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目的探讨艾滋病(AIDS)患者机会性感染病原微生物分布特征及其多重感染特点,为临床早期预防和合理用药提供参考依据。方法采用描述流行病学方法,对住院治疗AIDS患者的血液、脑脊液、痰液等标本进行病原微生物检测。结果 2012-2015年云南省传染病专科医院/AIDS关爱中心共收治AIDS患者3 819例,其中3 222例检出真菌、革兰阴性杆菌、革兰阳性球菌、病毒、螺旋体、寄生虫等共56种病原微生物。其中在564例(17.50%)患者中共检出9种真菌,570例(17.69%)患者中共检出23种革兰阴性杆菌,135例(4.19%)患者共检出17种革兰阳性球菌,1 398例(43.39%)患者共检出5种病毒,322例(9.99%)患者检出梅毒螺旋体,233例(7.23%)患者检出弓形虫。真菌以马内菲青霉菌为主,占8.44%,其次是新型隐球菌和白念珠菌。革兰阴性杆菌以分枝杆菌属为主,占10.40%。革兰阳性球菌以金黄色葡萄球菌为主,占1.40%。病毒及其他主要以丙型肝炎病毒(HCV)为主,占28.43%。临床标本中以血液检出率最高达69.03%,痰液检出率18.53%,脑脊液检出率8.68%。从AIDS患者613份无菌标本血液、脑脊液和骨髓中检测出病原微生物,其中9份同时合并感染结核分枝杆菌。机会性感染最多可同时出现HCV、结核分枝杆菌、大肠埃希菌、梅毒螺旋体和弓形虫五重感染,双重感染最常见的是HCV,其次是结核分枝杆菌。结论云南省AIDS患者机会性感染的病原微生物种类复杂,HCV是最常见的合并感染病原微生物,其次是结核分枝杆菌、梅毒螺旋体和马内菲青霉菌。在临床诊疗时,应多关注肝炎、结核、梅毒和真菌多重感染。
Objective To investigate the distribution of opportunistic infections in patients with AIDS and the characteristics of multiple infections, so as to provide a reference for the prevention and rational use of drugs in clinical practice. Methods Descriptive epidemiological methods were used to detect the pathogenic microorganisms in blood, cerebrospinal fluid and sputum in hospitalized patients with AIDS. Results A total of 3 819 AIDS patients were admitted to Yunnan Infectious Diseases Hospital / AIDS Care Center from 2012 to 2015. Among them, 3 222 cases of fungi, gram-negative bacilli, gram-positive cocci, viruses, spirochetes and parasites were detected Species of pathogenic microorganisms. Wherein the 564 cases (17.50%) patients were detected nine kinds of fungi were detected 23 kinds of Gram-negative bacteria 570 cases (17.69%) patients, 17 kinds of Gram-positive cocci 135 cases (4.19%) patients were detected, Totally 5 viruses were detected in 398 patients (43.39%). Treponema pallidum was detected in 322 patients (9.99%) and Toxoplasma gondii in 233 patients (7.23%). The fungi were Penicillium marneffei, accounting for 8.44%, followed by Cryptococcus neoformans and Candida albicans. Gram-negative bacilli are mainly Mycobacterium, accounting for 10.40%. Gram-positive cocci Staphylococcus aureus, accounting for 1.40%. Viruses and others are mainly hepatitis C virus (HCV), accounting for 28.43%. In clinical specimens, the highest detection rate of blood was 69.03%, sputum detection rate was 18.53%, and cerebrospinal fluid detection rate was 8.68%. Pathogenic microorganisms were detected in blood, cerebrospinal fluid and bone marrow from 613 sterile specimens of AIDS patients, of which 9 were concurrently infected with Mycobacterium tuberculosis. Occurrence of opportunistic infections can occur at the same time HCV, Mycobacterium tuberculosis, Escherichia coli, Treponema pallidum and Toxoplasma gondii infection, the most common double infection is HCV, followed by Mycobacterium tuberculosis. Conclusion The types of pathogenic microorganisms in opportunistic infections in AIDS patients in Yunnan Province are complex. HCV is the most common pathogenic microorganism with combined infection, followed by Mycobacterium tuberculosis, Treponema pallidum and Penicillium marneffei. In clinical diagnosis and treatment, should pay more attention to hepatitis, tuberculosis, syphilis and fungal multiple infections.