Institute of Pathogenic Microorganisms, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, China.
Hangzhou Baocheng Biotechnology Co., Ltd., Hangzhou, China.
J Infect Dev Ctries. 2022 Mar 31;16(3):575-579. doi: 10.3855/jidc.15348.
Penicillium marneffei is one of the most common opportunistic infectious fungi associated with AIDS (Acquired Immunodeficiency Syndrome). It is prevalent in Southeast Asia and southern China (such as Guangdong), but rare in inland provinces of China. Penicillium marneffei infections are often misdiagnosed.
Here, we report a patient with Penicillium marneffei infection from Shaanxi Province, China, who was previously repeatedly diagnosed as Kala-azar in two hospitals. The patient received medical treatment due to fever and multiple papules, worked as a tour guide, and had travel history in Southeast Asian countries. We performed nanopore genome sequencing on blood samples of the patient and obtained 84,000 reads in 3.5 hours. The average length of the sequences was 7088.7 bases and the longest sequence was 87471 bases. Through comparison with the pathogenic bacteria database, 13 homologous Penicillium marneffei sequences were identified. Furthermore, by using specific quantitative real time-polymerase chain reaction of Penicillium marneffei, fungal ITS (Internal Transcribed Spacer) sequencing, and fungal biphasic culture, we further confirmed the pathogen as Penicillium marneffei. Meanwhile, the patient was confirmed to be HIV (Human Immunodeficiency Virus) positive. Thus, the patient was diagnosed with AIDS combined with Penicillium marneffei infection, which, to the best of our knowledge, is the first report of Penicillium marneffei infection in Shaanxi Province, China.
Metagenomic analysis based on nanopore sequencing provides an important reference for the diagnosis of Penicillium marneffei infection in this case.
马尔尼菲青霉是与艾滋病（获得性免疫缺陷综合征）相关的最常见机会性感染真菌之一。它在东南亚和中国南方（如广东）流行，但在中国内陆省份罕见。马尔尼菲青霉感染常被误诊。
在这里，我们报告了一例来自中国陕西省的马尔尼菲青霉感染患者，该患者曾在两家医院被误诊为黑热病。患者因发热和多发丘疹就诊，曾担任导游，并在东南亚国家有旅行史。我们对患者的血液样本进行了纳米孔基因组测序，在 3.5 小时内获得了 84000 个读数。序列的平均长度为 7088.7 个碱基，最长序列为 87471 个碱基。通过与病原菌数据库进行比较，鉴定出 13 个同源马尔尼菲青霉序列。此外，通过使用马尔尼菲青霉的特异性定量实时聚合酶链反应、真菌 ITS（内部转录间隔区）测序和真菌两相培养，我们进一步证实了病原体为马尔尼菲青霉。同时，该患者被确认为 HIV（人类免疫缺陷病毒）阳性。因此，该患者被诊断为艾滋病合并马尔尼菲青霉感染，据我们所知，这是中国陕西省首例马尔尼菲青霉感染的报告。
基于纳米孔测序的宏基因组分析为该病例的马尔尼菲青霉感染诊断提供了重要参考。
