Supparatpinyo K, Khamwan C, Baosoung V, Nelson K E, Sirisanthana T
Faculty of Medicine, Chiang Mai University, Thailand.
Lancet. 1994 Jul 9;344(8915):110-3. doi: 10.1016/s0140-6736(94)91287-4.
Disseminated infection with the fungal pathogen Penicillium marneffei is, after extrapulmonary tuberculosis and cryptococcal meningitis, the third most common opportunistic infection in HIV disease in northern Thailand. We report the clinical, microbiological, and therapeutic features of a large series of HIV-infected adults with disseminated P marneffei infection. From August, 1987, to June, 1992, 92 patients with P marneffei infection confirmed by culture were seen at Chiang Mai University Hospital, of whom 86 were also infected with HIV. Clinical information was available for 80 of these patients. The most common presenting symptoms and signs were fever (92%), anaemia (77%), weight loss (76%), and skin lesions (71%). 87% of patients presenting with skin lesions had generalised papules with central umbilication. Presumptive diagnosis was made in 50 patients by microscopic examination of Wright's-stained bone-marrow aspirate and/or touch smears of skin biopsy or lymph-node biopsy specimens. Most patients who were diagnosed responded initially to amphotericin or itraconazole, whereas most who were not diagnosed and treated died. 12 patients relapsed within 6 months of cessation of treatment. P marneffei has become an important pathogen of HIV-associated opportunistic infection in Thailand.
在泰国北部，播散性马尔尼菲青霉菌真菌感染是继肺外结核和隐球菌性脑膜炎之后，艾滋病患者中第三常见的机会性感染。我们报告了一大系列播散性马尔尼菲青霉菌感染的艾滋病成年患者的临床、微生物学和治疗特征。1987年8月至1992年6月期间，清迈大学医院共收治了92例经培养确诊为马尔尼菲青霉菌感染的患者，其中86例同时感染了艾滋病病毒。这86例患者中有80例有临床资料。最常见的症状和体征为发热（92%）、贫血（77%）、体重减轻（76%）和皮肤损害（71%）。出现皮肤损害的患者中，87%有中央凹陷的全身性丘疹。50例患者通过对瑞氏染色的骨髓穿刺液和/或皮肤活检或淋巴结活检标本的触片进行显微镜检查作出初步诊断。大多数确诊患者最初对两性霉素或伊曲康唑有反应，而大多数未确诊和未接受治疗的患者死亡。12例患者在停止治疗后6个月内复发。在泰国，马尔尼菲青霉菌已成为艾滋病相关机会性感染的一种重要病原体。
