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目的探讨马尔尼菲青霉病的临床特征,病理和检验等多学科合作对其快速诊断的意义。方法对2例马尔尼菲青霉病患者的临床资料、骨髓穿刺、颈部淋巴结活检组织学及细针穿刺细胞学、微生物培养等进行观察分析,并复习相关文献。结果 2例患者均出现肺部多发病灶及颈部肿大淋巴结,结核分枝杆菌血清学检查及痰涂片均为阴性。例1为HIV抗体阴性患者,骨髓涂片查见嗜血细胞并提示荚膜组织胞浆菌。患者死亡后,颈部淋巴结活检病理提示真菌感染,骨髓及血培养鉴定为马尔尼菲青霉菌。例2为HIV感染患者,颈部淋巴结细针穿刺细胞学考虑真菌感染,涂片革兰染色提示马尔尼菲青霉菌。细针穿刺样本培养并鉴定为马尔尼菲青霉菌。患者抗马尔尼菲青霉菌治疗病情好转。结论马尔尼菲青霉病内地少见,临床表现多无特异性,细针穿刺细胞学和骨髓穿刺检查有助于快速诊断,但为避免单科医生认识的局限性,应加强多学科医生的合作。
Objective To explore the clinical significance, pathology and test of multi-disciplinary cooperation of Penicillium marneffei for its rapid diagnosis. Methods The clinical data, bone marrow aspirate, histological examination of cervical lymph node biopsy and fine needle aspiration cytology and microbial culture in 2 cases of Marneffei penicilli were observed and analyzed, and the related literatures were reviewed. Results In both cases, multiple pulmonary lesions and enlarged neck lymph nodes were found. The results of mycobacterium tuberculosis serology and sputum smear were negative. Example 1 HIV-negative patients, bone marrow smears see blood cells and prompted Histoplasma capsulatum. After the death of the patient, cervical lymph node biopsy pathology prompted fungal infection, bone marrow and blood culture identified as Penicillium marneffei. Example 2 HIV-infected patients, cervical lymph node fine needle aspiration cytology consider fungal infection smear Gram-stain prompted Penicillium marneffei. Fine-needle aspiration samples were cultured and identified as Penicillium marneffei. Patients with anti-Penicillium marneffei treatment improved. Conclusions Penicillium marneffei is rarely found in the interior of the country and there are many non-specific clinical manifestations. Fine needle aspiration cytology and bone marrow aspiration are helpful for rapid diagnosis. However, in order to avoid the limitations of single physicians, multidisciplinary cooperation should be strengthened .