Yousukh Amnat, Jutavijittum Prapan, Pisetpongsa Pises, Chitapanarux Taned, Thongsawat Satawat, Senba Masachika, Toriyama Kan
Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Arch Pathol Lab Med. 2004 Feb;128(2):191-4. doi: 10.5858/2004-128-191-CSOHPM.
Penicillium marneffei, an opportunistic fungus, is endemic in Southeast Asia, especially in human immunodeficiency virus-infected individuals living in northern Thailand.
We present the results of a clinicopathologic study of hepatic penicilliosis among human immunodeficiency virus/acquired immunodeficiency syndrome patients.
A search of liver biopsies in one institution from 1998 to 1999 identified 30 cases of penicilliosis.
Histologically, hepatic lesions could be classified into 1 of 3 patterns: diffuse, granulomatous, and mixed. The diffuse pattern showed a diffuse infiltration of foamy macrophages that contained numerous P marneffei. The granulomatous pattern showed a formation of multiple granulomata with various degrees of inflammatory cell infiltration. The mixed pattern showed features intermediate between the diffuse and granulomatous patterns. Liver function tests of the 3 pathologic pattern groups were evaluated, but there were no statistically significant differences in aspartate aminotransferase, alanine aminotransferase, or alkaline phosphatase levels among the various histologic groups.
To our knowledge, this is the largest series to date that documents the liver pathology that results from this pathogen. We hypothesize that the histologic patterns seen on biopsy reflect the level of the host's immunity. Hence, in addition to a diagnosis of penicilliosis, a liver biopsy may also provide an assessment of the host's immune status, whereas liver function tests do not.
马尔尼菲青霉是一种机会性真菌，在东南亚为地方病，尤其是在泰国北部感染人类免疫缺陷病毒的个体中。
我们展示了对人类免疫缺陷病毒/获得性免疫缺陷综合征患者肝青霉病的临床病理研究结果。
对1998年至1999年在一个机构进行的肝活检进行检索，确定了30例青霉病病例。
组织学上，肝脏病变可分为三种模式之一：弥漫性、肉芽肿性和混合性。弥漫性模式表现为含有大量马尔尼菲青霉的泡沫状巨噬细胞弥漫浸润。肉芽肿性模式表现为形成多个肉芽肿，伴有不同程度的炎性细胞浸润。混合性模式表现为介于弥漫性和肉芽肿性模式之间的特征。对这三种病理模式组的肝功能检查进行了评估，但不同组织学组之间的天冬氨酸转氨酶、丙氨酸转氨酶或碱性磷酸酶水平无统计学显著差异。
据我们所知，这是迄今为止记录该病原体所致肝脏病理的最大系列研究。我们推测活检所见的组织学模式反映了宿主的免疫水平。因此，除了诊断青霉病外，肝活检还可评估宿主的免疫状态，而肝功能检查则不能。
