Pongpech Nisha, Rotjanapan Porpon
Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Infect Drug Resist. 2019 Jun 4;12:1493-1499. doi: 10.2147/IDR.S207819. eCollection 2019.
() is an important opportunistic pathogen found in human immunodeficiency virus-positive individuals in Southeast Asia, Southern China, and Northeastern India. Patients with disseminated talaromycosis commonly develop multi-organ involvement including the skin. In this report, we describe the clinical presentation, investigation, management, and clinical outcome of an acquired immune deficiency syndrome (AIDS) patient with newly diagnosed disseminated talaromycosis without skin involvement.
A 27-year-old male with AIDS presented with acute onset of abdominal pain for 4 days and fever for 2 days. He had been diagnosed with AIDS, pneumocystis pneumonia, and presumptive smear-negative pulmonary tuberculosis 2 months previously. His initial CD4 count was 91 cells/mm. After a 3-week course of trimethoprim/sulfamethoxazole and anti-tuberculosis treatment, anti-retroviral therapy was initiated. Physical examination revealed left upper quadrant tenderness but no abnormal skin lesions. On this visit, his CD4 count rose to 272 cells/mm (19%). Computed tomography of the abdomen showed evidence of a small hypodense lesion with a thin enhancing rim at the spleen and extensive intra-abdominal lymphadenopathy. Empirical amphotericin B deoxycholate was administered in response to positive serum galactomannan, although this was switched to intravenous liposomal amphotericin B 1 week later because of acute kidney injury. Blood and bone marrow cultures for fungus grew on days 9 and 12, respectively. After 21 days of treatment, oral itraconazole replaced intravenous therapy. The patient was discharged home after 29 days in the hospital and continued to improve clinically at a follow-up visit as an outpatient.
Talaromycosis is a fairly common opportunistic infection among AIDS patients in Thailand, despite a rise in CD4 count which may reflect a change in immune status. To a lesser extent, a systemic disease without skin involvement can be expected in real clinical practice.
（）是在东南亚、中国南部和印度东北部的人类免疫缺陷病毒阳性个体中发现的一种重要的机会性病原体。播散性足分支霉病患者通常会出现多器官受累，包括皮肤。在本报告中，我们描述了一名新诊断为无皮肤受累的播散性足分支霉病的获得性免疫缺陷综合征（AIDS）患者的临床表现、检查、治疗及临床结局。
一名27岁的艾滋病男性患者，突发腹痛4天，发热2天。2个月前他被诊断为艾滋病、肺孢子菌肺炎和疑似涂片阴性的肺结核。他最初的CD4细胞计数为91个/mm³。在接受了3周的甲氧苄啶/磺胺甲恶唑和抗结核治疗后，开始了抗逆转录病毒治疗。体格检查发现左上腹压痛，但无异常皮肤病变。此次就诊时，他的CD4细胞计数升至272个/mm³（19%）。腹部计算机断层扫描显示脾脏有一个小的低密度病变，边缘有薄强化，并有广泛的腹腔淋巴结肿大。鉴于血清半乳甘露聚糖阳性，给予经验性的去氧胆酸两性霉素B治疗，尽管1周后因急性肾损伤改为静脉注射脂质体两性霉素B。血液和骨髓真菌培养分别在第9天和第12天生长出（真菌名称未给出）。治疗21天后，口服伊曲康唑替代静脉治疗。患者住院29天后出院回家，门诊随访时临床情况持续改善。
在泰国，足分支霉病是艾滋病患者中相当常见的机会性感染，尽管CD4细胞计数有所上升，这可能反映了免疫状态的变化。在实际临床实践中，在较小程度上，可以预期出现无皮肤受累的全身性疾病。
