马尔尼菲青霉菌病并发浆膜腔积液的临床分析_老启芳

摘要: 目的 为临床诊治马 尔尼菲 青霉 菌病 ( PSM )浆 膜侵 犯出现 的浆 膜腔积 液提 供经 验。方法 回 顾性 分析 2001年 3月至 2008年 3月在广西医科大学第一附属 医院住院 确诊为 PSM 患者 ( 61例 )中出 现胸膜 腔、腹 膜腔、 心包腔积液或脑 脊液异常的 10例临床资 料。结果 ( 1) 临床表 现胸 腔积 液 10 例, 其 中同 时合并 有心 包积 液 2 例、腹腔积液 5例、脑脊液异常 2例。误诊为结核 性胸膜 炎 10 例, 曾行抗 结核治疗, 同 时误诊 为结核 性脑膜 炎 2 例, 结核性心包炎 2例, 结核性腹膜炎 5例, 癌性 胸腔积液 5例。 ( 2)所有患者均有发热、贫血、乏力、消瘦等症状。 其中咳嗽 9例, 胸痛 8例, 呼吸困难 6例, 腹泻 2例, 腹痛 3例。坏死性丘疹 5例, 皮下脓肿、结节 8例, 淋巴结肿大 9例, 肝脾肿 大 9例, 湿性啰音 7例。 ( 3)白细胞总数增高 9例, 以中性粒细胞总数 [ ( 171 6 ? 51 3) @ 109 /L ]及比值 ( 01841 ? 01 048)显著增高为主, 淋巴细胞比值相对 降低 ( 01976 ? 01035), 但总数正常 ( 11 59 ? 017 ) @ 109 /L。 ( 4) 所有患者人免疫 缺陷病毒 (H IV ) 阴性, CD4 /CD8比值 11 19 ? 0138。 ( 5) A /G 倒置 10例, 胆红素增高 6例, 肾功能 异常 5例, 红细胞沉降率增快 10例, C反应蛋白 ( CR P)增高 10例。 ( 6)所有病 例均有病原 学依据, 其中血培 养 5 例, 骨髓培养 2例, 痰培养 1例, 脓肿分泌物 培养 4例, 组织病理 4例。 ( 7) 影像检查肺部有 实质性异常 10 例, 肝 脾肿大或腹主动脉旁淋巴 结肿大 9例, 溶骨性破坏 6例。 ( 8)浆膜腔积 液性质为渗 出液, 表现为混浊 的黄色或血 性外观, 细胞数明显增高, 以中性粒细胞为主, 蛋白增高。 ( 9) 4 例抗真 菌治疗 好转, 死亡 3例, 死于 呼吸衰 竭、心 力衰竭、肝肾功能衰竭。恶化 2例、1例未治自动出院。 结论 PSM 浆膜腔 侵犯常发 生于免 疫功能 正常者, 临床 上表现以中性粒细胞显著 增高的慢性化脓性感染性疾病, 侵犯肺部、腹部器官及脑膜时常常同时伴有胸腹腔积液 及脑脊液异常, 其性质符合炎症性积液, 有效抗真菌治疗可完全吸收, 临床转归 与全身状态相关。 关键词: 青霉属; 感染; 浆膜腔积液
816
论
著
Ch inese Journal of P ractical InternalM ed icine
Sep. 2009 V o.l 29 N o. 9
马尔尼菲青霉菌病并发浆膜腔积液的临床分析
老启芳, 张建全, 钟小宁, 白 晶
文章编号: 1005- 2194( 2009) 09- 0816- 04 中图分类号: R5 文献标志码: A
cases w ere m isd iagnosed as tubercu lous p leurisy and accepted ant-i tubercu lo sis treatm ent, two cases as tubercu lousm enin-
g itis, two cases as tubercu lous pericard itis, fiv e cases as tubercu lous per iton itis and five cases as m a lignan t pleura l e ffu-
ty, N anning 530021, Ch ina
Abstrac t: O bjective T o ana ly ze the clin ica l data o f patients w ith penic illiosis ma rneffe i( PSM ) , summ arize c lin ica l char-
ac teristics o f serosal involvem ent and prov ide exper ience to diagnose and treat serous e ffus ion. M ethod s W e retrospec-
tive ly ana lyzed 61 patients w ith estabo lished PSM infection in our hosp ital from M2008. P atientsw ere
w hose ages rang ing from 36yr to 67y r[ m ean( 5412 ? 813) yr]. R esu lts ( 1) There we re ten cases w ith pleura l effusion,
inc luding tw o cases w ith pericard ia l effusion, fiv e cases w ith asc ites and tw o cases w ith abnorm a l cerebro spina l flu id. T en
u la, e ight cases w ith subcu taneous abscess, n ine cases w ith lym phadenec tasis, nine cases w ith sp lenohepatom ega lia and
seven cases w ith m o ist ra les. ( 3) T o tal wh ite b lood ce lls count increase in n ine cases w hich m a in ly presented w ith sign if-i
cantly inc rease in neutroph il count[ ( 1716 ? 513) @ 109 /L ] and ratio( 01841 ? 01 048 ). Lym pho cy te ratio w as re lative ly
low ( 01976 ? 01 035 ), but count w as norm a l [ ( 1159 ?
C lin ical analysis in pen ic illiosis m arneffei comp licated w ith serous effu sion.
LAO Q i-fang, ZHAN G J ian-quan,
ZH ON G X iao-ning, BA I J ing. D epar tm ent of R esp eratory D iseases, the F irst AffiliatedH o sp ital of Guangx iM ed ical U niver si-
2009 年 9月第 29卷第 9 期
中国实用内科杂志
817
ry throcyte sed im entation ra te and C-reactive pro te in increase in six cases, ten cases and ten cases respectiv ely. A bnorm a l renal function appeared in five cases. ( 6) A ll cases we re defined acco rding to etio logy including hem oculture( 5 cases), m edulloculture( 2 cases), sputum culture( 1 case), abscess secretion culture( 4 cases) and histopatho logy ( 4 cases). ( 7) Im ag ing check demonstrated parenchym atous abnorm a lity in lung( 10 cases), splenohepatom egalia o r abdom ina l para- ao rtic lym phadenec tasis( 9 cases) and osteo ly tic dam age( 6 cases). ( 8) The property of se rous effusion wh ich appeared cloudy ye llow or upr ightness was exudate. The ce ll count espec ially neutrophil count and prote in content inc reased in it. ( 9) A nt-i eum ycete m ed icine were adm in iste red to four cases and achieved improv em ent. T hree cases died of respiratory fa ilu re, card iac failure, hepatic and renal failure. Two patientps cond ition agg ravated and one pa tient vo lunta rily leaved hospita lw ithout treatm ent. Conc lu sion Pen ic illio sis m arneffei often occurs in se rous cav ity o f norm a l imm une function c rowd. Clin ica l characteristics m anifest w ith chron ic pyogenic and infected d iseases which appear sign ificant increase in neutrophil count. It invades lung, abdom inal org an and m ight be com plica ted w ith p leura l effusion, ascites and abnom a l ce rebrosp inal fluid. T he property o f effusion is consistent w ith inflamm ato ry efflusion w hich can be tota lly abso rbed under effec tive an t-i funga l treatment. C linical progno sis relates w ith general body state. K eyword s: pen ic illium; infec tion; serous effusion