马尔尼菲青霉病研究新发现——溶骨病变及关节炎

播散性马尔尼菲青霉病嗜侵犯单核巨噬细胞系统，主要为骨髓、肝（枯否细胞）、脾、淋巴结和肺（尘细胞），引起一系列相应病变和症状：在骨髓最常引起巨噬细胞增生性炎，并吞噬大量病原体，但却无肿痛表现；但当引起化脓性溶骨性病变和波及关节引起关节炎时则出现该病唯一的自发性疼痛。本文报告６例并复习文献发现３例有骨及关节肿痛的病例。患者为中青年人，具有较强的炎症反应能力；同时都有骨外脓肿形成，好发生于扁骨和下肢关节；病灶都能培养出马尔尼菲青霉，但病变局部病原数量较少，组织中不易找见，必须用霉菌特殊染色，用免疫酶染色找抗原则更敏感；该病治疗不彻底易复发，需长期积极抗霉菌治疗。

New Finding on Penicilliosis marneffei: Osteolytic Lesion and Arthritis

Disseminated Penicilliosis marneffei predominantly involve mononuclear phagocyte system,and mainly bone marrow,liver(Kuffer cells),spleen,lymph node and lungs(dust cells).The pathogen causes a series of corresponding lesions and signs there.The most common lesion at bone marrow is inflamatory macrophagocytes proliferatic reaction and engulfs large number of pathogenic bodies, but there is no pain and swell. However, pustular osteolytic lesion and arthritis caused by these fungi break out a spontaneous painful sign that appears to be the first and only painful sign in this disease. This paper reports six new cases and other three cases from literature review. The patients are all in middle age.(23to51),with better potentiality of inflamatory reaction,and often concomitant with abscess formation outside the skeleton.Osteolytic lesion and arthritis are liable to develop at flat bones and joints of the leg.Positive culture could be reaped from materials being taken at any of these lesions, but just a little fungi could be found at pathologic slices.Speclal stain is need and to find fungi so few and scattered in slices.Immunohistochemistric technique for pathogenic stain is much more sensitive than other methods.This disease needs a long term of active treatment with antifungus medicine.It is easy to recur in incomplete-treated patients.