Department of Dermatology, Shanghai Key Laboratory of Molecular Medical Mycology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China.
Department of Pharmacy, No. 905 Hospital of PLA Navy, Shanghai, 200052, China.
Mycopathologia. 2022 Jun;187(2-3):169-180. doi: 10.1007/s11046-021-00614-5. Epub 2022 Feb 14.
Knowledge about the clinical characteristics and prognostic factors of Talaromyces marneffei infection in children is limited, especially in HIV-positive children. We performed a retrospective study of all HIV-positive pediatric inpatients with T. marneffei infection in a tertiary hospital in Southern China between 2014 and 2019 and analyzed the related risk factors of poor prognosis using logistic regression. Overall, 28 cases were enrolled and the prevalence of talaromycosis in AIDS children was 15.3% (28/183). The median age of the onset was 8 years (range: 1-14 years). The typical manifestation of skin lesion with central umbilication was not common (21.4%). All the children had very low CD4 cell counts (median 13.5 cells/μL, range: 3-137 cells/μL) on admission. 92.9% children were misdiagnosed and talaromycosis was only noted after positivity for HIV infection. 89.3% diagnoses of T. marneffei infections were based on positive blood cultures, with a long culture time (median 7 days, range from 3-14 days). The sensitivity of fungus 1,3-β-D-glucan assay was 63.2%. Amphotericin B was superior to itraconazole in the induction antifungal therapy of talaromycosis in HIV-positive children. A six-month follow-up revealed a 28.6% mortality. Lower ratio of CD4/CD8 and amphotericin B treatment not over 7 days predicted poor prognosis. Our retrospective study provided an overview and update on the current knowledge of talaromycosis in HIV-positive children. Pediatricians in endemic areas should be aware of mycoses to prevent misdiagnosis. 1,3-β-D-glucan assay did not show optimal sensitivity. Amphotericin B treatment over 7 days can improve poor prognosis.
有关儿童马尔尼菲青霉感染的临床特征和预后因素的知识有限，尤其是在 HIV 阳性儿童中。我们对 2014 年至 2019 年间中国南方一家三级医院所有 HIV 阳性住院儿童进行了马尔尼菲青霉感染的回顾性研究，并使用逻辑回归分析了不良预后的相关危险因素。总体上共纳入 28 例病例，艾滋病儿童中马尔尼菲青霉病的患病率为 15.3%（28/183）。发病中位年龄为 8 岁（范围：1-14 岁）。具有中央脐凹的典型皮损表现并不常见（21.4%）。所有患儿入院时 CD4 细胞计数均极低（中位数 13.5 个/μL，范围：3-137 个/μL）。92.9%的患儿误诊，仅在 HIV 感染阳性后才发现马尔尼菲青霉病。89.3%的 T. marneffei 感染诊断基于血培养阳性，培养时间较长（中位数 7 天，范围 3-14 天）。真菌 1,3-β-D-葡聚糖检测的敏感性为 63.2%。两性霉素 B 在 HIV 阳性儿童中抗真菌治疗诱导方面优于伊曲康唑。6 个月的随访显示死亡率为 28.6%。CD4/CD8 比值较低和两性霉素 B 治疗时间不足 7 天预测预后不良。我们的回顾性研究提供了 HIV 阳性儿童马尔尼菲青霉病的最新知识概述。流行地区的儿科医生应注意真菌病以避免误诊。1,3-β-D-葡聚糖检测的敏感性并不理想。两性霉素 B 治疗超过 7 天可改善不良预后。
