艾滋病合并中枢性马尔尼菲篮状菌病临床特征

目的 分析艾滋病合并中枢性马尔尼菲篮状菌病患者的临床特点，提高临床早期诊断水平。 方法 回顾性分析2014—2020年南宁市第四人民医院收治的5例经脑脊液培养确诊马尔尼菲篮状菌感染的艾滋病患者的临床资料。 结果 5例艾滋病合并中枢性马尔尼菲蓝状菌感染者中男性4例，平均年龄35.2岁。脑脊液检出马尔尼菲篮状菌平均时间8 d。脑脊液改变主要表现为白细胞计数和蛋白质升高，葡萄糖和氯化物降低。头颅影像检查主要表现为颅内感染灶。5例患者结局均死亡，其中2例误诊为中枢性结核分枝杆菌感染，2例病情危重入院不足1周死亡，1例经过有效抗真菌治疗但最终因感染性休克死亡。3例既往接受过规范抗人类免疫缺陷病毒(HIV)治疗。 结论 艾滋病合并中枢性马尔尼菲篮状菌病临床表现缺乏特异性，早期诊断困难，临床易误诊、漏诊，病死率高，临床应高度重视。

Clinical characteristics of acquired immunodeficiency syndrome complica-ted with Talaromyces marneffei infection of central nervous system

Objective To analyze the clinical characteristics of patients with acquired immunodeficiency syndrome(AIDS) and central nervous system (CNS) Talaromyces marneffei (T. marneffei) infection, and improve early clinical diagnosis level. Methods Clinical data of 5 AIDS patients who were co-infected with T. marneffei confirmed by cerebrospinal fluid (CSF) culture and admitted to the Fourth Peoples'' Hospital of Nanning City from 2014 to 2020 were analyzed retrospectively. Results Among the 5 AIDS patients complicated with CNS T. marneffei infection, 4 were male, with an average age of 35.2 years. The average time for isolating T. marneffei in CSF was 8 days. CSF changes mainly manifested as an increase in white blood cell count and protein, as well as a decrease in glucose and chloride levels. The main manifestation of cranial imaging examination was intracranial infection. Five patients all died, 2 of whom were misdiagnosed as central nervous Mycobacterium tuberculosis infection, 2 critically ill patients died within 1 week after admission, and 1 patient received effective antifungal treatment but ultimately died due to septic shock. Three patients previously received standardized anti-human immunodeficiency virus treatment. Conclusion AIDS complicated with CNS T. marneffei infection lacks specific clinical manifestations. Early diagnosis is difficult, misdiagnosis and missed diagnosis during clinical practice occur often, and it is with high mortality. Clinicians should attach great importance to it.