AIDS-associated Talaromyces marneffei central nervous system infection in patients of southwestern China
AIDS-associated Talaromyces marneffei central nervous system infection in patients of southwestern China
复制标题
中国西南地区患者中与艾滋病相关的马尔尼菲踝节菌中枢神经系统感染
DOI：
10.1186/s12981-020-00281-4
复制
发表时间：
2020-05-26
影响因子：
2.2
通讯作者：
Zhang, Yun-Gui
中科院分区：
文献类型：
--
作者：
Li, Yu-Ye;Dong, Rong-Jing;Zhang, Yun-Gui
背景
与艾滋病相关的马尔尼菲踝节菌感染是一种罕见但致命的中枢神经系统真菌病，其临床和实验室特征仍不清楚。
案例展示
在此，我们对 10 名 AIDS 患者进行了回顾性研究，其脑脊液培养证实为马尔尼菲踝节菌引起的中枢神经系统感染。所有 10 名患者均及时接受了长期抗真菌治疗和早期抗病毒治疗 (ART)。其中，7名患者为农民。 9名患者痊愈出院，1名患者在住院期间死亡，死亡率达10%。所有患者最初均出现颅内压增高的症状和体征，主要表现为头痛、头晕、呕吐、发热、肌力下降、复视，严重者甚至出现意识改变伴癫痫发作。 9名患者（90%）在脑CT上显示侧脑室扩张或颅内感染性病变。脑脊液检查结果包括颅内压升高、白细胞计数增加、低葡萄糖、低氯和高脑脊液蛋白。发病时患者的中位 CD4+ T 计数为 104 个细胞/μL（IQR，36-224 个细胞/μL）。最终死亡的三名患者的 CD4+ T 细胞计数显着低于存活患者（W = 6.00，p = 0.020）。
结论
马尔尼菲毛虫中枢神经系统感染常见的临床症状与高颅压和颅内感染性病变有关。早期识别和诊断以及延长两性霉素 B 治疗疗程，然后联合伊曲康唑联合早期 ART 可能会降低死亡率。
Background
The clinical and laboratory characteristics of AIDS-associated Talaromyces marneffei infection, a rare but a fatal mycosis disease of the central nervous system, remain unclear.
Case presentation
Herein, we conducted a retrospective study of ten AIDS patients with cerebrospinal fluid culture-confirmed central nervous system infection caused by Talaromyces marneffei. All 10 patients were promptly treated with antifungal treatment for a prolonged duration and early antiviral therapy (ART). Among them, seven patients were farmers. Nine patients were discharged after full recovery, while one patient died during hospitalization, resulting in a mortality rate of 10%. All patients initially presented symptoms and signs of an increase in intracranial pressure, mainly manifesting as headache, dizziness, vomiting, fever, decreased muscle strength, diplopia or even altered consciousness with seizures in severe patients. Nine patients (90%) showed lateral ventricle dilatation or intracranial infectious lesions on brain CT. Cerebrospinal fluid findings included elevated intracranial pressure, increased leukocyte count, low glucose, low chloride and high cerebrospinal fluid protein. The median CD4+ T count of patients was 104 cells/μL (IQR, 36–224 cells/μL) at the onset of the disease. The CD4+ T cell counts of three patients who eventually died were significantly lower (W = 6.00, p = 0.020) than those of the patients who survived.
Conclusions
The common clinical symptoms of T. marneffei central nervous system infection are associated with high intracranial pressure and intracranial infectious lesions. Earlier recognition and diagnosis and a prolonged course of amphotericin B treatment followed by itraconazole combined with early ART might reduce the mortality rate.