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

中国真菌学杂志　 2016, Vol. 11 　Issue (3): 174-177.

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

谢雅利¹, 李园园¹, 胡成平¹, 邓彭博¹, 刘和平², 王琼²

1. 中南大学湘雅医院呼吸科国家呼吸疾病临床医学研究中心核心单位, 长沙 410008;
2. 湖南省株洲市二医院呼吸科, 株洲 412005

收稿日期:2015-12-21 出版日期:2016-06-28 发布日期:2016-06-28
通讯作者: 李园园,E-mail:leeround@163.com E-mail:leeround@163.com
作者简介:谢雅利,女(汉族),硕士,住院医师.E-mail:1241855371@qq.com

The analysis of risk factors and the immune status in Penicillium marneffei in patients without human immunodeficiency virus infection

XIE Ya-li¹, LI Yuan-yuan¹, HU Cheng-ping¹, DENG Peng-bo¹, LIU He-ping², WANG Qiong²

Department of Respiratory Medicine, Xiangya Hospital of Central South University, key cite of National Clinical Research Center for Respiratory Disease, Changsha, 410008;
2. Department of Respiratory Medicine, Second Hospital of Zhuzhou, Zhuzhou 412005

Received:2015-12-21 Online:2016-06-28 Published:2016-06-28

摘要/Abstract

摘要：

目的对HIV阴性的马尔尼菲青霉菌病患者的易感因素及免疫状态进行分析，以提高该病的临床诊断率。方法回顾我科确诊的1例HIV阴性播散性马尔尼菲青霉菌病例特点，复习相关文献，以"马尔尼菲青霉菌"为关键词检索万方数据库、中国期刊网全文数据库，以Penicillium marneffei为关键词检索PubMed数据库，总结并分析其易感因素及可能的免疫机制。结果患者系中年男性，以间断发热、干咳、呼吸困难、多发淋巴结肿大为主要临床特点。肺部影像学示双肺弥漫性病变，外院抗结核治疗无效，我院经皮肺穿刺组织真菌培养及病理诊断为肺马尔尼菲青霉菌病。在以上数据库共检索出2 083篇文献，剔除非相关文献，以及可能重复、资料不全病例，共检索出HIV阴性者91例，其中45例有基础疾病。结论马尔尼菲青霉菌可发生在于HIV阴性，因结缔组织病、血液系统疾病、器官移植等基础疾病或与真菌免疫相关基因的突变等致使免疫功能受损的患者，与储存宿主接触史、流行区域生活或旅游、环境暴露、气候湿度等易感因素有关，对以上患者应警惕是否为马尔尼菲青霉菌感染，尽早确诊并治疗。

关键词: 马尔尼菲青霉菌, 人免疫缺陷病毒阴性, 免疫状态

Abstract:

Objective To analyze the risk factors and the immune status in Penicillium marneffei,for improving the clinical diagnosis.Methods A case admitted to Xiangya Hospital Central South University,diagnosed as Penicillium marneffei,was retrospectively analyzed and the related literature was reviewed.Databases including PubMed,Wanfang and Chinese National infrastructure (CNKI) were searched by using the keyword "Penicillium marneffei".Then the risk factors and possible immune mechanism were summarized.Results The patient,middle-age male,was a forest worker,presented with intermittent fever,cough,dyspnea,emaciation,and frequent enlargement of left supraclavicular and mediastinal lymph nodes.Although without any underlying disease,the patient was found to have a history of contact with wild animal.Imageology showed diffuse pulmonary lesions.G,GM test were dramatically accelerated,and HIV test was negative.Anti-tuberculosis treatment was invalid.Penicillium marneffei was proved by fungal culture from percutaneous lung biopsy tissue and pathological diagnosis.The syptoms and imageology of the patient,after 4months of sequential treatment of Amphotericin B and itraconazole,were relieved and improved.From databases above,91 cases of HIV-negative Penicillium marneffei were retrieved.Among the cases above,45 cases were reported with underlying diseases.Conclusions Penicillium marneffei,associated with the history of contacting with reservoir host,the life or journey in epidemic region,exposure to certain environment,climate and humidity,could happen in patients without HIV,while with underlying diseases,such as connective tissue diseases,hematological system disease,organ transplantation,and so on,or those happened with gene mutation,related to antimycotic immunity.Patiens,described as before,should be alerted for their possibility of diagnose as Penicillium marneffei. The sequential treatment of Amphotericin B to itraconazole turned out to be effective.

Key words: Penicillium marneffei, human immunodeficiency virus negative, immune status

中图分类号:

R519.8

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.

XIE Ya-li, LI Yuan-yuan, HU Cheng-ping, DENG Peng-bo, LIU He-ping, WANG Qiong. The analysis of risk factors and the immune status in Penicillium marneffei in patients without human immunodeficiency virus infection[J]. Chinese Journal of Mycology, 2016, 11(3): 174-177.

参考文献

[1] 易虹,曾一芹,艾红,等.白血病化疗后合并播散型马尔尼菲青霉菌1例[J].实用医学杂志,2013,29(11):1730.
[2] 赵献连.警惕慢性阻塞性肺疾病并马尔尼菲青霉菌病[J].临床误诊误治,2009,22(10):43-44.
[3] 何柳,杨继勇,王蕊,等.类风湿关节炎伴马尔尼菲青霉菌败血症1例[J].检验医学与临床,2015,18(6):875-876.
[4] 苏小芬,张挪富,刘春丽,等.免疫健全者播散性马尔尼菲青霉菌病一例及文献复习[J].中国呼吸与危重监护杂志,2013,12(3):244-248.
[5] 邱晔,张建全,钟小宁,等.难治性马尔尼菲青霉菌病二例[J].中华结核和呼吸杂志,2014,37(5):387-389.
[6] 陈统清,孔耀中,罗绮雯,等.肾移植后合并马尔尼菲青霉菌感染1例[J].中国组织工程研究与临床康复,2011,15(53):10068-10070.
[7] 何翠嫦,陈振念,韦启麒.系统性红斑狼疮合并马尔尼菲青霉菌病1例报告[J].右江民族医学院学报,2013,35(2):193-194.
[8] Kawila R,Chaiwarith R,Supparatpinyo K.Clinical and laboratory characteristics of Penicilliosis marneffei among patients with and without HIV infection in Northern Thailand:a retrospective study[J].BMC Infect Dis,2013,13(1):464.
[9] Wong SS,Wong KH,Hui WT,et al.Differences in clinical and laboratory diagnostic characteristics of Penicilliosis marneffei in human immunodeficiency virus (HIV)-and non-HIV-infected patients[J].J Clin Microbiol,2001,39(12):4535-4540.
[10] 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.
[11] Chan JF,Chan TS,Gill H,et al.Disseminated Infections with Talaromyces marneffei in Non-AIDS patients given monoclonal antibodies against CD20 and Kinase Inhibitors[J].Emerg Infect Dis,2015,21(7):1101-1106.
[12] 毛从政,何志义,罗洪林,等.以气管-支气管受累为主的播散性马尔尼菲青霉病一例[J].中华结核和呼吸杂志,2015,38(2):141-143.
[13] Stathakis A,Lim KP,Boan P,et al.Penicillium marneffei infection in a lung transplant recipient[J].Transpl Infect Dis 2015,17(3):429-434.
[14] Hart J,Dyer JR,Clark BM,et al.Travel-related disseminated Penicillium marneffeiinfection in a renal transplant patient[J].Transpl Infect Dis 2012,14(4):434-439.
[15] 苏惠春,程波,施秀明,等.马尔尼菲青霉致真菌性脂膜炎一例[J].中华医学杂志,2012,92(16):1152.
[16] 刘桂红,顾莹莹,姜桔红,等.播散性马尔尼菲青霉病累及中枢神经系统1例并文献复习[J].临床与实验病理学杂志,2012(5):573-575.
[17] 夏修蛟,陶茂灿,单筠筠,等.播散性皮肤马尔尼菲青霉病1例[J].中国皮肤性病学杂志,2005,19(8):489-491.
[18] 许庆芳,赖维,陆春,等.马尔尼菲青霉病1例[J].临床皮肤科杂志,2005,34(9):609-610.
[19] Lin JN,Lin HH,Lai CH,et al.Renal transplant recipient infected with Penicillium marneffei[J].Lancet Infect Dis,2010,10(2):138.
[20] Hung CC,Hsueh PR,Chen MY,et al.Invasive infection caused by Penicillium marneffei:an emergingpathogen in Taiwan[J].Clin Infect Dis,1998,26(1):202-203.
[21] Chan Y,Wong K,Lee K,et al.Pneumonia and mesenteric lymphadenopathy caused by disseminated Penicillium marneffei infection in a cadaveric renal transplant recipient[J].Transpl Infect Dis,2004,6(1):28-32.
[22] Xi L,Lu C,Zhou X,et al.Fifteen cases of penicilliosis in Guangdong,China[J].Mycopathologia,2004,158(2):151-155.
[23] 毕新岭,王英,顾军,等.以肠道症状为首发的马尔尼菲青霉病1例[J].中国皮肤性病学杂志,2004,18(1):47-48.
[24] Vanittanakom N,Cooper CR Jr,Fisher MC,et al.Penicillium marneffei infection and recent advances in the epidemiology and molecular biology aspects[J].Clin Microbiol Rev,2006,19( 1):95-110.
[25] Bulterys PL,Le T,Quang VM,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.
[26] Sisto F,Miluzio A,Leopardi O,et al.Differential cytokine pattern in the spleens and livers of BALB/cMice infected with Penicillium marneffei:protective role of gamma interferon[J].Infect Immun,2003,71(1):465-473.
[27] Sarah K.Browne,Peter D,et al.Adult-onset immunodeficiency in Thailand and Taiwan[J].N Engl J Med,2012,367(8):725-734.