马尔尼菲蓝状菌病致溶骨性损害合并Sweet样皮疹1例

本文报道广西医科大学第一附属医院皮肤性病科收治的马尔尼菲蓝状菌病致溶骨性损害合并Sweet样皮疹1例。免疫力正常人群较少患马尔尼菲蓝状菌病。本例患者既往体健,起初合并融骨性损害,在两性霉素B、伊曲康唑治疗过程中逐渐出现Sweet样皮疹。患者经两性霉素B、伊曲康唑、激素等治疗后,病情逐渐好转。     

Fine needle aspiration diagnosis of Penicillium marneffei infection

A disseminated infection with Penicillium marneffei, a rare human pathogen that may infect both healthy and immunocompromised patients, was diagnosed by fine needle aspiration cytology in a patient infected with the human immunodeficiency virus. The presence of yeast-form organisms with an eccentric or central dot and occasional septate and elongated forms highly suggested the diagnosis, which was confirmed on culture. Establishment of the diagnosis is important because this infection is potentially curable.     

Penicillium marneffei-stimulated dendritic cells enhance HIV-1 trans-infection and promote viral infection by activating primary CD4+ T cells

Penicillium marneffei (P. marneffei) is considered an indicator pathogen of AIDS, and the endemicity and clinical features of P. marneffei have been described. While, how the co-infection of P. marneffei exacerbate deterioration of the immune response remains poorly understood. Here we isolated P. marneffei from the cutaneous lesions of AIDS patients and analyzed its effects on HIV-1-dendritic cells (DCs) interaction. We demonstrated that the monocyte-derived dendritic cells (MDDCs) could be activated by both thermally dimorphic forms of P. marneffei for significantly promoting HIV-1 trans-infection of CD4(+) T cells, while these activated MDDCs were refractory to HIV-1 infection. Mechanistically, P. marneffei-activated MDDCs endocytosed large amounts of HIV-1 and sequestrated the internalized viruses into tetrapasnin CD81(+) compartments potentially for proteolysis escaping. The activated MDDCs increased expression of intercellular adhesion molecule 1 and facilitated the formation of DC-T-cell conjunctions, where much more viruses were recruited. Moreover, we found that P. marneffei-stimulated MDDCs efficiently activated resting CD4(+) T cells and induced more susceptible targets for viral infection. Our findings demonstrate that DC function and its interaction with HIV-1 have been modulated by opportunistic pathogens such as P. marneffei for viral dissemination and infection amplification, highlighting the importance of understanding DC-HIV-1 interaction for viral immunopathogenesis elucidation.     

非HIV感染的马尔尼菲青霉病2例报道并文献复习

目的 探讨非HIV感染的马尔尼菲青霉病的临床特征,提高对本病的早期诊断与治疗水平.方法 分析广州医科大学附属第一医院广州呼吸疾病研究所收治的2例非HIV感染的马尔尼菲青霉病患者的临床、影像、微生物和病理资料,并复习相关文献.结果 例1,男,37岁,反复咳嗽、发热1个月,双肩关节疼痛伴消瘦,广谱抗生素治疗无效,左锁骨上及左腹股沟淋巴结肿大,头颅MR发现颅内及咽后脓肿,经纤维支气管镜肺活检及脓液培养确诊马尔尼菲青霉病,继发性癫痫.予两性霉素B脂质体静滴治疗后好转出院,继续予伊曲康唑口服液治疗3个月症状消失,复查胸部CT及头颅MRI病灶吸收,患者自行停药后复发,再次予两性霉素B脂质体治疗仍有效.例2,男,32岁,咳嗽、咳痰5月余,皮下肿块伴发热3月余,胸部CT示纵膈脓肿伴胸骨骨髓炎形成,抽吸脓液培养有马尔尼菲青霉生长.予两性霉素B脂质体抗真菌治疗过程中,患者继发感染性休克,弥漫性血管内凝血.结论 马尔尼菲青霉病属于少见病,侵犯颅内的是国内首例报道,经纤维支气管镜肺活检和脓液培养可确诊.复发病例予两性霉素B脂质体治疗仍有效.早期诊断是提高治愈率的关键.     

Isolation and properties of extracellular proteinases of Penicillium marneffei

Penicillium marneffei is a dimorphic fungus native to Southeast Asia. Disease caused by this organism, until recently a very rare condition, has increased dramatically in parallel with the increase in the number of individuals in the region immunocompromised by AIDS and other conditions. While much research has been performed on the control of dimorphic switching in P. marneffei, there is a relative dearth of information regarding the proteinases secreted by this pathogen. Our laboratory has purified and characterized two proteinases produced by this organism in liquid culture and cloned the gene of a third. Both the recombinant enzyme expressed from the cloned gene and one of those purified from culture supernatants have been identified as members of the eqolisin family, a group of pepstatin-insensitive acid proteinases. The other enzyme purified from a culture supernatant is a serine proteinase with activity in the neutral pH range. These enzymes appear to be differentially expressed, depending on culture conditions.     

Recurrent Talaromyces marneffei Infection Presenting with Intestinal Obstruction in a Patient with Systemic Lupus Erythematosus

Mycopathologia - Talaromyces marneffei is an important opportunistic pathogen mainly afflicting the HIV-infected patients, in rare instance, it could cause infection in non-HIV-infected...     

非人类免疫缺陷病毒感染马尔尼菲青霉病9例临床特征分析及文献复习

为探讨和总结非人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者发生马尔尼菲青霉病的临床特点,回顾性研究复旦大学附属华山医院感染科2007年1月-2017年8月收治的9例及同期发表文献中的马尔尼菲青霉病病例,分析其临床表现、实验室检查、治疗及转归。9例马尔尼菲青霉病患者的HIV检测均为阴性,5例CD4^＋ T细胞计数正常。非HIV感染马尔尼菲青霉病的起病较缓,临床表现与经典马尔尼菲青霉病类似,真菌血症较少见,病理特点以肉芽肿改变及化脓性炎症为主,诊断方法仍以培养为主(8/9),1例通过病理及二代测序技术诊断。目前,非HIV感染马尔尼菲青霉病发病率有升高趋势,部分发生于免疫正常人群,需引起临床医师的重视。     

Role of superoxide anion in the fungicidal activity of murine peritoneal exudate macrophages against Penicillium marneffei.

Penicillium marneffei is an important opportunistic fungal pathogen. The mechanisms of host defense against P. marneffei are not fully understood. In the present study, we, for the first time, investigated the role of superoxide anion (O2-) in the killing of two forms of P. marneffei, yeast cells and conidia, and the role of this killing mediator in the fungicidal activity of IFN-gamma-stimulated murine peritoneal macrophages. P. marneffei yeast cells were susceptible to the killing effect of activated macrophages and chemically generated O2, while conidia were not. These results suggested that O2- played some role in the fungicidal activity of macrophages. However, an oxygen radical scavenger, superoxide dismutase (SOD), did not suppress, but rather enhanced the fungicidal activity of IFN-gamma-stimulated macrophages against P. marneffei yeast cells. This inconsistency was explained by the release of insufficient concentrations of O2- by activated macrophages as compared with the amount of O2- necessary for the killing of yeast cells, which was predicted in a chemical generating system. On the other hand, SOD enhanced the production of nitric oxide (NO) by IFN-gamma-activated macrophages, and their increased fungicidal activity was significantly inhibited by N(G)-monomethyl-L-arginine (L-NMMA), a competitive inhibitor of NO synthase. Our results suggested that O2- does not function as the killing mediator of macrophages against P. marneffei, but rather plays an important role in the regulation of the NO-mediated killing system by suppressing NO production.     

A basic helix-loop-helix protein with similarity to the fungal morphological regulators, Phd1p, Efg1p and StuA, controls conidiation but not dimorphic growth in Penicillium marneffei

Members of the APSES protein group are basic helix-loop-helix (bHLH) proteins that regulate processes such as mating, asexual sporulation and dimorphic growth in fungi. Penicillium marneffei is a human pathogen and is the only member of its genus to display a dimorphic growth transition. At 25 degrees C, P. marneffei grows with a filamentous morphology and produces asexual spores from multicellular con-idiophores. At 37 degrees C, the filamentous morphology is replaced by yeast cells that reproduce by fission. We have cloned and characterized an APSES protein-encoding gene from P. marneffei that has a high degree of similarity to Aspergillus nidulans stuA. Deletion of stuA in P. marneffei showed that it is required for metula and phialide formation during conidiation but is not required for dimorphic growth. This suggests that APSES proteins may control processes that require budding (formation of the metulae and phialides, pseudohyphal growth in Saccharomyces cerevisiae and dimorphic growth in Candida albicans) but not those that require fission (dimorphic growth in P. marneffei). The A. nidulans DeltastuA mutant has defects in both conidiation and mating. The P. marneffei stuA gene was capable of complementing the conidiation defect but could only inefficiently complement the sexual defects of the A. nidulans mutant. This suggests that the P. marneffei gene, which comes from an asexual species, has diverged significantly from the A. nidulans gene with respect to sexual but not asexual development.     

An STE12 homolog from the asexual, dimorphic fungus Penicillium marneffei complements the defect in sexual development of an Aspergillus nidulans steA mutant

Penicillium marneffei is an opportunistic fungal pathogen of humans and the only dimorphic species identified in its genus. At 25 degrees P. marneffei exhibits true filamentous growth, while at 37 degrees P. marneffei undergoes a dimorphic transition to produce uninucleate yeast cells that divide by fission. Members of the STE12 family of regulators are involved in controlling mating and yeast-hyphal transitions in a number of fungi. We have cloned a homolog of the S. cerevisiae STE12 gene from P. marneffei, stlA, which is highly conserved. The stlA gene, along with the A. nidulans steA and Cryptococcus neoformans STE12alpha genes, form a distinct subclass of STE12 homologs that have a C2H2 zinc-finger motif in addition to the homeobox domain that defines STE12 genes. To examine the function of stlA in P. marneffei, we isolated a number of mutants in the P. marneffei-type strain and, in combination with selectable markers, developed a highly efficient DNA-mediated transformation procedure and gene deletion strategy. Deletion of the stlA gene had no detectable effect on vegetative growth, asexual development, or dimorphic switching in P. marneffei. Despite the lack of a detectable function, the P. marneffei stlA gene complemented the sexual defect of an A. nidulans steA mutant. In addition, substitution rate estimates indicate that there is a significant bias against nonsynonymous substitutions. These data suggest that P. marneffei may have a previously unidentified cryptic sexual cycle.     

Usefulness of a microimmunodiffusion test for the detection of Penicillium marneffei antigenemia,antibodies, and exoantigens

Eight sera from culturally-proven cases of penicilliosis marneffei and their corresponding isolates were examined for circulating antibody(ies) and antigen, and exoantigens, respectively, using a microimmunodiffusion (MID) test. Two of the 8 sera produced strong precipitins (1-2) when reacted against control Penicillium marneffei antigen (5-week-old shaken cultures at 25 C) in the presence of control rabbit anti-P. marneffei serum. Five of the 8 sera produced a strong precipitin line when reacted against control hyperimmune serum to P. marneffei. These five sera, and one additional serum, which tested negative for antibody to P. marneffei, demonstrated the presence of antigen by reacting only against the anti-P. marneffei serum. Serological evaluations of the sera revealed that the MID test is capable of detecting antibody and antigen in AIDS patients having penicilliosis marneffei infections. Exoantigen analysis of the 8 P. marneffei isolates, which were previously identified using this conventional and time-consuming macro- and micro-morphological characteristics, showed the presence of 1 to 4 specific exoantigens in MID. With the exoantigen analysis, the identity of all of the isolates was confirmed as P. marneffei. Our studies indicated that the serological tests are useful for detecting circulating antibody and/or antigen in patients' sera, and that the exoantigen test is reliable for confirming the identity of P. marneffei cultures. This revised version was published online in June 2006 with corrections to the Cover Date.     

AIDS合并马尔尼菲青霉病36例分析

目的探讨艾滋病合并马尔尼菲青霉病的临床表现,治疗与转归。方法回顾分析本院2008年8月～2009年8月收治的艾滋病合并马尔尼菲青霉36例。结果 36例艾滋病合并马尔尼菲青霉病平均年龄35.8岁。马尔尼菲青霉感染临床表现呈现非特异性,其中发热86.11%,贫血94.44%,GGT升高69.44%,AST升高63.89%,淋巴结肿大88.89%,脾大63.89%,低蛋白血症83.33%,咳嗽36.11%,皮损30.56%(其中典型改变仅5例,占13.89%),CD4+50cells/mm388.89%,骨髓培养(27/27)及皮损活检培养(2/2)阳性率100%,血液培养阳性率69.44%(25/36)。36例经抗真菌治疗,其中29例给予HAART治疗,28例治愈,7例好转,1例死亡。结论马尔尼菲青霉是艾滋病常见的机会性感染,早发现,早治疗,长程敏感抗真菌药物联合治疗可提高治愈率,减少复发。     

Genomic and experimental evidence for a potential sexual cycle in the pathogenic thermal dimorphic fungus Penicillium marneffei

All meiotic genes (except HOP1) and genes encoding putative pheromone processing enzymes, pheromone receptors and pheromone response pathways proteins in Aspergillus fumigatus and Aspergillus nidulans and a putative MAT-1 alpha box mating-type gene were present in the Penicillium marneffei genome. A putative MAT-2 high-mobility group mating-type gene was amplified from a MAT-1 alpha box mating-type gene-negative P. marneffei strain. Among 37 P. marneffei patient strains, MAT-1 alpha box and MAT-2 high-mobility group mating-type genes were present in 23 and 14 isolates, respectively. We speculate that P. marneffei can potentially be a heterothallic fungus that does not switch mating type.     

Low effective dispersal of asexual genotypes in heterogeneous landscapes by the endemic pathogen Penicillium marneffei

Long-distance dispersal in microbial eukaryotes has been shown to result in the establishment of populations on continental and global scales. Such "ubiquitous dispersal" has been claimed to be a general feature of microbial eukaryotes, homogenising populations over large scales. However, the unprecedented sampling of opportunistic infectious pathogens created by the global AIDS pandemic has revealed that a number of important species exhibit geographic endemicity despite long-distance migration via aerially dispersed spores. One mechanism that might tend to drive such endemicity in the face of aerial dispersal is the evolution of niche-adapted genotypes when sexual reproduction is rare. Dispersal of such asexual physiological "species" will be restricted when natural habitats are heterogeneous, as a consequence of reduced adaptive variation. Using the HIV-associated endemic fungus Penicillium marneffei as our model, we measured the distribution of genetic variation over a variety of spatial scales in two host species, humans and bamboo rats. Our results show that, despite widespread aerial dispersal, isolates of P. marneffei show extensive spatial genetic structure in both host species at local and country-wide scales. We show that the evolution of the P. marneffei genome is overwhelmingly clonal, and that this is perhaps the most asexual fungus yet found. We show that clusters of genotypes are specific to discrete ecological zones and argue that asexuality has led to the evolution of niche-adapted genotypes, and is driving endemicity, by reducing this pathogen's potential to diversify in nature.     

马尔尼菲青霉病12例临床回顾性分析

目的 分析我院马尔尼菲青霉病的临床特征和预后.方法 回顾性分析我院2003年1月～2012年12月10 a间诊断的12例马尔尼菲青霉病,分析其临床表现、实验室和辅助检查、治疗和预后.结果 除了既往报道的临床表现如发热、皮疹、咳嗽、气促、浆膜腔积液、肝脾淋巴结肿大、消化道症状、溶骨性损害外,还包括咽痛、双下肢水肿、血管闭塞或狭窄.实验室检查发现尿常规异常6例,其中4例血肌酐升高.4例HIV阳性患者中3例给予伊曲康唑单用或联合两性霉素B治疗好转出院.8例HIV阴性患者给予伏立康唑单用或联合其他抗真菌药物治疗,5例有效,3例在起始抗真菌治疗后2～11d死亡,其中2例有气促和腹水.结论 马尔尼菲青霉病除了既往报道累单核巨噬细胞系统外,也可累及咽部黏膜、泌尿系统、外周循环系统.应用伏立康唑或伊曲康唑治疗有效,气促和腹水可能提示预后差,早期诊治可能改变患者的预后.     

艾滋病合并咽喉马尔尼菲青霉菌病的研究

目的研究艾滋病(AIDS)患者合并咽喉马尔尼菲青霉菌病(Penicilliosis marneffei,PSM)的咽喉表现和诊疗方法。方法收集2002年5月~2007年3月,经真菌学、血清学和组织病理学证实的5例AIDS合并咽喉PSM患者。应用抗逆转录病毒药物治疗AIDS,用两性霉素B联合氟康唑静滴治疗PSM。结果咽痛、声嘶及粘膜溃疡是AIDS合并PSM的咽喉部症状体征。5例病变组织病理学检查发现细胞内PM菌体。真菌培养分离出双相性马尔尼菲青霉菌(Penicillium marneffei,PM)。经抗真菌治疗,2例体温下降,咽喉疼痛减轻,声嘶改善,扁桃体炎症消退,溃疡面缩小,全身症状减轻。最终4例机会性感染死亡,1例仍在随访中。结论AIDS合并咽喉PSM是根据病史、临床表现和实验检查三方面作出诊断;HIV/AIDS用抗逆转录酶病毒治疗,PM用两性霉素B联合氟康唑静滴治疗。     

AreA controls nitrogen source utilisation during both growth programs of the dimorphic fungus Penicillium marneffei

The opportunistic pathogen Penicillium marneffei displays a temperature-dependent dimorphic switching program with saprophytic hyphal growth at 25 °C and yeast growth at 37 °C. The areA gene of P. marneffei has been isolated and found to be required for the utilisation of nonpreferred nitrogen sources during both growth programs of P. marneffei, albeit to differing degrees. Based on this functional characterisation and high degree of sequence conservation with other fungal GATA factors, P. marneffei areA represents an orthologue of Aspergillus nidulans areA and Neurospora crassa NIT2. Based on this study it is proposed that AreA is likely to contribute to the pathogenicity of P. marneffei by facilitating growth in the host environment and regulating the expression of potential virulence factors such as extracellular proteases.     

RNA干扰Fus3基因对二态性真菌马尔尼菲青霉菌的孢子形成和细胞壁组分合成功能的影响

马尔尼菲青霉菌Penicillium marneffei是一种重要的条件致病真菌,可致艾滋病患者产生严重的系统性霉菌病并发症。基因组学的研究和RNA干扰技术,为马尔尼菲青霉菌致病基因和致病机制的深入探讨提供了可能。我们研究马尔尼菲青霉菌的一个新基因Fus3,它是丝氨酸/苏氨酸-特异性激酶丝裂原活化蛋白激酶家族的成员。为了研究Fus3的功能,我们利用根癌农杆菌介导的双链RNA干扰技术构建了Fus3 RNA干扰菌株(Fus3-i)。RNA干扰的活性是由木糖诱导的启动子xylP控制的。Fus3基因活性下降后影响了马尔尼菲青霉菌生长,包括孢子的生成,细胞壁组分的合成。实验表明,Fus3基因对于马尔尼菲青霉菌细胞生长发育起着重要的调控作用,为研究真菌疾病提供了帮助。