| 裴学玉,方明霞,池云,等.艾滋病并发马尔尼菲篮状菌病 23例的临床特征[J].安徽医药,2025,29(10):2036-2040. |
| 艾滋病并发马尔尼菲篮状菌病 23例的临床特征 |
| Clinical characteristics of 23 cases of AIDS complicated with Penicilliosis marneffei |
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| DOI：10.3969/j.issn.1009-6469.2025.10.025 |
| 中文关键词: 艾滋病 马尔尼菲篮状菌 CD4+T淋巴计数 血小板减少 半乳甘露聚糖抗原试验 疾病特征 |
| 英文关键词: AIDS Penicillium marneffei CD4+ T lymphocyte count Thrombocytopenia Galactomannan antigen test Dis-ease attributes |
| 基金项目:江苏省卫生健康委科研项目( ZDA2020014)；南京市卫生科技发展专项资金项目( ZKX22040) |
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| 中文摘要: |
| 目的分析艾滋病合并马尔尼菲篮状菌病的临床特征，提高对该疾病的认识。方法回顾分析 2017年 9月至 2023年 8月南京市第二医院收治的 23例确诊为马尔尼菲篮状菌病的艾滋病病人的临床、实验室及影像学资料，总结其临床特征。结果病人主要以发热、皮疹、咳嗽咳痰、乏力、淋巴结肿大为临床特征，可出现白细胞、血红蛋白、血小板下降，肝功能受损，降钙素原、 C反应蛋白、乳酸脱氢酶、 G试验( 1，3-β-D葡聚糖试验)、 GM试验(血清半乳甘露聚糖试验)增高，马尔尼菲篮状菌肺炎影像学上多表现为多发小结节影、斑片影、团块影、空洞样表现，且艾滋病病人 CD4+T淋巴计数较低常常合并机会性感染，本研究发现 CD4+T淋巴细胞计数水平与马尔尼菲篮状菌病类型有关( P=0.039 5)在 CD4+T淋巴细胞 ≤50个/微升的 18例中， 100%(18/ 18)表现为播散性马尔尼菲篮状菌病；而 CD4+T淋巴细胞 >50个/微升的 5例中，6，0%(3/5)为播散性马尔尼菲篮状菌病， 40%(2/5)为局限性马尔尼菲篮状菌病。结论艾滋病合并马尔尼菲篮状菌感染病人临床表现复杂多样，缺乏特异性，对于合并贫血及血小板下降且 CD4+T淋巴细胞低于 50个/微升的艾滋病者要重点考虑马尔尼菲篮状菌感染的可能，尽早获得病原菌学结果，启动抗真菌治疗，降低艾滋病合并马尔尼菲篮状菌病死率。 |
| 英文摘要: |
| Objective To analyze the clinical characteristics of acquired immunodeficiency syndrome (AIDS) patients with Penicilli-um Marneffei infection and to enhance understanding of this disease.Methods A retrospective analysis was conducted on the clinical,laboratory, and imaging data of 23 AIDS patients with confirmed Penicillium Marneffei infection who were hospitalized in Nanjing Sec-ond Hospital from September 2017 to August 2023, and their clinical features were summarized.Results The patients mainly present-ed with fever, rash, cough with expectoration, fatigue, and lymphadenopathy. They may experience decreased white blood cells, hemo-globin, and platelets, impaired liver function, increased procalcitonin, C-reactive protein, lactate dehydrogenase, G test (1,3-β-glucan), and GM test (galactomannan). Imaging of Penicillium Marneffei pneumonia often showed multiple small nodules, patchy shadows, massshadows, and cavitary manifestations. All patients had low CD4+ T-cell counts and often had concurrent opportunistic infections. This study found a significant correlation between CD4+ T-cell count levels and the type of Talaromyces marneffei infection (P = 0.039 5). Among the 18 patients with CD4+ T-cell counts ≤ 50/μL, 100% (18/18) exhibited disseminated Talaromyces marneffei infection, where-as among the 5 patients with CD4+ T-cell counts > 50/μL, 60% (3/5) had disseminated infection and 40% (2/5) had localized infection. Conclusions The clinical manifestations of AIDS patients with Marneffei infection are complex and diverse, lacking specificity. ForAIDS patients with anemia, thrombopenia and CD4+ T lymphocytes less than 50 /μL, the possibility of Marneffei infection should bemainly considered. The pathogenic bacteriology results should be obtained as soon as possible, and antifungal therapy should be startedto reduce the mortality rate of AIDS patients with Marneffei infection. |
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