获得性免疫缺陷综合征合并马尔尼菲篮状菌导致肠道感染的内镜下表现（附6例报告）

Endoscopic manifestations of intestinal infection caused by talaromyces marneffei in acquired immunodeficiency syndrome patients (6 cases)

摘要:

目的 探讨获得性免疫缺陷综合征（AIDS）合并马尔尼菲篮状菌（TM）感染导致肠道感染的内镜下特征。方法 回顾性分析2022年11月－2024年10月于该院确诊为AIDS合并TM感染导致肠道感染的6例患者的临床资料。包括：临床症状、实验室检查、影像学检查、内镜检查和病理检查等。结果 6例患者中，男5例，女1例；发病年龄26～67岁；AIDS合并TM感染导致肠道感染患者的临床表现为：腹泻、腹痛、腹胀和恶心呕吐。其中，2例有消化道出血表现。实验室检查：6例患者外周血白细胞计数为（1.37～4.49）×10⁹/Ｌ，血红蛋白计数为（67～99）g/L；CD4⁺T淋巴细胞为（1～52）个/μL，CD8⁺ T淋巴细胞为（61～321）个/μL，CD4⁺T淋巴细胞/CD8⁺T淋巴细胞比值为（0.01～0.18）。6例患者均行HIV RNA检测。其中，5例HIV RNA阳性。血培养：可见丝状真菌，报告显示为TM。影像学检查：6例患者CT结果可见肠系膜及腹膜后多发淋巴结肿大。内镜检查：6例患者内镜下均可见肠道病变。其中，十二指肠糜烂溃疡2例，结肠多发糜烂溃疡4例。病理检查：6例患者幽门螺杆菌（Hp）结果均为阴性，黏膜下可见成簇的小球形真菌孢子，符合TM感染；特殊染色：PAS（+），六胺银染色（+）。结论 当AIDS晚期患者出现消化道症状时，应警惕TM感染，病变部位常见于全结肠和直肠，亦可累及十二指肠，内镜下表现多为溃疡、糜烂和隆起性病变，形态表现无特异性；及时行胃肠镜检查、病理活检、特殊染色和免疫组化是确诊的关键。

Abstract:

Objective To explore the endoscopic features of intestinal infection caused by talaromyces marneffei (TM) in patients with acquired immunodeficiency syndrome (AIDS).Methods The clinical data of patients diagnosed with AIDS complicated with TM-induced intestinal infection from November 2022 to October 2024 were retrospectively analyzed, including symptoms, laboratory tests, imaging examinations, endoscopic examinations, and pathological examinations.Results There were 6 patients, including 5 males and 1 female, with an age range of 26 to 67 years. The clinical manifestations of AIDS patients with TM-induced intestinal infection included diarrhea, abdominal pain, abdominal distension, nausea, and vomiting, with 2 cases presenting with gastrointestinal bleeding. Laboratory tests: The peripheral blood white blood cell count of the 6 patients was (1.37 ~ 4.49)×10⁹/L, and the hemoglobin count was (67 ~ 99) g/L. CD4⁺ T lymphocytes were (1 ~ 52) cells/μL, CD8⁺ T lymphocytes were (61 ~ 321) cells/μL, and the CD4⁺/CD8⁺ ratio was (0.01 ~ 0.18). All 6 patients underwent HIV RNA testing, and 5 were positive. Blood culture: filamentous fungi was visible, and the report indicated TM. Imaging examination: CT results of the 6 patients showed multiple enlarged lymph nodes in the mesentery and retroperitoneum. Endoscopic examination: all 6 patients had intestinal lesions under endoscopy, including 2 cases of duodenal erosion and ulcer, and 4 cases of multiple erosions and ulcers in the colon. Pathological examination: The HP results of all 6 patients were negative, and clusters of small spherical fungal spores were seen in the submucosa, consistent with TM infection. Special staining: PAS(+), methenamine silver staining(+).Conclusion When AIDS patients in the late stage present with gastrointestinal symptoms, TM infection should be suspected. The lesion sites are commonly found in the entire colon and rectum, and may also involve the duodenum. The endoscopic manifestations are mostly ulcers, erosions, and elevated lesions, with no specific morphological features. Timely gastroscopy and colonoscopy, pathological biopsy, special staining, and immunohistochemistry are key to diagnosis.