传染病信息

目的 探讨获得性免疫缺陷综合征(acquired immunodeficiency syndrome, AIDS)合并上消化道马尔尼菲篮状菌病的临床及病理特征。方法 回顾性分析3例AIDS合并马尔尼菲篮状菌病累及上消化道患者的临床资料，总结其临床及病理特点、治疗及转归情况。结果 3例患者均为男性，CD4~+T细胞均<50个/μL，均有腹痛、腹胀、腹泻及大便隐血等消化道症状，其中1例呕血；均有皮疹及体质量减轻。实验室检查示中性粒细胞百分比增高，不同程度贫血及低蛋白血症，不同样本马尔尼菲篮状菌培养阳性。浅表、腹腔深部淋巴结及肝脾肿大。显微内镜示病变黏膜糜烂或溃疡，其中1例溃疡呈穿凿样，似巨细胞病毒感染后改变，1例伴幽门狭窄。病理特点为黏膜慢性炎伴糜烂或溃疡形成，大量泡沫样组织细胞增生聚集，细胞内外可见浅灰色酵母样真菌，特殊染色呈圆形或类圆形，部分呈腊肠状，可见中央横隔。3例患者均进行抗真菌治疗，1例治疗1周后要求出院并失访，另2例全程规范治疗后好转，长期门诊随诊，病情稳定。结论 AIDS合并马尔尼菲篮状菌病累及上消化道少见单独报道，临床症状无特异性，当CD4~+T细胞计数明显减少，患者有马尔尼菲篮状菌病流行地旅居史伴发热、皮疹、体质量减轻、肝脾肿大等临床症状时，应尽早完善病原学或组织病理学检查，及时确诊与治疗。

Objective To investigate the clinical and pathological characteristics of AIDS complicated with talaromycosis marneffei of upper digestive tract. Methods A retrospective analysis was conducted on the clinical data of 3 cases of AIDS patients with upper gastrointestinal talaromycosis marneffei infection. The clinical and pathological characteristics, treatment and outcome were summarized. Results All 3 patients all were male with CD4⁺ T lymphocytes counts less than 50 cell/μL. All patients had gastrointestinal symptoms such as abdominal pain, abdominal distension, diarrhea and fecal occult blood. One case had hematemesis. All patients had rash and weight loss. Laboratory tests showed an elevated percentage of neutrophils, anemia and hypoalbuminemia of varying degrees, and positive cultures of Talaromyces marneffei from different samples. Superficial and deep abdominal lymph nodes as well as hepatosplenomegaly. Microendoscopy revealed mucosal erosion or ulceration. One case of ulcer showed a chisel like appearance, resembling the changes after cytomegalovirus infection. One case had pyloric stenosis. Pathological features include chronic mucosal inflammation of with erosion or ulceration, proliferation and aggregation of a large number of foamy histiocytes, and pale gray yeast-like fungi visible both intracellularly and extracellularly. Special stains reveal the fungi as round or oval-shaped, some sausage-shaped, with visible central septa. All 3 patients were treated with antifungal therapy. One patient requested discharge after 1 week of treatment and was lost to followup, and the other 2 patients showed improvement after completing the full course of standardized treatment, and remained in stable condition during long-term outpatient follow-up. Conclusion There are few individual reports on AIDS complicated by upper gastrointestinal talaromycosis marneffei and the clinical symptoms are non-specific. When the CD4⁺ T lymphocytes are obviously decreased, patients have a history of living in endemic areas, fever, rash, weight loss, and hepatosplenomegaly, etiological or histopathological examination should be promptly performed for timely diagnosis and treatment.