肺结核合并马尔尼菲蓝状菌病临床特点分析
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摘要
目的分析肺结核合并马尔尼菲蓝状菌病的临床特点指导临床诊治。方法回顾性分析南宁市第四人民医院2013年1月—2016年12月22例HIV抗体阴性肺结核合并马尔尼菲蓝状菌病患者的临床资料,分析其临床表现、实验室检查、肺部影像学特点、治疗及预后。结果肺结核合并局限型肺马尔尼菲蓝状菌病14例,表现为慢性咳嗽、咳痰急性加重伴或不伴有发热、气促、咯血,胸部CT肺部病灶以小结节、斑片、纤维空洞伴有支气管扩张或肺毁损改变为主;肺结核合并播散型马尔尼菲蓝状菌病8例,均有高热、乏力及明显呼吸道症状,淋巴结肿大2例,皮肤损害1例,肺部病灶表现为片状、雪花样、磨玻璃样影,4例患者病情进展迅速合并多器官功能衰竭死亡,与肺结核合并局限型马尔尼菲蓝状菌病相比外周血血红蛋白下降,中性粒细胞百分比、总胆红素、CRP、PCT、G试验明显升高,差异有统计学意义。结论肺结核合并局限型马尔尼菲蓝状菌病症状轻,多继发于复治伴有慢性纤维空洞肺结核患者,预后好;肺结核合并播散型马尔尼菲蓝状菌病全身炎症反应重,CD4细胞低者预后不良,死亡率高。
Objective To analyze the clinical characteristics of pulmonary tuberculosis combined with infections caused by Penicillium marneffei in order to guide the clinical diagnosis and treatment.Methods The clinical data of 22 patients of HIV antibody negative infected with pulmonary tuberculosis combined with Penicillium marneffei treated in Nanning Municipal Fourth People's Hospital from January 2013 to December 2016 were retrospectively analyzed. The clinical manifestations,laboratory tests, pulmonary imaging features, treatment and prognosis of pulmonary tuberculosis locally combined with Penicillium marneffei were analyzed.Results Among of 22 cases, 14 cases of patients with pulmonary tuberculosis combined with localized Penicillium marneffei infection showed that the main symptoms included chronic cough, expectoration,accompanied by or without fever, shortness of breath, and hemoptysis, chest CT showing lung lesions with small nodules, patchyand fibrous cavities accompanied by bronchiectasis or pulmonary lesion; another 8 cases infected with pulmonary tuberculosis complicated with disseminated Penicillium marneffei were hyperthermia, asthenia and obvious respiratory symptoms; among them, 2 cases had lymph node enlargement and 1 case had skin lesion. The pulmonary lesions were flaky, snowflake and ground glass. Four patients deteriorated rapidly and died of multiple organ failure. Compared with pulmonary tuberculosis complicated with localized Marneffei cyanosis, the peripheral blood hemoglobin decreased, while the percentage of neutrophils,total bilirubin, CRP, PCT, G test increased significantly, the differences were statistically significant.Conclusion The symptoms of pulmonary tuberculosis combined with Penicillium marneffei symptoms are mild and mostly secondary to retreatment pulmonary tuberculosis with chronic fibrovascular, and the prognosis of these patients is mostly good; pulmonary tuberculosis complicated with disseminated Penicillium marneffei caused severe systemic inflammatory response, The patients with low CD4 cells have poor prognosis and high mortality.
Objective To analyze the clinical characteristics of pulmonary tuberculosis combined with infections caused by Penicillium marneffei in order to guide the clinical diagnosis and treatment.Methods The clinical data of 22 patients of HIV antibody negative infected with pulmonary tuberculosis combined with Penicillium marneffei treated in Nanning Municipal Fourth People's Hospital from January 2013 to December 2016 were retrospectively analyzed. The clinical manifestations,laboratory tests, pulmonary imaging features, treatment and prognosis of pulmonary tuberculosis locally combined with Penicillium marneffei were analyzed.Results Among of 22 cases, 14 cases of patients with pulmonary tuberculosis combined with localized Penicillium marneffei infection showed that the main symptoms included chronic cough, expectoration,accompanied by or without fever, shortness of breath, and hemoptysis, chest CT showing lung lesions with small nodules, patchyand fibrous cavities accompanied by bronchiectasis or pulmonary lesion; another 8 cases infected with pulmonary tuberculosis complicated with disseminated Penicillium marneffei were hyperthermia, asthenia and obvious respiratory symptoms; among them, 2 cases had lymph node enlargement and 1 case had skin lesion. The pulmonary lesions were flaky, snowflake and ground glass. Four patients deteriorated rapidly and died of multiple organ failure. Compared with pulmonary tuberculosis complicated with localized Marneffei cyanosis, the peripheral blood hemoglobin decreased, while the percentage of neutrophils,total bilirubin, CRP, PCT, G test increased significantly, the differences were statistically significant.Conclusion The symptoms of pulmonary tuberculosis combined with Penicillium marneffei symptoms are mild and mostly secondary to retreatment pulmonary tuberculosis with chronic fibrovascular, and the prognosis of these patients is mostly good; pulmonary tuberculosis complicated with disseminated Penicillium marneffei caused severe systemic inflammatory response, The patients with low CD4 cells have poor prognosis and high mortality.
引文
[1]HU Y X,ZHANG J M,LI X Q,et al.Penicillium marneffei infection:an emerging disease in Mainland China[J].Mycopathologia,2013,175(1/2):57-67.
[2]唐志荣,陆珍珍,刘伟,等.广西艾滋病例合并马尔尼菲青霉菌病感染及其治疗[J].应用预防医学,2007,13(1):28-30.
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[5]赵国庆,冉玉平,向耘.中国大陆马尔尼菲青霉病的临床表现及流行病学特征的系统评价[J].中国真菌学杂志,2007,2(2):68-72.
[6]SUPPARATPINYO K,KHAMWAN C,BAOSOUNG V,et al.Disseminated penicillium marneffei infection in southeast asia[J].the Lancet,1994,344(8915):110-113.
[7]李梦东,王宇明.实用传染病学[M].上海:人民卫生出版社,2005:1056-1058.
[8]蒙志好,韦一,吕康言,等.艾滋病合并结核病及马尔尼菲青霉病14例临床分析[J].中华结核和呼吸杂志,2007,30(9):702-703.
[9]陈跃华,林艳荣,刘升.两性霉素B、氟康唑和伊曲康唑治疗AIDS合并马尔尼菲青霉病疗效的Meta分析[J].传染病信息,2016,29(2):101-105,128.
[10]叶萍,孔晋亮,吴聪,等.不同方案治疗马尔尼菲青霉病的疗效分析[J].中华医院感染学杂志,2016,26(18):4128-4131.
[11]LE T,KINH N V,CUC N T K,et al.A trial of itraconazole or amphotericin B for HIV-associated talaromycosis[J].New England Journal of Medicine,2017,376(24):2329-2340.
[12]黄俊云,丁涛,刘小勇,等.马尔尼菲青霉菌的分离鉴定与耐药性分析[J].中华医院感染学杂志,2016,26(11):2450-2452.
[13]MEYER V,MINKWITZ S,SCHüTZE T,et al.The Aspergillus niger RmsA protein:A node in a genetic network?[J].Commun Integr Biol,2010,3(2):195-197.
[2]唐志荣,陆珍珍,刘伟,等.广西艾滋病例合并马尔尼菲青霉菌病感染及其治疗[J].应用预防医学,2007,13(1):28-30.
[3]中华人民共和国国家卫生和计划生育委员会.肺结核诊断标准:WS288-2017[S].北京:中华人民共和国国家卫生和计划生育委员会,2017.
[4]NITTAYANANTA W.Penicilliosis marneffei:another AIDS defining illness in Southeast Asia[J].Oral Diseases,2008,5(4):286-293.
[5]赵国庆,冉玉平,向耘.中国大陆马尔尼菲青霉病的临床表现及流行病学特征的系统评价[J].中国真菌学杂志,2007,2(2):68-72.
[6]SUPPARATPINYO K,KHAMWAN C,BAOSOUNG V,et al.Disseminated penicillium marneffei infection in southeast asia[J].the Lancet,1994,344(8915):110-113.
[7]李梦东,王宇明.实用传染病学[M].上海:人民卫生出版社,2005:1056-1058.
[8]蒙志好,韦一,吕康言,等.艾滋病合并结核病及马尔尼菲青霉病14例临床分析[J].中华结核和呼吸杂志,2007,30(9):702-703.
[9]陈跃华,林艳荣,刘升.两性霉素B、氟康唑和伊曲康唑治疗AIDS合并马尔尼菲青霉病疗效的Meta分析[J].传染病信息,2016,29(2):101-105,128.
[10]叶萍,孔晋亮,吴聪,等.不同方案治疗马尔尼菲青霉病的疗效分析[J].中华医院感染学杂志,2016,26(18):4128-4131.
[11]LE T,KINH N V,CUC N T K,et al.A trial of itraconazole or amphotericin B for HIV-associated talaromycosis[J].New England Journal of Medicine,2017,376(24):2329-2340.
[12]黄俊云,丁涛,刘小勇,等.马尔尼菲青霉菌的分离鉴定与耐药性分析[J].中华医院感染学杂志,2016,26(11):2450-2452.
[13]MEYER V,MINKWITZ S,SCHüTZE T,et al.The Aspergillus niger RmsA protein:A node in a genetic network?[J].Commun Integr Biol,2010,3(2):195-197.