顾永丽+叶晓芬+金美玲+蔡映云+吕迁洲

摘 要 1例63岁中老年男性因“咳嗽、发热伴淋巴结肿大1月余”入院，根据淋巴结穿刺的病理结果确诊为马尔尼菲青霉菌肺部感染。患者病情严重，感染累及心脏，全身炎症反应强烈。确诊后立即给予伊曲康唑注射液抗真菌治疗，但在治疗的第19天，医生将伊曲康唑注射液改为伊曲康唑胶囊序贯治疗，临床药师考虑到患者此时的病情尚不稳定且伊曲康唑口服胶囊的生物利用度低，其血药浓度达不到有效抗菌浓度，建议继续使用伊曲康唑注射液控制病情，待患者病情稳定后可考虑给予生物利用度较高的伊曲康唑口服溶液序贯治疗。临床医生采纳临床药师的意见，继续给予伊曲康唑注射液治疗，1周后患者病情相对稳定，予以出院。3周后患者门诊随访，病情进一步好转，且无药物不良反应发生。

关键词 马尔尼菲青霉菌 伊曲康唑 临床药师

中图分类号：R519 文献标识码：C 文章编号：1006-1533（2016）13-0071-02

Treatment of pulmonary infection with Penicillium marneffei involved by clinical pharmacist： 1 case report

GU Yongli1*， YE Xiaofen2**， JIN Meiling3， CAI Yingyun4， LV Qianzhou2（1. The Ministry of Health Clinical Pharmacists Training Base， Zhongshan Hospital， Fudan University； 2. Pharmaceutical Preparation Section， Zhongshan Hospital， Fudan University； 3. Department of Respiratory Medicine， Zhongshan Hospital， Fudan University； 4. Senile Disease Section， Zhongshan Hospital， Fudan University， Shanghai 200032， China）

ABSTRACT A 63-year-old man was hospitalized due to cough， fever and swollen lymph nodes for more than a month. According to the results of pathological lymph node biopsy， lung infection with Penicillium marneffei was clearly diagnosed. The pathogenic condition was serious with strong systemic inflammatory response and the infection was involved in his heart. Antifungal therapy with itraconazole injection was immediately administered. However， in the 19th day of treatment， the clinician replaced itraconazole injection with itraconazole capsules for sequential treatment. Considering the patients condition and the low bioavailability of itraconazole oral capsule， clinical pharmacist suggested that the patient should continue itraconazole intravenous injection to control the disease and switch to itraconazole oral solution for sequential treatment after the patient condition was stable. The clinician adopted this suggestion and continued itraconazole intravenous injection. A week later， the patients condition was relatively stable and discharged. Three weeks later， the patient followed up in the outpatient and his condition was further improved without adverse drug reactions.

KEY WORDS Penicillium marneffei； itraconazole； clinical pharmacist

马尔尼菲青霉菌（PM）是一种侵犯全身多器官的条件致病性真菌，马尔尼菲青霉病（PSM）是由PM感染引起的一种罕见的致死性真菌病。PSM多继发于艾滋病、血液恶性肿瘤、糖尿病、结核病、系统性红斑狼疮、器官移植受者或有糖皮质激素、细胞毒性药物用药史的患者，为艾滋病患者重要的死因之一[1]。本文就1例免疫功能正常者马尔尼菲青霉菌肺部感染的抗真菌治疗进行讨论。

1 病史摘要

患者，男性，63岁。身高172 cm，体重76 kg。因“咳嗽、发热伴淋巴结肿大1月余”入院。……