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Title: [Clinical analysis of 7 children infected with Talaromyces marneffei].
Author: Xie G, Chen JH, Sun LF, Wang W, Li ZC, Wang WJ.
Journal: Zhonghua Er Ke Za Zhi; 2022 Sep 02; 60(9):925-929. PubMed ID: 36038303.
Abstract:
Objective: To investigate the clinical manifestations, treatments, and prognosis of pediatric patients with Talaromyces marneffei infection. Methods: In this retrospective study, 7 children diagnosed with Talaromyces marneffei infection in Shenzhen Children's Hospital from July 2017 to October 2021 were recruited. The clinical features, radiology, pathogen detection, immunological evaluation, treatments, and prognosis were analyzed. Results: In 7 cases, 5 were male, 2 were females. The age was from 0.75 to 8.75 years. The main clinical manifestations were fever in 7 cases, cough in 6 cases, malnutrition in 4 cases, papules in 2 cases and medical history of recurrent infection in 3 cases. Physical examination showed that all 7 patients had hepatosplenomegaly, 4 had superficial lymphadenopathy. Laboratory examination showed that 6 cases had decreased hemoglobin and 3 cases had decreased platelet. Chest CT showed that 4 cases had patchy shadows, pleural effusion, mediastinal or axillary lymph node enlargement, 3 had nodular shadows and 2 had cavities. The positive ratio of Talaromyces marneffei culture was 2/2 with tissue samples, 4/5 with bone marrow. The positive ratio was 3/4 by metagenomic next generation sequencing. The fungus was detected in 3 cases by smear microscopy of bone marrow and (or) peripheral blood. All patients were negative for human immunodeficiency virus by the immune function assay. However, 5 cases were confirmed as primary immunodeficiency disease, including 2 cases with high IgM syndrome, 2 with STAT1 gene variation, and the last with severe combined immunodeficiency (IL2RG gene variation). Exclude 1 case which gave up treatment due to acute intracranial infection, and the other patients received effective treatments along with amphotericin B, voriconazole, and itraconazole alone or in combination. Two cases relapsed after medication withdrawal, but 1 case got complete rehabilitation after hematopoietic stem cell transplantation. Conclusions: The clinical manifestations involve multisystem, the common charateristics are fever and cough. The chest CT imaging manifestations are diverse, it should be considered in differentiating tuberculosis. The amphotericin B, voriconazole and itraconazole are effective, but it will easily relapse when withdrawing those antifungal agents. 目的： 探讨儿童马尔尼菲篮状菌感染的临床特点、治疗和预后。 方法： 回顾分析2017年7月至2021年10月深圳市儿童医院收治的7例马尔尼菲篮状菌感染患儿的临床表现、影像学、病原检测、免疫功能评估以及治疗和预后等资料。 结果： 7例患儿中男5例、女2例，就诊年龄0.75~8.75岁。7例患儿均发热、6例咳嗽、4例营养不良、2例丘疹，3例有反复感染病史。体格检查7例均有肝脾肿大、4例浅表淋巴结肿大。实验室检查示血红蛋白降低6例、血小板减少3例。胸部影像学表现多样，4例胸部CT表现片状斑片影、胸腔积液、纵隔或腋下淋巴结肿大，3例有结节影，2例有空洞。所有患儿通过组织或体液培养出病原，其中组织培养阳性比例2/2，骨髓培养阳性比例4/5。通过宏基因二代测序发现马尔尼菲篮状菌序列比例为3/4；3例骨髓和（或）外周涂片镜检快速发现真菌。免疫功能评估7例人类免疫缺陷病毒均阴性，5例确诊原发性免疫缺陷病，其中2例高IgM综合征，2例STAT1基因变异，1例重症联合免疫缺陷（IL2RG基因变异）。除1例合并颅内感染患儿病情危重放弃治疗，其余6例分别或联合使用两性霉素B、伏立康唑和伊曲康唑治疗有效，其中2例停药复发，1例停药后行造血干细胞移植无复发。 结论： 儿童马尔尼菲篮状菌感染临床表现累及多个系统，呼吸道常见表现多为发热、咳嗽。胸部CT影像学表现多样，容易被误诊为结核感染。两性霉素B、伏立康唑和伊曲康唑有效，但抗真菌治疗停药易复发。.

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