【摘要】 目的探讨健康宿主感染马尔尼菲青霉菌的临床特征及临床诊治。方法回顾分析3例主要累及肺部、支气管及胸膜的健康宿主感染马尔尼菲青霉菌的病例报告,并以"马尔尼菲青霉病"为关键词检索国内外相关文献,筛选出健康宿主感染的病例进行文献复习。结果 3例健康宿主患者均以发热、咳嗽、淋巴结肿大、白细胞升高为主要临床表现,胸部影像学检查表明肺部均有累及。病例2纤维支气管镜下可见多个息肉样结节,病例3胸腔镜下可见脏壁层胸膜有较多粘连带和多个白色小结节。3例患者均培养出马尔尼菲青霉菌而确诊,抗真菌治疗有效但治疗时间长未能停药。36例相关健康宿主感染马尔尼菲青霉菌的文献报告中,临床症状以发热、咳嗽/咳痰、皮疹/皮肤脓肿以及白细胞升高最为常见,胸部影像学以肺部炎性浸润常见,治疗上以使用两性霉素B单用或者联合伊曲康唑最为常见,高达47.22%误诊为结核。结论健康宿主感染马尔尼菲青霉菌肺部表现为多样性,易误诊为结核病,治疗较其他真菌感染需要更长时间。更多还原

【Abstract】 Objective To explore the clinical characters,diagnosis and treatment of Penicilliosis marneffei（PSM） in healthy hosts.Methods The clinical data of three cases of PSM involving the lung,bronchus and pleura in healthy hosts were retrospectively analyzed,and the case reports of Penicillium marneffei（PM） infection in healthy hosts were summarized by searching database for related articles,with "Penicilliosis marneffei" as key word both in English and Chinese literatures.Results The main clinical manifestations of three PSM patients included fever,cough,lymphadenopathy,and elevated white blood cell counts.Series of chest computed tomography of three cases demonstrated atypical and extensive lung lesions.The fiberoptic bronchoscopy of the 2^nd case showed several irregular nodules on the bronchial wall.The thoracoscopy of the 3^rd case showed much pleural adhesions and small nodules on visceral and parietal pleura.Final diagnosis of PSM was confirmed by the fungal culture,and all patients received antifungal treatment.The symptoms relieved on medication but reoccurred on discontinuation.Literature review identified 36 cases of PSM in healthy hosts.The main clinical features were fever,cough / expectoration,skin rash/skin abscess and elevated white blood cell counts.The most common used antifungal drug was amphotericin B alone or combined with traconazole.The thoracic radiological imaging showed that roughly half of them had clearly thoracic lesions（20/36,55.65%）,and the pulmonary inflammatory infiltrate shadow was most common.Seventeen cases（47.22%） were misdiagnosed as tuberculosis.Conclusions Pulmonary involvement is common in healthy hosts with PSM and the thoracic radiological features are variable and unspecific,so PSM is easy to be misdiagnosed as tuberculosis.The PSM patients need a longer treatment than other fungal infections.更多还原