艾滋病合并马尔尼菲青霉菌感染52例临床分析

目的探讨艾滋病合并马尔尼菲青霉菌感染患者的临床特征。方法回顾性分析2004年1月～2007年11月本院收治,并经省级疾病控制中心确诊的艾滋病合并马尔尼菲青霉菌感染52例患者的临床及实验室资料。结果该病以长期发热、进行性消瘦、咳嗽咯痰、皮疹、贫血、淋巴结肿大等为特征;外周血CD4+<50×106/L者47例,80×106/L～100×106/L者3例,>105×106/L者2例;血培养马尔尼菲青霉菌均阳性,其中痰培养阳性23例、皮疹疱液培养阳性5例、骨髓培养阳性3例,口腔白念珠菌阳性21例,19例痰培养肺炎球菌、流感杆菌、大肠杆菌、葡萄球菌、阴沟杆菌等均阳性,痰结核杆菌阳性6例,非结核分枝杆菌阳性2例,HBV-DNA阳性11例,HCV-RNA阳性9例(其中7例HBV,HCV双阳性),合并单纯疱疹、带状疱疹各4例;氟康唑、伊曲康唑或二性霉素B联合氟胞嘧啶等治疗,好转38例,自动出院8例,死亡6例。结论艾滋病合并马尔尼菲青霉菌病临床表现复杂,以长期发热、进行性消瘦、咳嗽咯痰、皮疹、贫血、淋巴结肿大等为特征,多发生于外周血CD+<50×106/L者,二性霉素B联合氟胞嘧啶疗效优于咪唑类药物。

Clinical Analysis of 52 Cases of AIDS-associated Infection with Penicilliosis Marneffei

Objective To explore the clinical and laboratory features of AIDS-associated infection with Penicillium Marneffei infection.Methods Patients hospitalized between September 2004 to September 2007 were selected for examination in this study,clinical and laboratory features of 52 cases of AIDS-associated infection with disseminated Penicilliosis Marneffei were analyzed retrospectively. Results The most presented clinical symptoms and signs in descending order were long-term fever,progressive symptosis,cough and stethocatharsis,skin rash,anaemia,lymphadenectasis and so on.Most patiens (47/52) had CD+4 count in periphery blood below 50/μL.All patients was found to be positive for Penicillium Marneffei in blood cultures and 23 were positive in sputum culture and 3 were positive in bone marrow cultures,21 were positive in oral cavity for Blastomyces albicans.19 were positive in sputum culture for pneumococcus,Bacillus aegyptiacus,Bacillus coli,staphylococci,Bacillus cloacae.6 were positive in sputum culture for Bacillus tuberculosis,2 were positive in sputum culture for non-Mycobacteria tuberculosis.11 were positive in Hepatitis B virus DNA,9 were positive in Hepatitis C virus RNA.Patients were treated with Fluconazole,Itraconazole or Amphotericin B combination 5-flucytosine with 38 improve,8 discontinued due to the their own reasons and 6 died. Conclusion Patients AIDS-complicated disseminated Penicillium Mameffei infection mainly manifested with long-term fever,progressive symptosis,cough and stethocatharsis,skin rash,anaemia,lymphadenectasis and so on; Penicillium Mameffei infection is mostly seen in AIDS patients with CD+4 count less than 50/μL; Amphotericin B combination 5-flucytosine most effective among these treatments.