摘要
目的报道2例较长时间误诊为肺结核的非HIV感染的马尔尼菲青霉病,结合文献复习,分析其临床表现。方法收集2015年入住重庆医科大学附属第一医院的2例马尔尼菲青霉病患者的临床资料,并以马尔尼菲青霉病作为关键词,分别在Pubmed、中国知网检索马尔尼菲青霉病病例文献,对报道的临床资料进行总结分析。结果病例1,男性,32岁,以发热、咳嗽、咳痰、咯血为主要表现,抗感染、抗结核治疗无效,支气管镜下见气管上段新生物,气管、支气管黏膜表面白色坏死物附着,气管黏膜组织、支气管镜抽吸液培养确诊为马尔尼菲青霉病。病例2,女性,28岁,以反复高热、咳嗽、咳痰为主要表现,胸部CT提示左上肺团块影伴左上肺不张,院外长时间抗结核治疗无效,并出现全身多处脓肿和溶骨性破坏,后经头顶部包块穿刺液培养确诊为马尔尼菲青霉病。对1980-2014年的文献进行回顾,中国知网共报道马尔尼菲青霉病1 826例,Pubmed共报道471例,78.3%-91.7%病例合并HIV感染,90%以上伴有发热,约50%患者伴有咳嗽、贫血、皮肤损害,近60%出现肺部浸润性阴影,40%左右的患者伴有肝脾、淋巴结肿大。结论马尔尼菲青霉病常发生于HIV感染的患者,但免疫功能正常者亦可发生,临床表现各异,容易被误诊为结核病。临床中对于经常规抗感染、抗结核治疗效果欠佳的免疫功能正常者需高度警惕,早期诊断和治疗是提高预后的关键。
Objective To report 2 cases of penicilliosis marneffei that was misdiagnosed as tuberculosis for a long time, and analysis relevant manifestations by literature review. Methods Two cases of disseminated penicilliosis marneffei in immunocompetent hosts from our hospital were presented, and the relevant manifestations by literature review were analyzed. Results The first case is a 32-year-old male, who was admitted with recurrent episodes of fever, productive cough and hemoptysis, and had accepted ineffective anti-infection and anti-tuberculosis treatment. Bronchoscopy showed that tracheas and bronchia mucosal epithelia were attached with white necrosis. Disseminated penicilliosis marneffei was diagnosed by fungal culture of tracheas necrosis and bronchoalveolar lavage fluid. The second case is a 28-year-old female, who was admitted with high temperature, cough, and sputum, had mass shadow with atelectasis in the upper lobe of left lung in her chest CT, and had accepted ineffective anti-tuberculosis treatment for a long time. Multiple subcutaneous abscess and osteolytic destruction appeared confirmed by fungal culture of crown mass puncture pus. at the same time. Finally, penicilliosis marneffei was Moreover, based on relevant literatures from 1980 to 2014, 1 826 cases in CNKI and 471 cases in PUBMED had been reported. 78.3% -91.7% of these patients were HIV-infected, more than 90% with fever, about 50% with cough, anemia and skin lesions, about 60% with lung infiltration shadows, and approximately 40% with hepatosplenomegaly and lymphadenopathy. Conclusion Penicilliosis marneffei is more common in the patients with HIV infection, and it may also occur in the persons with normal immune function. It has different symptoms and easy to be misdiagnosed as tuberculosis. When general anti-infection or anti-tuberculosis treatment is ineffective in the immunocompetent patients, penicilliosis marneffei should be highly considered. Early diagnosis and treatment is the key for good prognosis of penicilliosis marneffei.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2016年第14期1686-1690,共5页
Journal of Third Military Medical University
关键词
马尔尼菲青霉病
结核病
肺
penicilliosis marneffei
tuberculosis
lung
