马尔尼菲青霉病12例临床回顾性分析

中国真菌学杂志　 2013, Vol. 8 　Issue (6): 348-351.

马尔尼菲青霉病12例临床回顾性分析

唐旭华¹, 庄娘桥², 周晖¹, 胡荣欣³, 章星琪¹

1. 中山大学附属第一医院皮肤科, 广州 510080;
2. 中山大学附属第一医院惠亚医院皮肤科, 惠州 516081;
3. 广州市第八人民医院皮肤科, 广州 510060

收稿日期:2013-07-06 出版日期:2013-12-28 发布日期:2013-12-28
通讯作者: 章星琪，E-mail：xingqi.zhang@yahoo.com.cn E-mail:xingqi.zhang@yahoo.com.cn
作者简介:唐旭华，男（汉族），博士，主治医师.E-mail：txh0812@126.com

Retrospective review of 12 cases of penicilliosis marneffei

TANG Xu-hua¹, ZHUANG Niang-qiao², ZHOU Hui¹, HU Rong-xin³, ZHANG Xing-qi¹

1. Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080;
2. Department of Dermatology, Huiya branch of the First Affiliated Hospital, Sun Yat-sen University, Huizhou 516081;
3. Department of Dermatology, No.8 hospital of Guangzhou, Guangzhou 510060

Received:2013-07-06 Online:2013-12-28 Published:2013-12-28

摘要/Abstract

摘要： 目的分析我院马尔尼菲青霉病的临床特征和预后。方法回顾性分析我院2003年1月~2012年12月10 a间诊断的12例马尔尼菲青霉病，分析其临床表现、实验室和辅助检查、治疗和预后。结果除了既往报道的临床表现如发热、皮疹、咳嗽、气促、浆膜腔积液、肝脾淋巴结肿大、消化道症状、溶骨性损害外，还包括咽痛、双下肢水肿、血管闭塞或狭窄。实验室检查发现尿常规异常6例，其中4例血肌酐升高。4例HIV阳性患者中3例给予伊曲康唑单用或联合两性霉素B治疗好转出院。8例HIV阴性患者给予伏立康唑单用或联合其他抗真菌药物治疗，5例有效，3例在起始抗真菌治疗后2~11 d死亡，其中2例有气促和腹水。结论马尔尼菲青霉病除了既往报道累单核巨噬细胞系统外，也可累及咽部黏膜、泌尿系统、外周循环系统。应用伏立康唑或伊曲康唑治疗有效，气促和腹水可能提示预后差，早期诊治可能改变患者的预后。

关键词: 马尔尼菲青霉, 回顾性研究, 临床特征, 预后

Abstract: Objective To study the clinical characteristics and outcome of patients with penicilliosis marneffei.Methods Retrospective review of 12 inpatients with penicilliosis marneffei in our hospital during ten years from January 2003 to October 2012.Results In addition to previously reported clinical manifestations including fever, rash, cough, dyspnea, serous effusion, hepatosplenomegaly, lymphadenopathy, digestive disorder, and osteolysis, we also observed pharyngalgia, edema of lower limbs, and vascular stenosis or occlusion as well. Laboratory examinations indicated 6 patients had abnormal routine urine examination, of whom 4 had elevated serum creatinine. Three out of four HIV positive patients were response to itraconazole combined with or without amphotericin B. Five out of eight HIV negative patients were response to voriconazole combined with or without other antifungal agents, and the other 3 were dead 2 to 11 days after the initiation of antifungal agents. Two of the 3 dead presented with ascites and dyspnea.Conclusions Pharynx, urinary system, peripheral circulation can also be involved in penicilliosis marneffei in addition to mononuclear phagocyte system.Penicillium marneffei is sensitive to voriconazole and itraconazole in vivo. Ascites and dyspnea possibly suggests poor prognosis. Early diagnosis and treatment of penicilliosis marneffei could improve the outcome.

Key words: Penicillium marneffei, retrospective review, clinical characteristic, prognosis

中图分类号:

R519.9

唐旭华, 庄娘桥, 周晖, 胡荣欣, 章星琪. 马尔尼菲青霉病12例临床回顾性分析[J]. 中国真菌学杂志, 2013, 8(6): 348-351.

TANG Xu-hua, ZHUANG Niang-qiao, ZHOU Hui, HU Rong-xin, ZHANG Xing-qi. Retrospective review of 12 cases of penicilliosis marneffei[J]. Chinese Journal of Mycology, 2013, 8(6): 348-351.

参考文献

[1] Hu Y, Zhang J, Li X, et al. Penicillium marneffei infection: an emerging disease in mainland China[J]. Mycopathologia, 2013, 175(1-2):57-67.
[2] 李勇, 蒙志好, 苏凌松, 等. 艾滋病合并马尔尼菲青霉病256例临床研究[J]. 中国真菌学杂志, 2009, 4(6):347-350.
[3] Bulterys P L, Le T, Quang V M, et al. Environmental predictors and incubation period of AIDS-associated Penicillium marneffei infection in Ho Chi Minh City, Vietnam[J]. Clin Infect Dis, 2013, 56(9):1273-1279.
[4] 张建全, 钟小宁, 柳广南, 等. 健康宿主合并马尔尼菲青霉病的临床特征及误诊原因分析[J].中华内科杂志, 2010, 49(8): 700-701.
[5] 李无名, 蒙志好, 唐秀文, 刘存旭, 等. 免疫功能正常的马尔尼菲青霉病临床特征, 2012, 19(21): 3201-3202.
[6] Jones P D, See J. Penicillium marneffei infection in patients infected with human immunodeficiency virus: late presentation in an area of nonendemicity[J]. Clin Infect Dis, 1992, 15(4):744.
[7] Kanjanabuch T, Kittikowit W, Eiam-Ong S. An update on acute postinfectious glomerulonephritis worldwide[J]. Nat Rev Nephrol, 2009, 5(5):259-269.
[8] Vanittanakom N, Cooper C J, Fisher M C, et al. Penicillium marneffei infection and recent advances in the epidemiology and molecular biology aspects[J]. Clin Microbiol Rev, 2006, 19(1):95-110.
[9] Wu T C, Chan J W, Ng C K, et al. Clinical presentations and outcomes of Penicillium marneffei infections: a series from 1994 to 2004[J]. Hong Kong Med J, 2008, 14(2):103-109.
[10] Huang Y T, Hung C C, Liao C H, et al. Detection of circulating galactomannan in serum samples for diagnosis of Penicillium marneffei infection and cryptococcosis among patients infected with human immunodeficiency virus[J]. J Clin Microbiol, 2007, 45(9):2858-2862.
[11] Supparatpinyo K, Nelson K E, Merz W G, et al. Response to antifungal therapy by human immunodeficiency virus-infected patients with disseminated Penicillium marneffei infections and in vitro susceptibilities of isolates from clinical specimens[J]. Antimicrob Agents Chemother, 1993, 37(11):2407-2411.
[12] Kaplan J E, Benson C, Holmes K H, et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America[J]. MMWR Recomm Rep, 2009, 58(RR-4):1-207, E1-E4.
[13] Larsson M, Nguyen L H, Wertheim H F, et al. Clinical characteristics and outcome of Penicillium marneffei infection among HIV-infected patients in northern Vietnam[J]. AIDS Res Ther, 2012, 9(1):24.

[1]	陶鹏飞, 杨欣平, 李正伦, 周奇文, 闵海燕, 钱庆锦. 30例艾滋病合并侵袭性隐球菌病的临床特征及治疗转归[J]. 中国真菌学杂志, 2020, 15(3): 150-153.
[2]	张文, 罗莹, 国承杰, 徐英春, 肖盟, 类承斌, 赵燕, 毕蕾. 院内念珠菌血症临床特点及病原菌分析[J]. 中国真菌学杂志, 2020, 15(3): 154-160.
[3]	刘玉磊, 刘美清, 王丽, 袁慧, 郭莉娜. 心血管导管相关念珠菌血症菌种分布、药物敏感性及患者预后情况的分析[J]. 中国真菌学杂志, 2020, 15(1): 37-42.
[4]	王莉琳, 李爱新, 杨雪, 汪雯, 吴昊. 67例艾滋病合并新生隐球菌性脑膜脑炎临床分析[J]. 中国真菌学杂志, 2019, 14(6): 342-345.
[5]	鲁雁秋, 吴玉珊, 邱丹, 陈耀凯. 重庆地区149例艾滋病合并新生隐球菌性脑膜脑炎病例的回顾性研究[J]. 中国真菌学杂志, 2019, 14(4): 204-209.
[6]	蔡仁慧, 王英. 新生隐球菌性脑膜炎22例临床及预后分析[J]. 中国真菌学杂志, 2017, 12(4): 216-220.
[7]	王蕊. 糖尿病真菌性角膜炎患者临床特征及病原学分析[J]. 中国真菌学杂志, 2017, 12(4): 221-224.
[8]	陈春梅, 冯姣, 陈志文, 肖星, 蒋敏敏, 史茗岚, 贺莉雅, 蔡文莹, 席丽艳, 李希清. 原生质体介导马尔尼菲青霉基因转化体系的优化[J]. 中国真菌学杂志, 2016, 11(3): 140-144.
[9]	谢雅利, 李园园, 胡成平, 邓彭博, 刘和平, 王琼. HIV抗体阴性的马尔尼菲青霉菌病患者的易感因素及免疫状态分析[J]. 中国真菌学杂志, 2016, 11(3): 174-177.
[10]	严汝帆, 李鑫垒, 郑冬燕, 林冰, 梁浩, 曹存巍. 血清半乳甘露聚糖试验在诊断马尔尼菲青霉病中的应用[J]. 中国真菌学杂志, 2016, 11(1): 16-19.
[11]	李鑫垒, 李昕, 曹存巍. 农杆菌介导的马尔尼菲青霉基因转化技术的建立及优化[J]. 中国真菌学杂志, 2015, 10(2): 88-91.
[12]	王鹏, 冉玉平, 尹斌, 庄凯文, 林新瑜, 代亚玲. 3株不同表型马尔尼菲青霉外分泌蛋白酶活性比较[J]. 中国真菌学杂志, 2014, 9(4): 193-198.
[13]	黄芩, 李东明, 孙婷婷, 尚盼盼, 葛杰, 付又刚. 艾滋病并发马尔尼菲青霉败血症1例[J]. 中国真菌学杂志, 2014, 9(2): 99-101.
[14]	陈阳霞, 顾桉菁, 梁宇恒, 马团, 席丽艳. 电穿孔介导马尔尼菲青霉转化体系的建立和优化[J]. 中国真菌学杂志, 2014, 9(1): 12-15.
[15]	叶枫, 罗群, 周滢, 谢佳星, 顾莹莹, 苏丹虹, 陈荣昌. 非HIV感染的马尔尼菲青霉病2例报道并文献复习[J]. 中国真菌学杂志, 2013, 8(6): 342-347,377.