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【目的】探讨艾滋病合并马尔尼菲青霉病的临床及实验室特征。【方法】回顾分析2002年11月至2005年12月本院收治明确诊断为艾滋病合并马尔尼菲青霉病的53例临床及实验室资料。【结果】艾滋病合并马尔尼菲青霉病以发热、消瘦、咳嗽、皮疹、贫血等为主要临床特点,皮损主要表现为坏死性丘疹、脐凹状丘疹、溃疡、结节、血痂;外周血CD4+细胞显著减少;在沙氏琼脂培养基中马尔尼菲青霉呈酵母相(37℃)或菌丝相(25℃);药敏结果显示伊曲康唑、酮康唑对马尔尼菲青霉的MIC值最低,两性霉素B、5-氟胞嘧啶次之,氟康唑最高;病理组织六胺银染色见圆形、椭圆形或腊肠样病原体,部分有横隔。【结论】艾滋病合并马尔尼菲青霉病临床表现复杂,主要发生于CD4+计数少于50细胞∕μL的患者,真菌培养鉴定结合组织病理检查是确诊的关键,治疗上建议使用伊曲康唑、两性霉素B。
【Objective】 To investigate the clinical and laboratory features of AIDS combined with Penicillium marneffei. 【Methods】 Retrospective analysis of 53 cases of clinical and laboratory data of confirmed HIV-positive Penicillium marneffei in our hospital from November 2002 to December 2005 were retrospectively analyzed. 【Results】 The main clinical features of AIDS combined with Penicillium marneffei were fever, weight loss, cough, rash and anemia. The lesions mainly showed necrotic papules, umbilical concave papules, ulcers, nodules and blood scabs. CD4 + cells were significantly decreased; Penicillium marneffei was yeast phase (37 ℃) or mycelial phase (25 ℃) in Sabouraud agar medium; drug susceptibility results showed that itraconazole, ketoconazole to marfin phenanthrene Mycobacterium MIC value of the lowest, followed by amphotericin B, 5-fluorocytosine, fluconazole highest; histamine hexamine silver see round, oval or sausage-like pathogens, part of the diaphragm. 【Conclusion】 The clinical manifestations of AIDS complicated with Penicillium marneffei are complex and mainly occur in patients with CD4 + counts less than 50 cells / μL. Fungi identification combined with histopathology is the key to diagnosis. Itraconazole, Amphotericin B.