44例马尔尼菲篮状菌感染患者的临床特征及预后分析

中国真菌学杂志　 2022, Vol. 17 　Issue (6): 461-466.

44例马尔尼菲篮状菌感染患者的临床特征及预后分析

邱付兰¹, 邱树胜², 林燕青³, 刘辉¹, 钟荣荣⁴

1. 福建医科大学附属龙岩第一医院检验科, 龙岩 364000;
2. 福建省龙岩市第二医院药剂科, 龙岩 364000;
3. 福建省龙岩市第二医院检验科, 龙岩 364000;
4. 福建医科大学附属龙岩第一医院急诊科, 龙岩 364000

收稿日期:2022-04-26 发布日期:2023-01-04
通讯作者: 钟荣荣,E-mail:welcomezrr@sina.com E-mail:welcomezrr@sina.com
作者简介:邱付兰,女(汉族),本科,副主任技师.E-mail:fjqfl9933@163.com
基金资助:
福建省自然科学基金（2018J01408）

Clinical characteristics and prognosis of 44 patients with Talaromyces marneffei infection

QIU Fulan¹, QIU Shusheng², LIN Yanqing³, LIU Hui¹, ZHONG Rongrong⁴

1. Department of Laboratory Medicine, Longyan Frist Hospital Affiliated to Fujian Medical University, longyan 364000, China;
2. Department of pharmacy, Longyan second hospital, Fujian Province, longyan 364000, China;
3. Department of Laboratory Medicine, Longyan second hospital, Fujian Province, longyan 364000, China;
4. Department of Emergency, Longyan Frist Hospital Affiliated to Fujian Medical University, longyan 364000, China

Received:2022-04-26 Published:2023-01-04

摘要/Abstract

摘要： 目的了解福建龙岩地区马尔尼菲篮状菌感染的临床特点及预后，为尽早识别该病并进行有效的治疗提供参考依据。方法收集2017年1月至2021年11月福建医科大学附属龙岩第一医院和龙岩市第二医院收治44例马尔尼菲篮状菌感染的患者资料，包括患者一般资料、临床表现、实验室检查结果、影像学改变、菌种鉴定及药敏试验、治疗与预后。两组间比较采用χ²检验或曼-惠特尼U检验。结果 44例患者中人类免疫缺陷病毒（HIV）阳性和阴性各22例，两组在发病年龄段、临床症状、白细胞（WBC）、CD4⁺T淋巴细胞、血红蛋白（HB）、血小板（PLT）、谷草转氨酶（AST）、谷丙转氨酶（ALT）、白蛋白（ALB）与降钙素原（PCT）存在统计学差异，95.4%的HIV合并马尔尼菲篮状菌病（TSM）患者的CD4⁺T淋巴细胞<50个/μL，且以播散型TSM为主，而HIV阴性组以局限型为主。血清1-3-β-D葡聚糖（G试验）和半乳甘露聚糖（GM试验）对HIV阳性TSM的阳性率为81.8%、70.7%，而HIV阴性TSM的G和GM试验阳性率为18.2%、9.1%。12株TM药敏结果显示泊沙康唑、伊曲康唑、伏立康唑和两性霉素B具有较低的最低抑菌浓度（MIC），棘白菌素类和氟康唑的MIC较高。马尔尼菲篮状菌病病死率为45.5%。结论 TSM患者临床症状和影像学表现无特异性，须尽早进行相关病原学检查，G试验和GM试验对HIV合并TSM的患者具有早期提示诊断价值，及时使用抗真菌治疗对降低病死率具有重要意义。

关键词: 马尔尼菲篮状菌感染, 临床特征, 真菌药敏试验, 预后

Abstract: Objective To understand the clinical features and prognosis of patients with Talaromyces marneffei infection in Longyan, Fujian Province, and provide evidence for early identification and effective treatment of the disease. Methods The data of 44 patients with Talaromyces marneffei infection treated in Longyan first hospital and Longyan Second Hospital Affiliated to Fujian Medical University from January 2017 to November 2021 were collected. It includes general data, clinical manifestations, laboratory examination results, imaging changes, strain identification, drug sensitivity test, treatment and prognosis. Comparison between the two groups by χ²test or Mann Whitney U test was made. Results Among the 44 patients, 22 were HIV positive and 22 were HIV negative. The significant differences were existed in onset age, clinical symptoms, WBC, CD4⁺T lymphocytes, HB, PLT, AST, ALT, ALB and PCT between the two groups. The CD4⁺T lymphocytes of 95.4% AIDS combined with TSM patients was less than 50/μL. The HIV positive group was dominated by disseminated TSM, while the HIV negative group was localized TSM. The positive rates of serum G test and GM test to HIV positive TSM were 81.8% and 70.7%, while they were 18.2% and 9.1% in HIV negative TSM. The MIC values of posaconazole, itraconazole, voriconazole and amphotericin B were lower, and MICs of echinocandins and fluconazole were higher in 12 TM strains. The mortality of Talaromycesis marneffii infection was 45.5%. Conclusion There is no specificity in clinical symptoms and imaging results of TSM patients, so relevant etiological examination should be carried out as soon as possible. G and GM tests have early diagnostic values for AIDS patients with TSM. Timely use of antifungal therapy is of great significance in reducing mortality.

Key words: Talaromycesis marneffii, clinical characteristics, fungal susceptibility test, prognosis

中图分类号:

R 519.8 A

邱付兰, 邱树胜, 林燕青, 刘辉, 钟荣荣. 44例马尔尼菲篮状菌感染患者的临床特征及预后分析[J]. 中国真菌学杂志, 2022, 17(6): 461-466.

QIU Fulan, QIU Shusheng, LIN Yanqing, LIU Hui, ZHONG Rongrong. Clinical characteristics and prognosis of 44 patients with Talaromyces marneffei infection[J]. Chinese Journal of Mycology, 2022, 17(6): 461-466.

参考文献

[1] 中华医学会感染病学分会艾滋病丙型肝炎学组.中国艾滋病诊疗指南(2018版)[J]. 协和医学杂志, 2019, 10(1):31-52.
[2] DONNELLY J P, CHEN S C, KAUFFMAN C A, et al. Revision and update of the consensus definitions of invasive fungal disease from the European organization for research and treatment of cancer and the mycoses study group eeducation and research consortium[J]. Clin Infect Dis, 2020, 71(6):1367-1376.
[3] 王星,董明亮. 33例艾滋病伴播散性马尔尼菲青霉菌病患者的临床分析及其对抗真菌治疗的影响[J].抗感染药学,2019,16(1):72-75.
[4] 吴联朋,何贵清,胡型忠,等.温州地区51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].中华全科医学,2021,19(8):1398-1402.
[5] LEE P P,MAO H W,YANG WL,et al. Peniilium marneffei infection and impaired IFN-y immunty in humans wth autoso mal-dominantgain-of-phosphorylation STAT1 mutations[J]. J Alergy ClinImmunol,2014,133(3):894-896.
[6] 张云桂, 赵月娟, 李玉叶,等. 226例艾滋病合并马尔尼菲青霉菌病患者的影像学特征[J].皮肤病与性病, 2016, 38(2):91-94.
[7] 施伎蝉, 蒋贤髙, 刘赛朵, 等. 艾滋病合并播散性马尔尼菲蓝状菌病25例临床特征分析[J].中华医院感染学杂志, 2019, 29(24):3706-3709, 3714.
[8] QIU Y, ZHANG J Q, LIU G N, et al. Retrospective analysis of 14 cases of disseminated Penicillium marneffei infection with osteolytic lesions[J]. BMC Infect Dis, 2015,15:47.
[9] LIU G N, HUANG J S, ZHONG X N, et al. Penicillium marneffei infection with in an osteolytic lesioninan HIV-negative patient[J]. Int J Infect Dis,2014,23:1-3.
[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]. Clin Microbiol, 2007, 45(19):2858-2862.
[11] 张培燕, 李建明, 何云, 等. 53例艾滋病合并马尔尼菲蓝状菌感染者的临床特点[J]. 中国热带医学, 2019, 19(9):893-895.
[12] LI X L, ZHANG Y Q, WU F Y, et al. Evaluation of quantitative real time PCR and platelia galactomannan assays for the diagnosis of disseminated Talaromyces marneffei infection[J]. Med Mycol, 2020,58(2):181-186.
[13] 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.
[14] 曹静, 袁雅璐, 成卫英, 等. HIV阴性的马尔尼菲蓝状菌病研究进展[J]. 中国皮肤性病学杂志, 2018,32(4):462-465.
[15] ZHOU F, BI X, ZOU X,et al. Retrospective analysis of 15 cases of Penicilliosis mameffei in a southern China hospital[J]. Mycopathologia, 2014, 177(5-6):271-279.