Penicillosis marneffei
Introduction
Introduction to Marniffe Penicillium Penicillium marneffei (PM) is the only pathogenic bacteria in Penicillium that is a biphasic temperature. It is a rare pathogen. The disease can occur in healthy people, but it is more common in immunodeficiency or immune function suppression. As HIV infections increase, the report of Penicillium marneffei is increasing year by year. The disease can be limited, but it is mostly disseminated. It often involves many tissues and organs such as lung, liver, skin, lymph nodes, etc., so the literature is mostly infected with Penicillium marneffei or disseminated Penicillium marneffei. Describe the disease (disseminated penicillium marneffeiinfection). In the past, due to insufficient understanding of the disease, the diagnosis was often delayed and the mortality rate was high. On the other hand, the disease was treatable. Therefore, a correct understanding of the disease, early diagnosis and treatment is particularly important to save the lives of patients. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: spleen spleen
Cause
The cause of Penicillium marneffei
(1) Causes of the disease
PM is the only biphasic bacteria among more than 300 Penicillium species, that is, the hyphal phase at 25 ° C and the yeast type at 37 ° C. The former can form red pigment in the medium, the latter does not. It is worth mentioning that the time between the two phases is different. It is easier to change from yeast to hyphae. It takes only 1-2 days to grow the stalks and produce red pigment, while the latter becomes the former. It takes more than 3 weeks to pass a short rod or deformity transition period, so it cannot be decided too early as a single-phase Penicillium, and only the yeast type is pathogenic.
(two) pathogenesis
PM patients with multiple invasive immune dysfunction, mainly invading the mononuclear phagocytic system, namely lung, liver, intestinal lymphoid tissue, lymph nodes, spleen, bone marrow, kidney and tonsils, etc., with the most severe lung and liver, immunodeficiency in infants and young children Easy to spread through blood, adult immune system is relatively sound, PM reproduction is inhibited, lesions are localized, granuloma, clinically in infants and young children are characterized by disseminated PM disease, lung performance is mostly interstitial Pneumonia, more common in adults with multiple abscesses, as well as liver, intestinal lymph nodes, nerve tissue and endocrine glands, etc., the latter two are rarely involved, pathological sections show changes in suppurative granuloma, central necrosis, a large number of mononuclear giant In phagocytic infiltration, PAS or Grocott fungal staining can show that fungal PM is trapped in macrophages, and mulberry cell clusters, sausage cells and transverse walls are the major histomorphological changes of PM.
Prevention
Marnifi Penicillosis Prevention
As the exact route of transmission of this disease is still unclear, it is yet to be explored that effective preventive measures, immune deficiency or inferiority, are susceptible to this disease when traveling to Southeast Asia, so these people should avoid travel to endemic areas, residents of the area, or People who have been to the area have opportunistic infections and should consider the possibility of PM infection to make diagnosis and treatment as soon as possible.
Complication
Marnifi <br>chalamic complications Complications, spleen and spleen
Concurrent spleen PM infection.
Symptom
Marnifi's symptoms of blue mold disease Common symptoms Abscess pericarditis Subcutaneous nodules Hyperthermia Liver splenomegaly Weak lymph node swelling Cold appetite loss of progressive weight loss
Penicillium marneffei is often concealed, and the incubation period is difficult to estimate. Clinically, the disease is classified into lesion type and disseminated type:
Sick type
The primary lesion is related to the fungal invasion portal. Because the pathogen is mainly invaded by the respiratory tract, the primary symptom is mainly in the lung, and the clinical manifestation is tuberculosis, which is easily misdiagnosed. It can also be covered by underlying disease without symptoms or symptoms.
2. Spread type
The clinical manifestations are complex, mainly involving the lungs, liver, intestines, lymph nodes, tonsils, skin, bones, bone marrow, kidneys and spleen. Among them, lung and liver are the most affected and severe, with typical symptoms, sudden onset, high fever, shiver Loss of appetite, progressive weight loss, generalized lymphadenopathy, hepatosplenomegaly, cough, pericarditis, anemia, leukocyte elevation and disseminated abscess, etc. Skin damage is a clinical feature of disseminated penicillium marneffei. It is often the first sign of attention in disseminated cases. Skin lesions are common in the face, upper torso and upper limbs. There are various types of skin lesions, such as papules, maculopapular rash, nodules, necrotous papules, contagious soft palate-like papules, and hemorrhoids. Such lesions, folliculitis and ulcers, etc., some people think that necrotizing papules is the most characteristic manifestation of this disease, necrosis occurs in the center of the papules that rise from the skin, and the necrosis is umbilical, and it is easy to find Manifeci in the lesions. Mildew is very helpful for clinical diagnosis.
Examine
Manifir Penicillium
Microscopic examination of the fungus: taking specimens such as sputum, nails, pus, urine, etc., separated hyphae and microspores.
Fungal culture: Shabao weak medium grows slowly at 25 °C, the surface is fluffy, gray or pink, and can also diffuse into the whole medium in red. The typical scorpion branches can be seen under the microscope, and the two-wheeled, scattered, there are 2~ 7 stems, which have 2 to 6 bottles of stems, shorter and straighter, the bottle is more swollen, the stem is short and straight, and the single bottle stem can be seen. It grows directly from the hyphae in the gas, and the top has a single chain. spore.
If the medium is set at 37 ° C, it is yeast-like, initially pale brown membrane-like, moist, flat colonies, followed by red pigment, microscopic examination of round or oval yeast spores, sometimes visible and biopsy The same yeast-like cells were seen.
Chest radiography and CT showed diffuse net nodules, localized and diffuse cellular changes and localized interstitial infiltration, and pleural effusion.
Pathological examination of lesions showed granuloma with different morphological and morphological changes, central necrosis, neutrophil infiltration, surrounded by organized cells and a few multinucleated giant cells. Penicillium marneffei was located inside or outside the cell, and it was round or Oval, 2 ~ 4m in diameter, PAS stained blue, surrounded by a halo around the nucleus, a special diagnostic significance, the bacteria outside the extracellular tissue, can be long, uniform thickness, two rounded Sausage cells.
Diagnosis
Diagnosis and identification of Penicillium marneffei
diagnosis
The widespread presence of this bacterium and the diversity of organs invading the organs make the diagnosis very difficult. The patients are sporadic rare cases, which increases the difficulty of diagnosis. Yang summarizes the following points for reference:
1. The body's immune function is low and the field activities are in contact with the epidemic source.
2. Clinical manifestations of fever, chills, cough, cough, weight loss, liver and spleen and superficial lymph nodes, rash, subcutaneous nodules or abscess, etc., the complex diversity of the disease is one of its characteristics.
3. The number of white cells increased significantly, with varying degrees of anemia.
4. Various antibiotics are ineffective.
5. Serological tests have specific antibodies to PM, and positive blood PM immunodiffusion test can help diagnose.
6. Pathological specimens can have the above three characteristics.
7. The PM cultured by the fungus is a biphasic bacteria and must be differentiated from the capsular histoplasma.
Differential diagnosis
It needs to be differentiated from capsular histoplasmosis, and the diseased tissue is cultured and identified, which can be completely different.
