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目的探讨艾滋病(AIDS)合并皮肤马尔尼菲青霉感染的临床及实验室特征。方法分析2005年1月至2006年6月本院收治的明确诊断为AIDS合并皮肤马尔尼菲青霉感染的4例患者临床特征;取皮损、血和骨髓分别在25℃和37℃进行真菌培养,观察菌落形态、显微镜下特征;对皮肤活检组织行HE及六胺银染色,观察镜下皮损组织学及马尔尼菲青霉的特征。结果AIDS合并皮肤马尔尼菲青霉感染伴多系统损害,皮损特征:早期表现为淡红色丘疱疹、糜烂性丘疹,继而为坏死性丘疹、传染性软疣样丘疹、皮肤溃疡及血痂。37℃培养呈酵母相,25℃呈菌丝相,皮肤病理活检六胺银染色(+)。使用二性霉素B、伊曲康唑治疗,3例临床症状缓解、皮疹消退出院,1例死亡。结论AIDS合并皮肤马尔尼菲青霉感染皮损特征:坏死性丘疹、传染性软疣样丘疹。皮损25℃、37℃真菌培养结合皮肤病理活检是确诊的关键,二性霉素B、伊曲康唑是目前治疗AIDS合并皮肤马尔尼菲青霉感染的首选药物。
Objective To investigate the clinical and laboratory features of AIDS and Penicillium marneffei infection. Methods The clinical features of 4 patients diagnosed as AIDS complicated with Penicillium marneffei in our hospital from January 2005 to June 2006 were analyzed. The lesions, blood and bone marrow were harvested at 25 ℃ and 37 ℃, respectively. The morphology of colonies and microscopic features were observed. HE staining and hexamine silver staining were performed on the skin biopsies. The histological features of microscopic lesions and the characteristics of Penicillium marneffei were observed. Results The infection of skin with Penicillium marneffei combined with multiple systemic lesions in AIDS patients with skin lesions was characterized by early reddish herpes and erosive papules followed by necrotic papules, molluscum contagiosum, skin ulcers and blood scabs. 37 ℃ culture was yeast phase, mycelial phase at 25 ℃, skin biopsy hexamine silver staining (+). The use of amphotericin B, itraconazole treatment, 3 cases of clinical symptoms, exacerbation of the rash, 1 case of death. Conclusions Skin lesions of AIDS combined with Penicillium marneffei infection: necrotic papules and molluscum contagiosum. Skin lesions 25 ℃, 37 ℃ fungal culture combined with skin biopsy is the key to diagnosis, amphotericin B, itraconazole is currently the treatment of AIDS skin infections with Penicillium marneffei drug of choice.