内科理论与实践

内科理论与实践 ›› 2026, Vol. 21 ›› Issue (03): 257-261.doi: 10.16138/j.1673-6087.2026.03.11

• 研究报道 • 上一篇    下一篇

获得性免疫缺陷综合征合并马红球菌感染14例临床分析

姚远1a(), 周锐峰1a, 王力1a, 张亚萍1a, 王启明1b, 陈莲1b, 向往2, 杨彤彤1a()   

  1. 1.成都市公共卫生临床医疗中心 a. 感染科；b. 检验科微生物室，四川 成都　610000
    2.南充市蓬安县疾病预防控制中心，四川 南充　637000
  • 收稿日期:2026-01-19 修回日期:2026-04-13 接受日期:2026-06-08 出版日期:2026-06-25 发布日期:2026-08-19
  • 通讯作者: 杨彤彤 E-mail：yangtong_929@163.com
  • 作者简介:作者贡献/Authors’ Contributions姚远负责论文撰写与研究数据整理；周锐峰、杨彤彤负责研究设计及论文指导与修订；王力、张亚萍负责临床与检验数据采集与分析；王启明、陈莲负责微生物学检测与鉴定；向往负责数据录入与核验。所有作者均对最终稿件做出实质性贡献并确认。
  • 基金资助:
    四川省临床重点专科建设项目(2023AGRKP001)

Clinical analysis of 14 cases of acquired immunodeficiency syndrome complicated with Rhodococcus equi infection

YAO Yuan1a(), ZHOU Ruifeng1a, WANG Li1a, ZHANG Yaping1a, WANG Qiming1b, CHEN Lian1b, XIANG Wang2, YANG Tongtong1a()   

  1. 1. a. Department of Infectious Diseases; b. Microbiology Division, Department of Laboratory Medicine, the Public Health Clinical Center of Chengdu, Chengdu 610000, China
    2. Peng'an County Center for Disease Control and Prevention, Nanchong 637000, China
  • Received:2026-01-19 Revised:2026-04-13 Accepted:2026-06-08 Online:2026-06-25 Published:2026-08-19

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摘要：

目的：总结获得性免疫缺陷综合征合并马红球菌感染患者的临床特征及治疗转归。方法：回顾性分析成都市公共卫生临床医疗中心2017年9月至2025年9月收治的14例获得性免疫缺陷综合征合并马红球菌感染患者的临床资料。结果：14例患者中男性13例，年龄23～55岁，中位年龄为40（37，43）岁。所有患者均报告性接触暴露史，其中1例报告男男性行为，1例兼有静脉注射吸毒史。确诊人类免疫缺陷病毒（human immunodeficiency virus，HIV）感染至确诊马红球菌感染时间为5 d~7年。7例患者未启动抗逆转录病毒治疗（antiretroviral therapy，ART）。已启动ART的7例患者中，3例病毒学治疗失败，2例自行中断治疗。确诊马红球菌感染时，CD4+T淋巴细胞计数为26.0（16.5，47.5）个/μL，CD4/CD8比值为0.11（0.06，0.15）。临床主要表现为咳嗽、咳痰、发热、胸痛等，影像学多见肺部浸润或实变、空洞及胸腔积液。马红球菌培养阳性标本包括血液、痰、支气管肺泡灌洗液、咽拭子、胸腔积液等，同一患者可有多种类型标本培养阳性。治疗转归为好转10例、未治疗或放弃治疗3例、死亡1例。结论：获得性免疫缺陷综合征合并马红球菌感染少见，常可引起菌血症和空洞性肺炎。诊断后尽早依据药物敏感性试验结果选用敏感抗菌药物足疗程治疗，并及时启动ART，可能改善患者预后。

关键词: 获得性免疫缺陷综合征, 马红球菌, 机会性感染, 临床特征, 预后

Abstract:

Objective To summarize the clinical characteristics and treatment outcomes of patients with acquired immunodeficiency syndrome complicated with Rhodococcus equi infection. Methods A retrospective analysis was conducted on the clinical data of 14 patients with acquired immunodeficiency syndrome complicated with Rhodococcus equi infection, who were admitted to the Public Health Clinical Center of Chengdu from September 2017 to September 2025. Results Of the 14 patients, 13 were male, with an age range of 23 to 55 years and a median age of 40 (37, 43) years. All patients reported a history of sexual exposure, among whom 1 reported male-to-male sexual contact and 1 had a history of intravenous drug use. The time from diagnosis of human immunodeficiency virus (HIV) infection to diagnosis of Rhodococcus equi infection ranged from 5 days to 7 years. Seven patients had not initiated antiretroviral therapy (ART). Among the 7 patients who had initiated ART, 3 had confirmed virological treatment failure and 2 had self-discontinuation of ART. At the time of diagnosis of Rhodococcus equi infection, the CD4+ T lymphocyte count was 26.0 (16.5, 47.5) cells/μL, and the CD4/CD8 ratio was 0.11 (0.06, 0.15). The main clinical manifestations included cough, sputum production, fever, chest pain, etc. Imaging findings predominantly showed pulmonary infiltration and consolidation, cavitary lesions, and pleural effusion. Rhodococcus equi-positive specimens included blood, sputum, bronchoalveolar lavage fluid, pharyngeal swabs, pleural effusion, etc., with multiple specimen types often collected from the same patient. Regarding treatment outcomes, 10 patients showed clinical improvement, 3 did not receive or abandoned treatment, and 1 patient died. Conclusions Rhodococcus equi infection is uncommon in patients with acquired immunodeficiency syndrome, but it often causes bacteremia and cavitary pneumonia. Selecting sensitive antibacterial agents for a full course of treatment based on antibacterial susceptibility test results as soon as possible after diagnosis, along with prompt initiation of ART, may improve patient prognosis.

Key words: acquired immunodeficiency syndrome, Rhodococcus equi, opportunistic infection, clinical characteristics, prognosis

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