【摘要】：目的分析馬爾尼菲青霉菌(PMA)在無基礎疾病低齡患兒的感染狀況及耐藥性,為馬爾尼菲青霉菌病(PSM)患兒選擇及時、有效的抗真菌治療提供依據(jù)。方法收集2006年1月-2014年12月23例馬爾尼菲青霉病患兒血液和骨髓標本中分離的PMA,從細菌學檢驗、骨髓像染色檢查、組織病理學常規(guī)染色和特殊染色檢查鑒定PMA,并且采用Rosoo紙片擴散法進行馬爾尼菲青霉菌藥物敏感性試驗。結果 BACT/ALERT 3D120全自動血液培養(yǎng)儀提示有菌生長;糖同化試驗均陽性;組織病理學常規(guī)染色顯示為肉芽腫病變,中心壞死,并見典型細胞為臘腸形孢子,長形、、粗細均勻、兩頭鈍圓、中央有一橫隔;23株馬爾尼菲青霉菌對5種抗真菌藥物抗菌活性均較好,兩性霉素B、伏立康唑、氟胞嘧啶、伊曲康唑的耐藥率分別為13.0%、8.7%、4.3%、4.3%。結論馬爾尼菲青霉菌已嚴重危害免疫力低下的低齡兒童,需嚴防漏檢而貽誤治療時機,尤其重視降低基層醫(yī)院的馬爾尼菲青霉菌病的誤診率,因氟康唑敏感性高、能透過血腦屏障、不良反應小、治療費用較低,所以在馬爾尼菲青霉病患兒治療上推薦首選藥物為氟康唑。
[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.
【作者單位】： 贛南醫(yī)學院第一附屬醫(yī)院檢驗科;贛南醫(yī)學院第三附屬醫(yī)院檢驗科;贛南醫(yī)學院第一附屬醫(yī)院血液實驗室;贛南醫(yī)學院第一附屬醫(yī)院病理科;
【基金】：江西省自然科學基金項目(2012ZBAB205007) 江西省教育廳青年科學基金項目(GJJ10229)
【分類號】：R446;R725.1

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