儿童马尔尼菲青霉病临床分析并文献复习

发布时间：2018-05-31 03:45

本文选题：马尔尼菲青霉病 + 儿童　；参考：《广西医科大学》2013年硕士论文

【摘要】：目的：分析儿童马尔尼菲青霉病(PSM)的临床特征,探讨其治疗。方法：对从2003年1月至2012年12月入住广西医科大学第一附属医院确诊的6例年龄14岁PSM患者的临床资料进行回顾性分析,并结合国内外文献讨论。结果：6例均为男性,平均年龄3岁4月(1岁2月,9岁)。病程39天(15天、120天)。2例为人类免疫缺陷病毒(HIV)阳性；4例HIV阴性,其中1例存在G6PD缺乏症,3例患儿发病前体弱多病。所有患者都有贫血、消瘦、淋巴结肿大,5例发热,3例出现呼吸系统症状、肝肿大,1例脾肿大,1例中枢神经系统受累,1例黑便;2例HIV(+)的PSM患儿出现皮疹。2例HIV(+)患儿的PSM患儿白细胞降低,2例HIV(-)患儿的PSM患者白细胞升高,1例降低；共有4例(4/6)出现淋巴细胞下降。所有病例存在淋巴细胞功能的异常。4例胸部影像学提示异常,2例提示纵膈、肺门淋巴结肿大,2例提示两肺多发的团块状密度增高影。病原学检查淋巴结病3/3(100.00%),骨髓4/5(80.00%),血4/6(66.67%),肺泡灌洗液1／1(100.00%)：所以病人均有两个部位的病原学阳性。病理特征主要为肉芽肿、坏死性表现。6例中3例未接受抗真菌治疗,2例死亡,1例放弃治疗出院；余3例分别以氟康唑、两性霉素B、伏立康唑抗真菌治疗后好转出院。结论：1、儿童马尔尼菲青霉病患者,多见HIV感染、存在其他基础疾病或存在潜在免疫力低下的患儿。2、患儿常常表现为全身播散性感染,可累及肺、淋巴结、肝、脾、血液、中枢神经系统等多个器官及系统。常见发热、贫血、淋巴结、肝脾肿大等临床表现,皮下脓肿、溶骨性等全身化脓性改变少见。3、相对成人,患儿较容易取得病原学依据,血、淋巴结、骨髓病原学阳性率较高。4、病理检查主要表现为肉芽肿及坏死性改变,化脓性改变少见。5、未抗真菌治疗,死亡率高,预后很差；及时的抗真菌治疗,治疗效果好。
[Abstract]:Objective: to analyze the clinical features of children with penicilliosis marneffei (PSM) and to explore its treatment. Methods: the clinical data of 6 patients with PSM aged 14 years who were admitted to the first affiliated Hospital of Guangxi Medical University from January 2003 to December 2012 were retrospectively analyzed and discussed in the literature at home and abroad. Results all of the 6 cases were male, with an average age of 3 years, 4 months, 1 year, 2 months and 9 years old. The course of disease was 39 days, 15 days and 120 days. 2 cases were HIV negative in 4 cases. Among them, 1 case had G6PD deficiency and 3 cases had weak disease before onset. All patients had anemia, wasting, lymphadenopathy, 5 cases of fever and 3 cases of respiratory symptoms. Hepatomegaly 1 patient with splenomegaly 1 case with central nervous system involvement 1 case with melanoma 2 cases with PSM and 2 cases with PSM with leukopenia 2 cases with PSM increased leukocyte in 1 case; A total of 4 cases (4 / 6) had lymphocytopenia. All cases had abnormal lymphocyte function in 4 cases. Chest imaging showed abnormal mediastinum in 2 cases, enlarged hilar lymph nodes in 2 cases, and increased mass density in both lungs in 2 cases. Etiology examination of lymphadenopathy 3 / 3 / 100.00000, bone marrow 4 / 5 / 80.000, blood 4 / 6, 66.67, alveolar lavage fluid 1 / 1 / 100.00000: so there are two sites of etiology positive in patients. The main pathological features were granuloma. Among the 6 cases, 3 cases were not treated with antifungal therapy, 2 cases died and 1 case was discharged from hospital, the remaining 3 cases were discharged after antifungal therapy with fluconazole, amphotericin B and voleconazole respectively. Conclusion in children with penicilliosis marneffei, HIV infection is more common, other underlying diseases or potential immunosuppression are found in children. The children often present with disseminated systemic infection, which can involve lung, lymph nodes, liver, spleen, blood. Central nervous system and other organs and systems. Common fever, anemia, lymph node, hepatosplenomegaly and other clinical manifestations, subcutaneous abscess, osteolytic and other systemic suppurative changes rare. The positive rate of bone marrow etiology was high. 4. The pathological examination mainly showed granuloma and necrotic change. The suppurative change was rare. 5. No antifungal treatment, high mortality, poor prognosis, timely antifungal treatment, good therapeutic effect.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R725.1

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