Zeng Wen, Qiu Ye, Lu DeCheng, Zhang Jianquan, Zhong Xiaoning, Liu Guangnan
From Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (WZ, YQ, JZ, XZ, GL); Department of Endocrinology Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (DCL).
Medicine (Baltimore). 2015 Aug;94(34):e1439. doi: 10.1097/MD.0000000000001439.
Infection with Penicillium marneffei has rarely been reported in human immunodeficiency virus (HIV)-negative infants. We aimed to determine the epidemiological, clinical, pathological, and immunological characteristics of 7 HIV-negative infants infected by P. marneffei, and to provide insights into its diagnosis and treatment.We retrospectively reviewed the cases of 7 HIV-negative infants infected by P. marneffei who presented to the First Affiliated Hospital of Guangxi Medical University between January 1, 2003 and December 1, 2014. The infants' median age was 23.43 months (SD = 8.34), and all lived in Guangxi Province in China, where P. marneffei is endemic. The median time from disease onset to diagnosis was 2.29 months (SD = 2.12). Of the cases studied, 5 (71.43%) had medical histories that included frequent pneumonia or bronchopneumonia, thrush, congenital megacolon, glucose-6-phosphate dehydrogenase deficiency, and hemophagocytic syndrome. The most common symptoms were fever, cough, and anemia, followed by lymphadenopathy, hepatosplenomegaly, and being underweight. Four patients had slightly elevated white blood cell counts. The lymphocyte and CD4 T-cell counts were normal. The CD8 T-cell counts, serum immunoglobulin (Ig) G titer, and serum IgA titer were low in 5 patients, and the serum IgM titers were high in 3 infants. Caseous necrosis was observed in 3 patients whose lymph nodes were affected. One case who received intravenous amphotericin B and 3 cases who received intravenous voriconazole improved, and these patients were cured after continual treatment with oral voriconazole for 6 or 12 months. The remaining patients died before they received antifungal treatment.P. marneffei causes severe disease and disseminated infections, and it has high mortality rates in HIV-negative infants in endemic areas. P. marneffei susceptibility may be associated with immunodeficiencies or immune disorders. In endemic areas, clinicians should aware of disseminated P. marneffei infections when infants present with serious or recurrent infections, even if they are HIV negative. P. marneffei is highly susceptible to amphotericin B and voriconazole. Timely diagnosis and treatment can improve patients' prognoses. Intravenous voriconazole could be recommended as the initial antifungal agent for HIV-negative infants infected by P. marneffei, because of its low nephrotoxicity, high sensitivity, and high efficacy levels.
马尔尼菲青霉感染在人类免疫缺陷病毒（HIV）阴性婴儿中鲜有报道。我们旨在确定7例感染马尔尼菲青霉的HIV阴性婴儿的流行病学、临床、病理和免疫学特征，并为其诊断和治疗提供见解。我们回顾性分析了2003年1月1日至2014年12月1日期间在广西医科大学第一附属医院就诊的7例感染马尔尼菲青霉的HIV阴性婴儿的病例。这些婴儿的中位年龄为23.43个月（标准差=8.34），均居住在中国马尔尼菲青霉流行的广西省。从发病到诊断的中位时间为2.29个月（标准差=2.12）。在所研究的病例中，5例（71.43%）有包括频繁肺炎或支气管肺炎、鹅口疮、先天性巨结肠、葡萄糖-6-磷酸脱氢酶缺乏症和噬血细胞综合征在内的病史。最常见的症状是发热、咳嗽和贫血，其次是淋巴结病、肝脾肿大和体重不足。4例患者白细胞计数略有升高。淋巴细胞和CD4 T细胞计数正常。5例患者的CD8 T细胞计数、血清免疫球蛋白（Ig）G滴度和血清IgA滴度较低，3例婴儿的血清IgM滴度较高。3例淋巴结受累患者观察到干酪样坏死。1例接受静脉注射两性霉素B治疗的患者和3例接受静脉注射伏立康唑治疗的患者病情改善，这些患者在口服伏立康唑持续治疗6或12个月后治愈。其余患者在接受抗真菌治疗前死亡。马尔尼菲青霉可导致严重疾病和播散性感染，在流行地区的HIV阴性婴儿中死亡率很高。马尔尼菲青霉易感性可能与免疫缺陷或免疫紊乱有关。在流行地区，当婴儿出现严重或反复感染时，即使他们是HIV阴性，临床医生也应意识到马尔尼菲青霉的播散性感染。马尔尼菲青霉对两性霉素B和伏立康唑高度敏感。及时诊断和治疗可改善患者预后。由于其肾毒性低、敏感性高和疗效高，静脉注射伏立康唑可被推荐为感染马尔尼菲青霉的HIV阴性婴儿的初始抗真菌药物。
