Qiu Ye, Zhang Jianquan, Liu Guangnan, Zhong Xiaoning, Deng Jingmin, He Zhiyi, Jing Bai
Department of Integrated Medicine, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China.
BMC Infect Dis. 2015 Feb 6;15:47. doi: 10.1186/s12879-015-0782-6.
Penicillium marneffei disseminates hematogenously and can infect most organs, though infection leading to osteolysis is extremely rare. We describe the clinical and laboratory features, management, and outcomes of patients with penicilliosis marneffei (PSM) with osteolytic lesions.
This retrospective study was conducted between January 1, 2003 and May 1, 2014 at the First Affiliated Hospital of Guangxi Medical University. Patients who presented with culture and/or histopathologic proof of disseminated PSM within osteolytic lesions were included.
P. marneffei infection was diagnosed in 100 patients (65 HIV-infected and 35 HIV-negative). Fourteen patients, all HIV-negative, (14/35, 40%) had osteolytic lesions. The most common comorbidity was diabetes mellitus, though previous glucocorticoid therapy, β-thalassemia, breast cancer, and Langerhans cell histiocytosis also occurred. Five patients had no comorbidity. Fever, malaise, ostealgia, weight loss, and anemia were the most common symptoms, followed by cutaneous lesions, lymphadenopathy, hepatosplenomegaly, cough, sputum, and stethalgia. Ostealgia, joint pain, and joint disorders were also recorded. White blood cell and neutrophil counts were increased (mean 22.3 ± 7.4 × 10(9) cells/L; mean 18.84 ± 4.5 × 10(9) cells/L, respectively). The most common sites were the vertebrae, skull and femur, ribs and ilium, though the clavicle, scapula, humerus, and tibia were also involved. Radiography and computed tomography (CT) showed multiple radiolucencies with moth-eaten bone destruction, periosteal proliferation, bone fracture, and surrounding soft-tissue swelling. Emission CT showed significantly increased uptake in many skeletal regions. Positron emission tomography/CT showed generalized lymphadenopathy, bone metabolic activity, and bone destruction. The (18) F-FDG standard uptake value was increased in the entire skeleton (mean 6.16). Twelve patients received antifungal therapy, four of whom died during treatment, and eight recovered, though four of these eight relapsed within 3-24 months. Two patients discontinued treatment because of severe multiple organ failure and died.
Osteolysis is often overlooked in HIV-negative individuals with disseminated P. marneffei infection. However, P. marneffei involving the bone and leading to osteolysis may indicate severe systemic disturbance, and is characterized by a poor prognosis, high recurrence rate, and the need for prolonged antifungal treatment.
马尔尼菲青霉通过血液传播，可感染多数器官，不过导致骨质溶解的感染极为罕见。我们描述了马尔尼菲青霉病（PSM）合并溶骨性病变患者的临床和实验室特征、治疗及预后情况。
本回顾性研究于2003年1月1日至2014年5月1日在广西医科大学第一附属医院开展。纳入有溶骨性病变且有播散性PSM培养和/或组织病理学证据的患者。
100例患者确诊为马尔尼菲青霉感染（65例合并HIV感染，35例未合并HIV感染）。14例患者（均未合并HIV感染，14/35，40%）有溶骨性病变。最常见的合并症是糖尿病，不过既往糖皮质激素治疗、β地中海贫血、乳腺癌及朗格汉斯细胞组织细胞增多症也有发生。5例患者无合并症。发热、乏力、骨痛、体重减轻及贫血是最常见症状，其次是皮肤病变、淋巴结病、肝脾肿大、咳嗽、咳痰及胸痛。也记录到骨痛、关节疼痛及关节功能障碍。白细胞及中性粒细胞计数升高（分别平均为22.3±7.4×10⁹/L；平均为18.84±4.5×10⁹/L）。最常见部位是脊椎、颅骨及股骨、肋骨及髂骨，不过锁骨、肩胛骨、肱骨及胫骨也受累。X线摄影及计算机断层扫描（CT）显示多处透亮区伴虫蚀状骨质破坏、骨膜增生、骨折及周围软组织肿胀。发射型CT显示许多骨骼区域摄取明显增加。正电子发射断层扫描/CT显示全身淋巴结病、骨代谢活性及骨质破坏。全身骨骼的（18）F-FDG标准摄取值升高（平均为6.16）。12例患者接受抗真菌治疗，其中4例在治疗期间死亡，8例康复，不过这8例中有4例在3 - 24个月内复发。2例患者因严重多器官功能衰竭停止治疗并死亡。
在播散性马尔尼菲青霉感染的未合并HIV感染个体中，骨质溶解常被忽视。然而，马尔尼菲青霉累及骨骼并导致骨质溶解可能提示严重的全身紊乱，其特点是预后差、复发率高且需要长期抗真菌治疗。
