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目的探讨艾滋病合并马尔尼菲青霉菌病的临床表现特点、诊断和治疗。方法对151例艾滋病合并马尔尼菲青霉菌病病例的临床表现、实验室和影像学检查、治疗与转归的资料,进行系统的回顾性分析。结果临床表现以中高度发热、乏力和头面部皮疹多见。B超可见肝脾肿大和腹主动脉旁淋巴结肿大。实验室检查:白细胞正常或降低,血小板进行性下降;丙氨酸转氨酶(ALT)升高;CD4T细胞<50/μl。马尔尼菲青霉菌培养延长至16天时,阳性率达94.3%。治疗分为症状期、维持和预防复发治疗,好转出院率分别为81.5%、96.1%和88.0%。结论临床上同时具备中高度发热、中重度乏力、头面部和颈部丘疹性皮疹、浅表肿大淋巴结质中偏硬、B超腹主动脉旁/腹腔淋巴结肿大、肝脾肿大、白细胞正常或降低、进行性血小板降低、ALT升高、CD4<50个细胞/μl之中的数个症状体征及实验室检查结果,而且普通抗感染治疗无效时,应高度怀疑马尔尼菲青霉菌感染的可能,应追问该病流行区域居住史和旅行史,并积极作病原学检查确诊。
Objective To investigate the clinical manifestations, diagnosis and treatment of AIDS with Penicillium marneffei. Methods The clinical manifestations, laboratory and imaging examination, treatment and prognosis data of 151 AIDS cases complicated with penicillium marneffei were systematically analyzed retrospectively. Results The clinical manifestations of high fever, fatigue and head and face rash more common. B-visible hepatosplenomegaly and para-aortic lymph nodes. Laboratory tests: normal or reduced white blood cells, progressive decline in platelets; alanine aminotransferase (ALT) increased; CD4 T cells <50 / μl. Penicillium marneffei extended to 16 days, the positive rate of 94.3%. The treatment was divided into symptoms, maintenance and prevention of recurrence, the improvement of discharge rates were 81.5%, 96.1% and 88.0%. Conclusions Both clinical manifestations include moderate to severe fever, moderate to severe fatigue, papular rash on the face and neck, superficial superficial lymph nodes, B-abdominal para-aortic / abdominal lymph nodes, hepatosplenomegaly, leukocytes Normal or reduced, progressive thrombocytopenia, elevated ALT, several symptoms and signs in CD4 <50 cells / μl, and laboratory findings, and should be highly suspected of penicillium marneffei infection when the general anti-infective therapy is not effective The possibility should be asked about the residency and travel history of endemic areas of the disease and positive diagnosis of etiology.