Wu T C, Chan Johnny W M, Ng C K, Tsang Dominic N C, Lee M P, Li Patrick C K
Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.
Hong Kong Med J. 2008 Apr;14(2):103-9.
To describe the clinical presentation, management, and outcomes of patients with Penicillium marneffei infections in a regional hospital in Hong Kong.
Retrospective study.
A regional and tertiary human immunodeficiency virus-referral hospital in Hong Kong.
Those who had penicilliosis during the inclusive period January 1994 to February 2004.
Forty-seven immunocompromised patients (44 being human immunodeficiency virus-positive) with penicilliosis were retrospectively studied. Fever, malaise, and anaemia were the commonest presentations. Most diagnoses were obtained from blood cultures (83%) and lymph node biopsies (34%). Five (11%) died, death being attributable to penicilliosis; four (9%) of them had received no specific antifungal treatment due to late presentation and late diagnosis. The CD4 count of human immunodeficiency virus-infected patients upon diagnosis of penicilliosis was low (median, 20.0 cells/mm3). Most (70%) patients received amphotericin B as an induction treatment, followed by oral itraconazole, although a smaller proportion (21%) received oral itraconazole only. All surviving human immunodeficiency virus-infected patients took highly active antiretroviral treatment and oral itraconazole as secondary prophylaxis after treatment of penicilliosis. The prognosis appeared satisfactory with early diagnosis and administration of appropriate antifungal therapy. Relapse ensued in two (4%) of the patients only.
Penicillium marneffei infection in immunocompromised patients is a serious disease with significant mortality if not diagnosed early and treated with appropriate antifungal drugs. Simple investigations like blood culture enable the diagnosis in the majority of cases. Immunocompromised patients who have been successfully treated should receive oral itraconazole as a maintenance therapy to prevent relapse.
描述香港一家区域医院中马尔尼菲青霉菌感染患者的临床表现、治疗及预后。
回顾性研究。
香港一家区域及三级人类免疫缺陷病毒转诊医院。
1994年1月至2004年2月期间患有青霉病的患者。
对47例免疫功能低下的青霉病患者（44例为人类免疫缺陷病毒阳性）进行了回顾性研究。发热、乏力和贫血是最常见的表现。大多数诊断来自血培养（83%）和淋巴结活检（34%）。5例（11%）死亡，死因是青霉病；其中4例（9%）因就诊晚和诊断晚未接受特异性抗真菌治疗。人类免疫缺陷病毒感染患者在诊断青霉病时的CD4细胞计数较低（中位数为20.0个细胞/mm³）。大多数（70%）患者接受两性霉素B作为诱导治疗，随后口服伊曲康唑，不过较小比例（21%）的患者仅接受口服伊曲康唑治疗。所有存活的人类免疫缺陷病毒感染患者在青霉病治疗后接受了高效抗逆转录病毒治疗和口服伊曲康唑作为二级预防。早期诊断并给予适当的抗真菌治疗后，预后似乎令人满意。仅2例（4%）患者出现复发。
免疫功能低下患者的马尔尼菲青霉菌感染是一种严重疾病，若不及早诊断并使用适当的抗真菌药物治疗，死亡率很高。像血培养这样的简单检查能在大多数病例中实现诊断。成功治疗的免疫功能低下患者应接受口服伊曲康唑作为维持治疗以预防复发。
