicilliosis mameffei,an opportunistic infection in AIDS,is heterogenous, and often includes skin lesions.