22例艾滋病合并马尔尼菲篮状菌感染患者的临床特征

Clinical characteristics of 22 patients with acquired immunodeficiency syndrome and Talaromyces marneffei infection

摘要:

目的分析艾滋病合并马尔尼菲篮状菌感染患者的临床特征。方法收集2016年1—12月长沙市第一医院收治的22例艾滋病合并马尔尼菲篮状菌感染患者的临床病历资料，回顾性分析患者的临床表现、辅助检查结果、治疗经过及疾病转归等临床资料。结果22例患者中男性15例，女性7例，年龄18～57岁。22例患者均表现出呼吸系统症状，有20例患者出现不同程度的发热，12例患者出现皮疹，7例患者可触及脾大，15例患者伴有消瘦、口腔白斑、淋巴结大。患者辅助检查血常规白细胞、淋巴细胞下降，伴有贫血及血小板减少；CD4+计数均有不同程度减少，且均＜50 cells/μL；21例患者血清腺苷脱氨酶有不同程度的升高；感染患者的胸部影像学表现常见斑片状或斑点状浸润影，其次为结节影、毛玻璃样改变。两性霉素B和伊曲康唑对马尔尼菲篮状菌感染的治疗效果较好。16例患者在积极抗真菌治疗后病情得到控制，5例患者转回当地继续治疗，仅1例患者在住院期间由于出现严重的多器官衰竭死亡。结论艾滋病合并马尔尼菲篮状菌感染患者的临床表现复杂多样，血清腺苷脱氨酶可作为一个辅助诊断指标,艾滋病患者均有明显免疫力缺陷。

关键词:

艾滋病; 马尔尼菲篮状菌; 临床特征; 影像学检查

Abstract:

ObjectiveTo analyze clinical characteristics of patients with acquired immunodeficiency syndrome (AIDS) and Talaromyces marneffei (T. marneffei) infection. Methods22 patients with AIDS and T. marneffei infection were admitted to The First Hospital of Changsha between January and December 2016, clinical data were collected, clinical manifestations, auxiliary examination results, treatment course, and prognosis of disease of patients were analyzed retrospectively.ResultsOf 22 patients, 15 were males and 7 were females, aged 18-57 years. They all presented with respiratory symptoms, 20 had fever with varying degrees, 12 had rash, 7 had splenomegaly, 15 were accompanied by emaciation, oral leukoplakia, and lymphadenectasis. Blood routine examination showed a decrease in leukocyte and lymphocyte, accompanied by anemia and thrombocytopenia; CD4+ counts reduced with varying degrees, all were＜50 cells/μL; serum adenosine deaminase increased with varying degrees in 21 patients; chest imaging findings of infected patients were usually presented flaky or spotted infiltrating shadow, followed by nodule shadow and ground glasslike change. Amphotericin B and itraconazole were effective in the treatment of T. marneffei infection. 16 patients were controlled after active antifungal therapy, 5 patients were transferred to the local area for continuing treatment, only 1 patient died of severe multiple organ failure during hospitalization.ConclusionClinical manifestations of AIDS complicated with T. marneffei infection are complicated and diversity, serum adenosine deaminase can be used as an auxiliary diagnostic index, AIDS patients all present with obvious immunodeficiency.

Key words:

acquired immunodeficiency syndrome; AIDS; Talaromyces marneffei; clinical characteristic; imaging examination