艾滋病合并马尔尼菲蓝状菌的诊治现状及研究进展

中国真菌学杂志　 2019, Vol. 14 　Issue (5): 308-312.

艾滋病合并马尔尼菲蓝状菌的诊治现状及研究进展

周怡宏, 鲁雁秋, 陈耀凯

重庆市公共卫生医疗救治中心感染科, 重庆 400036

收稿日期:2018-07-30 出版日期:2019-10-28 发布日期:2019-10-28
通讯作者: 陈耀凯,E-mail:yaokaichen@hotmail.com E-mail:yaokaichen@hotmail.com
作者简介:周怡宏,女(汉族),本科,住院医师.E-mail:609410361@qq.com
基金资助:
"十三五"国家科技重大专项课题（2018ZX10302104；2017ZX10202101）；重庆市科卫联合医学科研项目（2018QNXM012）

Advances in diagnosis and treatment of Talaromyces marneffei in patients with acquired immunodeficiency syndrome

ZHOU Yi-hong, LU Yan-qiu, CHEN Yao-kai

Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing 400036, China

Received:2018-07-30 Online:2019-10-28 Published:2019-10-28

摘要/Abstract

摘要：

近年来，艾滋病合并马尔尼菲蓝状菌感染在早期诊断和抗真菌治疗方面均取得了一定进展。早期诊断方面，甘露糖蛋白双抗体夹心ELISA法和荧光免疫层析法均适用于临床急性期辅助诊断，具有高度特异性，但两者联合使用并未进一步提高检测敏感性和特异性；半乳甘露聚糖检测和血浆（1-3）-β-D葡聚糖检测有一定早期诊断价值；荧光定量PCR检测敏感性显著高于巢氏PCR法，但特异性较低。抗真菌治疗方面，两性霉素B诱导治疗期疗效明显优于伊曲康唑，但不良反应发生率高于后者，仍是诱导期首选治疗方案。回顾性研究及体外试验显示伏立康唑、泊沙康唑具有良好疗效，两者的临床应用价值仍有待进一步研究。

关键词: 马尔尼菲蓝状菌, 艾滋病, 机会性感染

Abstract:

In recent years, some progresses had been made in early diagnosis and antifungal therapy of Talaromyces marneffei infection in acquired immunodeficiency syndrome (AIDS). In early clinical diagnosis, double-antibody sandwich ELISA and fluoroimmunoassay were suitable for assistant diagnosis in clinical acute stage and both were regarded highly specific. However, the two methods combining did not increase sensitivity and specificity further. Galactomannan and plasma(1-3)-β-D glucan measurement also had some early diagnostic value for Talaromyces marneffei in patients with AIDS. Sensitivity of fluorescence quantitative PCR was significantly higher than Nest's PCR method in detecting Talaromyces marneffei inparaffin embedded tissue samples, but its specificity was lower. In the treatment of Talaromyces marneffei, amphotericin B was the first choice during the induction period, and its antifungal efficacy was significantly better than that of itraconazole, although the incidence of adverse effects of the former was higher. Voriconazole and posaconazole had shown good results in retrospective studies as well as in vitro tests, and the clinical application value of the two methods still needed further study.

Key words: Talaromyces marneffei, acquired immunodeficiency syndrome, opportunistic infection

中图分类号:

R519.8

周怡宏, 鲁雁秋, 陈耀凯. 艾滋病合并马尔尼菲蓝状菌的诊治现状及研究进展[J]. 中国真菌学杂志, 2019, 14(5): 308-312.

ZHOU Yi-hong, LU Yan-qiu, CHEN Yao-kai. Advances in diagnosis and treatment of Talaromyces marneffei in patients with acquired immunodeficiency syndrome[J]. Chinese Journal of Mycology, 2019, 14(5): 308-312.

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] Son VT, Khue PM,Strobel M.Penicilliosis and AIDS in Haiphong, Vietnam:evolution and predictive factors of death[J]. Med Mal Infect, 2014,44(11-12):495-501.
[3] Masur H, Brooks JT, Benson CA,et al. Prevention and treatment of opportunistic infections in HIV-infected adults and adolescents:Updated Guidelines from the Centers for Disease Control and Prevention, National Institutes of Health, and HIV Medicine Association of the Infectious Diseases Society of America[J]. Clin Infect Dis,2014,58(9):1308-1311.
[4] Hien HT, Thanh TT, Thu NT, et al. Development and evaluation of a real-time polymerase chain reaction assay for the rapid detection of Talaromyces marneffei MP1 gene in human plasma[J]. Mycoses, 2016, 59(12):773-780.
[5] Wang YF, Cai JP, Wang YD, et al. Immunoassays based on Penicillium marneffei Mp1p derived from Pichia pastoris expression system for diagnosis of penicilliosis[J]. PLoS One,2011, 6(12):e28796.
[6] Wang Y, Zeng L, Chen X, et al. A double-antigen sandwich ELISA for detecting Penicillium marneffei Mp1p-specific antibody[J]. Nan Fang Yi Ke Da Xue Xue Bao,2013,33(3):439-443.
[7] 柳丽娟,李圣聪,谢海花,等. ELISA法和荧光免疫层析法检测马尔尼菲蓝状菌抗原的应用价值[J]. 临床检验杂, 2016,34(11):831-832.
[8] 李凌华,肖赛银,何艳,等. 血清Mp1p抗原检测对艾滋病合并马尔尼菲蓝状菌病的诊断价值[J]. 中华传染病杂志, 2017,35(3):157-160.
[9] 何凯茵,冯理智,梁志伟,等. 血清半乳甘露聚糖试验在诊断艾滋病合并马尔尼菲青霉菌病中的价值探讨[J]. 广州医科大学学报,2016,44(3):16-19.
[10] 胡家光,蒋忠胜,温小凤, 等.血浆(1-3)-β-D葡聚糖检测诊断艾滋病患者合并播散性马尔尼菲青霉菌病的临床价值[J].中华医院感染学杂志,2015,(22):5128-5130,5141.
[11] 何小庆,鲁雁秋,周怡宏, 等.重庆地区56例AIDS合并播散性马尔尼菲篮状菌病患者临床特征及死亡危险因素分析[J].传染病信息,2018,31(6):521-524.
[12] 陈媛媛,刘旭辉,侯明杰, 等.58例艾滋病合并马尔尼菲青霉菌病患者临床特征分析[J].中国艾滋病性病,2018,24(1):30-32,52.
[13] Lu S, Li X, Calderone R, et al. Whole blood Nested PCR and Real-time PCR amplification of Talaromyces marneffei specific DNA for diagnosis[J]. Med Mycol,2016,54(2):162-168.
[14] Masur H, Brooks JT, Benson CA, et al. Department of Health and Human Services. Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents[J]. Clin Infect Dis,2014,58(9):1308-311.
[15] Le T, Kinh NV, Cuc NTK, et al. A trial of itraconazole or amphotericin B for HIV-associated Talaromycosis[J]. N Engl J Med,2017,376(24):2329-2340.
[16] Liu D, Liang L, Chen J. In vitro antifungal drug susceptibilities of Penicillium marneffei from China[J]. J Infect Chemother,2013,19(4):776-778.
[17] Ouyang Y, Cai S, Liang H, et al. Administration of voriconazole in disseminated talaromyces (Penicillium) Marneffei infection:A retrospective study[J]. Mycopathologia, 2017,182(5-6):569-75.
[18] Lau SK, Lo GC, Lam CS, et al. In vitro activity of posaconazole against Talaromyces marneffei by broth microdilution and Etest methods and comparison to itraconazole, voriconazole, and anidulafungin[J]. Antimicrob Agents Chemother[J]. 2017,61(3),e01480-e04516.
[19] Lei HL, Li LH, Chen WS, et al. Susceptibility profile of echinocandins, azoles and amphotericin B against yeast phase of Talaromyces marneffei isolated from HIV-infected patients in Guangdong,China[J]. Eur J Clin Microbiol Infect Dis,2018,37(6):1099-1102.