艾滋病合并肺结核和（或）马尔尼菲蓝状菌病的影像学研究

新发传染病电子杂志 ›› 2018, Vol. 3 ›› Issue (3): 171-174.

艾滋病合并肺结核和（或）马尔尼菲蓝状菌病的影像学研究

覃江龙¹, 梁纲², 卢祥婵¹, 张剑锋¹, 宁宗³, 卢亦波¹, 吴念宁¹, 吴锋耀¹

1.南宁市第四人民医院,广西南宁530023;
2.广西医科大学病理生理学教研室,广西南宁530021;
3.广西医科大学第一附属医院,广西南宁530021

收稿日期:2018-08-05 出版日期:2018-08-31 发布日期:2020-06-30
通讯作者: 张剑锋,E-mail：zjf@188.com
基金资助:
南宁市科学研究与技术开发项目：艾滋病肺结节的影像学研究（20153122）

AIDS complicated by pulmonary tuberculosis and/or Talaromyces marneffei: An analysis of radiological images

QIN Jiang-long¹, LIANG Gang², LU Xiang-chan¹, ZHANG Jian-feng¹, NING Zong³, LU Yi-bo¹, WU Nian-ning¹, WU Feng-yao¹

1. The Fourth People's Hospital of Nanning, Nanning 530023, China;
2. Guangxi Medical University, Nanning 530021, China

Received:2018-08-05 Online:2018-08-31 Published:2020-06-30

摘要/Abstract

摘要： 目的探讨艾滋病机会性感染中肺结核和（或）马尔尼菲蓝状菌病的影像学特点。方法对2015年1月至2015年12月在南宁市第四人民医院住院治疗的972例艾滋病进行回顾性分析,分析比较艾滋病不同机会性感染的肺部影像学。结果 972例患者中11.52%为艾滋病合并肺结核,6.06%为艾滋病合并马尔尼菲蓝状菌病,9.56%为艾滋病合并肺结核及马尔尼菲蓝状菌病。艾滋病合并肺结核组肺部CT影像学征象以条索状（39.2%）、肺结节（15.1）、胸膜增厚（17.8%）、胸腔积液（21.4%）表现为主。艾滋病合并马尔尼菲蓝状菌病组肺部CT影像学征象以条索状（20.3%）、肺结节（15.2%）、胸腔积液（13.6%）、纵隔淋巴结肿大（13.6%）为主。艾滋病合并肺结核及马尔尼菲蓝状菌病组肺部CT影像学征象以条索状（29.1%）、肺结节（18.3%）、胸腔积液（16.1%）、纵隔淋巴结肿大（13.9%）为主。结论艾滋病合并肺结核和（或）马尔尼菲蓝状菌病肺部影像学征象呈多元化不典型改变,主要表现为条索状及结节状,伴胸腔积液、胸膜增厚以及淋巴结肿大。因此,加强艾滋病机会性感染临床、影像学诊断的研究,为持续进行抗逆转录病毒治疗打下基础具有深远的意义。

关键词: 艾滋病, 机会性感染, 肺结核, 马尔尼菲蓝状菌病

Abstract: Objective To analyze the radiological characteristics of AIDS complicated by pulmonary tuberculosis and/or Talaromyces marneffei. Methods A total of 972 cases of HIV positive diagnosed at our hospital from January to December 2015 was retrospectively analyzed. The clinical radiological characteristics of the lungs in patients with different complications of AIDS were comparatively analyzed. Results In the 972 patients with AIDS, 11.52% suffered from the complication of pulmonary tuberculosis (PTB), 6.06% suffered from the complication of Talaromyces marneffei (TM), and 9.56% suffered from the complications of PTB and TM. In the cases of AIDS complicated by PTB, CT scan of lungs demonstrated cord-like lesions,nodules,pleural thickening and pleural effusion, accounting for 39.2%, 15.1%, 17.8%, and 21.4%, respectively. In the patients with AIDS complicated by TM, CT scan of lungs demonstrated cord-like lesions,nodules,pleural effusion,and mediastinal lymphadenectasis, accounting for 20.3%, 15.2%, 13.6%, and 13.6%, respectively. In the patients with AIDS complicated by PTB and TM, CT scan of lungs demonstrated cord-like lesions,nodules,pleural effusion,and mediastinal lymphadenectasis, accounting for 29.1%, 18.3%, 16.1%, and 13.9%, respectively. Conclusion Radiology of AIDS complicated by pulmonary tuberculosis and/or Talaromyces marneffei presents multiple atypical changes, mainly including cords like opacity and nodule with accompanying pleural effusion, pleural thickening and lymphadenectasis. A better understanding about the clinical and radiological characteristics of opportunistic infections complicating AIDS contributes to the treatment of AIDS.

Key words: AIDS, Opportunistic infections, pulmonary tuberculosis, Talaromyces marneffei

覃江龙, 梁纲, 卢祥婵, 张剑锋, 宁宗, 卢亦波, 吴念宁, 吴锋耀. 艾滋病合并肺结核和（或）马尔尼菲蓝状菌病的影像学研究[J]. 新发传染病电子杂志, 2018, 3(3): 171-174.

QIN Jiang-long, LIANG Gang, LU Xiang-chan, ZHANG Jian-feng, NING Zong, LU Yi-bo, WU Nian-ning, WU Feng-yao. AIDS complicated by pulmonary tuberculosis and/or Talaromyces marneffei: An analysis of radiological images[J]. Electronic Journal of Emerging Infectious Diseases, 2018, 3(3): 171-174.

参考文献

[1] Tanne JH.Nearly 40 million people worldwide are infected with hiv[J]. Bmj British Medical Journal, 2006,332(7553):1289.
[2] Xiao J, Gao G, Li Y, et al.Spectrums of opportunistic infections and malignancies in hiv-infected patients in tertiary care hospital, china[J]. PloS one, 2013,8(10):e75915.
[3] Naba MR, Kanafani ZA, Awar GN, et al.Profile of opportunistic infections in hiv-infected patients at a tertiary care center in lebanon[J]. Journal of Infection & Public Health, 2010,3(3):130-133.
[4] Masur H, Brooks JT, Benson CA, et al.Prevention and treatment of opportunistic infections in hiv-infected adults and adolescents: Updated guidelines from the centers for disease control and prevention, national institutes of health, and hiv medicine association of the infectious diseases soci[J]. Clinical Infectious Diseases An Official Publication of the Infectious Diseases Society of America, 2014,58(9):1308.
[5] Benson CA, Kaplan JE, Masur H, et al.Treating opportunistic infections among hiv-infected adults and adolescents: Recommendations from cdc, the national institutes of health, and the hiv medicine association/infectious diseases society of america[J]. Mmwr Recomm Rep, 2005,53(RR-15):1-112.
[6] Garcia GF, Moura AS, Ferreira CS, et al.Clinical and radiographic features of hiv-related pulmonary tuberculosis according to the level of immunosuppression[J]. Revista da Sociedade Brasileira de Medicina Tropical, 2007,40(6):622.
[7] Piehl MR, Kaplan RL, Haber MH.Disseminated penicilliosis in a patient with acquired immunodeficiency syndrome[J]. Archives of Pathology & Laboratory Medicine, 1988,112(12):1262-1264.
[8] Pasricha S, Payne M, Canovas D, et al.Cell-type-specific transcriptional profiles of the dimorphic pathogen penicillium marneffei reflect distinct reproductive, morphological, and environmental demands[J]. G3 (Bethesda), 2013,3(11):1997-2014.
[9] Vanittanakom N, Jr CC, Fisher MC, et al.Penicillium marneffei infection and recent advances in the epidemiology and molecular biology aspects[J]. Clinical Microbiology Reviews, 2006,19(1):95-110.
[10] Duong TA.Infection due to penicillium marneffei, an emerging pathogen: Review of 155 reported cases[J]. Clinical Infectious Diseases, 1996,23(1):125-130.
[11] Supparatpinyo K.Penicillium marneffei infections[J]. International Journal of Infectious Diseases, 2012,16(2):e16-e16.
[12] 戴小英, 陈欢, 李梅华,等. 健康宿主马尔尼菲青霉病肺部受累三例报告并文献复习[J]. 中国呼吸与危重监护杂志, 2016,1):12-16.

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