艾滋病合并马尔尼菲篮状菌病的研究现状

马尔尼菲篮状菌病是由条件致病性真菌马尔尼菲篮状菌（Talaromyces marneffei, TM）引起的深部真菌病,常见于免疫力低下患者。由于该病起病隐匿,临床表现复杂而多样,早期诊断较为困难,误诊率、漏诊率较高,是艾滋病患者重要的致死原因之一。目前认为患者是通过吸入获得致病性分生孢子感染TM。临床表现为发热、咳嗽、呼吸困难、腹痛等症状。中央坏死样皮疹是具有诊断意义的特征性体征。血液系统表现为三系不同程度的减少。标本直接涂片镜检具有快速、取材简单等特点;真菌培养报告时间通常大于14 d;组织病理改变大致分为肉芽肿型、化脓型和坏死型。G试验、GM试验有助于诊断;TM MP1P抗原检测的特异度和敏感度均较高,分子生物学检查是今后TM早期诊断的研究趋势。目前治疗马尔尼菲篮状菌病的首选药物是两性霉素B,伊曲康唑200 mg/d的剂量维持至CD4⁺T淋巴细胞计数>100 cells/μL。近年来建议抗真菌后尽早HAART控制HIV病毒。今后仍需研究快速诊断TM的方法,实现马尔尼菲篮状菌病的精准诊治。本文从流行病学、致病机制、临床表现、实验室诊断、治疗与预防现状,目前存在的问题及需要克服的困难进行系统综述。

Current status of research on Talarmoyces marneffei infection in AIDS patients

Talaromycosis (TM) is a deep fungal disease caused by Talarmoyces marneffei, which is a conditionally pathogenic fungus and common in immunocompromised patients. Because of the hidden onset of the disease, complicated and diverse clinical manifestations, early diagnosis is difficult, and the misdiagnosis rate and missed diagnosis rate are high, which is one of the important causes of death for AIDS patients. It is currently believed that the infection of patients with T. marneffei is obtained by inhalation of pathogenic conidia. The clinical manifestations of Talaromycosis marneffei are fever, cough, dyspnea, abdominal pain, etc. Central necrotic rash is a characteristic sign with diagnostic significance. The blood system is characterized by varying degrees of reduction in the three types of blood cells. Direct microscopic examination of specimens is characterized by fast and simple sampling. The reporting time of fungus culture is usually more than 14 days. Histopathological changes can be divided into granulomatous, suppurative and necrotic types. G test and GM test are helpful for diagnosis. The specificity and sensitivity of TM MP1P antigen detection are both high, and molecular biological examination is the research trend of early diagnosis of TM in the future. Amphotericin B is currently preferred for the treatment of Talaromycosis. After amphotericin B as an induction therapy, itraconazole can be maintained at a dose of 200 mg/d until the CD4⁺ T lymphocyte count is more than 100 cells/uL. In recent years, it is recommended to start HAART treatment as soon as possible after antifungal treatment. In the future, we still need to study the method of rapid diagnosis of TM to achieve accurate diagnosis and treatment of Talaromycosis. This article systematically reviews the current problems and difficulties that need to be overcome in terms of epidemiology, pathogenic mechanism, clinical manifestations, laboratory diagnosis, treatment and prevention.