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| 14例HIV阴性马尔尼菲篮状菌感染的临床分析 |
| Clinical characteristics of 14 cases of HIV negative Marneffei infection |
| 投稿时间：2024-02-20 修订日期：2024-02-20 |
| DOI： |
| 中文关键词: 马尔尼菲篮状菌 宏基因二代测序技术 临床特征 骨破坏 骨结核 HIV |
| 英文关键词: Talaromyces marneffei, metagenomic Next Generation Sequencing(mNGS),Clinical characteristics,osteolysis, bone tuberculosis,HIV |
| 基金项目:国家自然科学基金项目（面上项目，重点项目，重大项目） |
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| 中文摘要: |
| 目的：分析HIV阴性马尔尼菲篮状菌病患者的临床特征，提高临床认知与诊治水平。
方法： 回顾性分析2016年 1月至2022年1月深圳市第三人民医院收治的14例非HIV马尔尼菲篮状菌病患者临床资料, 分析HIV阴性马尔尼菲篮状菌病的临床特征。
结果：HIV阴性马尔尼菲篮状菌感染的患者14人，男10例、女4例，年龄（46.71±18.93）岁。主要临床表现：发热10（71.4%）咳嗽咳痰7（50%），肺部感染10（71.4%），贫血11（78.5%），皮肤病变5（35.7%）132（40.7%）p=0.468。 肝脾肿大4（28.5%），真菌血症2（14.2%）,骨破坏3（21.4%）。患者发病到明确诊断中位时间30（10 270）天，其中骨破坏患者诊断中位时间180（180 210）天。明确诊断方式：血培养2（14.2%）例，痰培养4（28.7%）例，病灶脓液或组织培养3（21.4%）例，宏基因二代测序技术诊断5例（35.7%）。2例误诊为骨结核及5例误诊为肺结核并行抗结核治疗，误诊率50%。抗真菌治疗后死亡3（21.4%）例。
结论：HIV阴性马尔尼菲篮状菌病临床表现无特异性，肝脾肿大及真菌血症发生率较少，在无基础疾病的人群容易出现骨破坏，容易误诊、延迟诊断。宏基因二代测序技术可为早期诊断马尔尼菲篮状菌病的重要辅助诊断工具。 |
| 英文摘要: |
| ［Abstract］ Objective: To analyze the clinical characteristics of HIV negative patients with Marneffei''s disease and improve the early clinical diagnosis. Methods: Retrospective analysis of the clinical data of 14 non HIV and 324 HIV patients with Marneffei''s disease admitted to Shenzhen Third People''s Hospital from January 2016 to January 2022, and analysis of the clinical characteristics of HIV negative Marneffei''s disease. Results: 14 HIV negative and 324 HIV positive patients with Marneffei''s disease were included in the study. In HIV negative patients, fever (71.4% P=0.325), cough and expectoration (64.2% P=0.451), pulmonary infection (71.4% P=0.346), and emaciation (78.5% P=0.466) were more common, and hepatosplenomegaly and fungemia were less common. Hepatosplenomegaly (28.5% P=0.012,) mycosis (14.2% P=0.001), bone destruction (21.4% P<0.0001); The median time from the onset of the disease to the definitive diagnosis of non HIV patients was 30 (10 270) days, among which the median time for bone destruction patients was 180 (79 180) days. Among them, 5 HIV negative patients were finally diagnosed by metagenomic detection. The mortality rate was 21.4%. Conclusion: The clinical manifestations of HIV negative Marneffei''s disease are nonspecific. Healthy hosts without basic diseases are prone to bone destruction and dissolution, and are prone to misdiagnosis, missed diagnosis and delayed diagnosis. Macrogene detection is an effective method for early diagnosis of Marneffei''s disease. |
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