艾滋病合并深部真菌感染58例临床分析

摘要

目的 探讨长沙地区艾滋病患者合并深部真菌感染的发生率、临床特点、治疗方法及预后.方法 对2003年4月-2009年12月在长沙市传染病医院住院的480例晚期艾滋病合并各种机会性感染患者的病历资料进行回顾性调查分析.结果 480例艾滋病患者中,并发深部真菌感染58例,占12.08％.58例合并深部真菌感染者主要临床特点:发热、咳嗽(干咳无痰或少痰)、腹痛、腹泻(水样泻)、皮肤病变(皮疹呈丘疹、出血痂、淤斑)、消瘦、意识障碍、贫血、肝脾及淋巴结大.主要检出青霉菌(27例,46.55％,以马尔尼菲青霉菌病为主)及新生隐球菌(16例,27.59％,隐球菌脑炎).对上述58例合并深部真菌感染患者,根据药敏试验结果,采用两性霉素B、氟康唑及5-氟胞嘧啶联合治疗,其中50例(86.21％)经治疗后好转.结论 该地区艾滋病患者合并深部真菌感染发病率高.早期诊断,及时有效的抗真菌治疗及高效抗逆转录病毒治疗,是改善预后的最主要手段.%Objective To investigate the incidence, clinical characteristics, treatment and prognosis of AIDS patients with deep fungal infection in Changsha. Methods Clinical data of 480 cases of AIDS treated in a hospital between April 2003 and December 2009 were reviewed retrospectively. Results Of 480 AIDS cases,58(12. 08%) had complications of deep fungal infection. The main clinical characteristics of these patients were: fever, cough (dry cough without sputum or less sputum), abdominal pain, diarrhea (watery diarrhea), skin lesion (papular eruption, exanthema haemorrhagicum,ecchymosis), pathogenic leanness, disturbance of consciousness, anemia, hepatospleno-megaly, and lymphadenectasis . The major pathogens were Penicilliummarnef fei (27 cases,46. 55%) , followed by Cryptococcus neoformans (16 cases, 27. 59%, cryptococcal meningitis). All 58 patients were treated with amphotericin B, fluconazole,and flucytosin based on drug susceptibility testing result, 50 (86. 21%) patients were cured after treatment Conclusion The incidence of deep fungal infection in AIDS patients are high. The key to the improvement of prognosis are early diagnosis, timely and effective anti-fungal treatment and highly active antiretroviral therapy.