马尔尼菲青霉菌病并发浆膜腔积液的临床分析_老启芳VIP免费

作者单位:广西医科大学第一附属医院呼吸内科,南宁530021通讯作者:钟小宁,电子信箱:xnzhong101@sina.com论著马尔尼菲青霉菌病并发浆膜腔积液的临床分析老启芳,张建全,钟小宁,白晶文章编号:1005-2194(2009)09-0816-04中图分类号:R5文献标志码:A摘要:目的为临床诊治马尔尼菲青霉菌病(PSM)浆膜侵犯出现的浆膜腔积液提供经验。方法回顾性分析2001年3月至2008年3月在广西医科大学第一附属医院住院确诊为PSM患者(61例)中出现胸膜腔、腹膜腔、心包腔积液或脑脊液异常的10例临床资料。结果(1)临床表现胸腔积液10例,其中同时合并有心包积液2例、腹腔积液5例、脑脊液异常2例。误诊为结核性胸膜炎10例,曾行抗结核治疗,同时误诊为结核性脑膜炎2例,结核性心包炎2例,结核性腹膜炎5例,癌性胸腔积液5例。(2)所有患者均有发热、贫血、乏力、消瘦等症状。其中咳嗽9例,胸痛8例,呼吸困难6例,腹泻2例,腹痛3例。坏死性丘疹5例,皮下脓肿、结节8例,淋巴结肿大9例,肝脾肿大9例,湿性啰音7例。(3)白细胞总数增高9例,以中性粒细胞总数[(1716?513)@109/L]及比值(01841?01048)显著增高为主,淋巴细胞比值相对降低(01976?01035),但总数正常(1159?017)@109/L。(4)所有患者人免疫缺陷病毒(HIV)阴性,CD4/CD8比值1119?0138。(5)A/G倒置10例,胆红素增高6例,肾功能异常5例,红细胞沉降率增快10例,C反应蛋白(CRP)增高10例。(6)所有病例均有病原学依据,其中血培养5例,骨髓培养2例,痰培养1例,脓肿分泌物培养4例,组织病理4例。(7)影像检查肺部有实质性异常10例,肝脾肿大或腹主动脉旁淋巴结肿大9例,溶骨性破坏6例。(8)浆膜腔积液性质为渗出液,表现为混浊的黄色或血性外观,细胞数明显增高,以中性粒细胞为主,蛋白增高。(9)4例抗真菌治疗好转,死亡3例,死于呼吸衰竭、心力衰竭、肝肾功能衰竭。恶化2例、1例未治自动出院。结论PSM浆膜腔侵犯常发生于免疫功能正常者,临床上表现以中性粒细胞显著增高的慢性化脓性感染性疾病,侵犯肺部、腹部器官及脑膜时常常同时伴有胸腹腔积液及脑脊液异常,其性质符合炎症性积液,有效抗真菌治疗可完全吸收,临床转归与全身状态相关。关键词:青霉属;感染;浆膜腔积液Clinicalanalysisinpenicilliosismarneffeicomplicatedwithserouseffusion.LAOQi-fang,ZHANGJian-quan,ZHONGXiao-ning,BAIJing.DepartmentofResperatoryDiseases,theFirstAffiliatedHospitalofGuangxiMedicalUniversi-ty,Nanning530021,ChinaAbstract:ObjectiveToanalyzetheclinicaldataofpatientswithpenicilliosismarneffei(PSM),summarizeclinicalchar-acteristicsofserosalinvolvementandprovideexperiencetodiagnoseandtreatserouseffusion.MethodsWeretrospec-tivelyanalyzed61patientswithestabolishedPSMinfectioninourhospitalfromMarch,2001toMarch,2008.Patientsweredividedintopositivegroupswhilepresentedoneormoreabnormalserouseffusionsuchaspleuraleffusion,ascites,pericar-dialeffusionorcerebrospinalfluid.Thereweretenpatientsinpositivegroupsfinally,includingninemaleandonefemalewhoseagesrangingfrom36yrto67yr[mean(5412?813)yr].Results(1)Thereweretencaseswithpleuraleffusion,includingtwocaseswithpericardialeffusion,fivecaseswithascitesandtwocaseswithabnormalcerebrospinalfluid.Tencasesweremisdiagnosedastuberculouspleurisyandacceptedant-ituberculosistreatment,twocasesastuberculousmenin-gitis,twocasesastuberculouspericarditis,fivecasesastuberculousperitonitisandfivecasesasmalignantpleuraleffu-sion.(2)Allpatientsmanifestedwithfever,anemia,hypodynamiaoremaciation,ninecaseswithcough,eightcaseswithchestpain,sixcaseswithdyspnea,twocaseswithalviprofluvium,threecaseswithbellyache,fivecaseswithnecroticpap-ula,eightcaseswithsubcutaneousabscess,ninecaseswithlymphadenectasis,ninecaseswithsplenohepatomegaliaandsevencaseswithmoistrales.(3)Totalwhitebloodcellscountincreaseinninecaseswhichmainlypresentedwithsignif-icantlyincreaseinneutrophilcount[(17...