马尔尼菲青霉菌的分离鉴定与耐药性分析

发布时间：2018-12-11 07:33

【摘要】：目的分析马尔尼菲青霉菌(PMA)在无基础疾病低龄患儿的感染状况及耐药性,为马尔尼菲青霉菌病(PSM)患儿选择及时、有效的抗真菌治疗提供依据。方法收集2006年1月-2014年12月23例马尔尼菲青霉病患儿血液和骨髓标本中分离的PMA,从细菌学检验、骨髓像染色检查、组织病理学常规染色和特殊染色检查鉴定PMA,并且采用Rosoo纸片扩散法进行马尔尼菲青霉菌药物敏感性试验。结果 BACT/ALERT 3D120全自动血液培养仪提示有菌生长;糖同化试验均阳性;组织病理学常规染色显示为肉芽肿病变,中心坏死,并见典型细胞为腊肠形孢子,长形、、粗细均匀、两头钝圆、中央有一横隔;23株马尔尼菲青霉菌对5种抗真菌药物抗菌活性均较好,两性霉素B、伏立康唑、氟胞嘧啶、伊曲康唑的耐药率分别为13.0%、8.7%、4.3%、4.3%。结论马尔尼菲青霉菌已严重危害免疫力低下的低龄儿童,需严防漏检而贻误治疗时机,尤其重视降低基层医院的马尔尼菲青霉菌病的误诊率,因氟康唑敏感性高、能透过血脑屏障、不良反应小、治疗费用较低,所以在马尔尼菲青霉病患儿治疗上推荐首选药物为氟康唑。
[Abstract]:Objective to analyze the infection status and drug resistance of Penicillium marneffei (PMA) in young children without basic diseases, and to provide evidence for the choice of timely and effective antifungal therapy in children with penicilliosis marneffei (PSM). Methods PMA, isolated from blood and bone marrow samples of 23 children with penicilliosis marneffei were collected from January 2006 to December 2014 to identify PMA, from bacteriological examination, bone marrow image staining, histopathological routine staining and special staining. The drug sensitivity of Penicillium marneffei was tested by Rosoo disk diffusion method. Results BACT/ALERT 3D120 automatic blood culture instrument indicated the growth of bacteria, and the glucose assimilation test was positive. Histopathological staining showed granulomatous lesions with central necrosis. Typical cells were sausage spores, long, thin and uniform, with obtuse circles at both ends and a horizontal septum in the center. 23 strains of Penicillium marneffei had better antimicrobial activity against 5 kinds of antifungal drugs. The resistance rates of amphotericin B, voliconazole, flucytosine and itraconazole were 13.0 and 8.7 respectively. Conclusion Penicillium marneffei has been seriously harmful to the young children with low immunity. It is necessary to prevent the missed examination and delay the treatment opportunity, especially to reduce the misdiagnosis rate of penicilliosis marneffei in the primary hospital because of the high sensitivity of fluconazole. Can penetrate the blood-brain barrier, the adverse reaction is small, the treatment cost is low, therefore in the Marneffei penicillium disease child treatment recommended the first choice drug is fluconazole.
【作者单位】：赣南医学院第一附属医院检验科;赣南医学院第三附属医院检验科;赣南医学院第一附属医院血液实验室;赣南医学院第一附属医院病理科;
【基金】：江西省自然科学基金项目(2012ZBAB205007) 江西省教育厅青年科学基金项目(GJJ10229)
【分类号】：R446;R725.1

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