Department of Respiratory Diseases, Shenzhen Children's Hospital, Shantou University Medical College, Shenzhen, 518038, China.
Department of Clinical Pharmacy, Shenzhen Children's Hospital, Shantou University Medical College, Shenzhen, 518038, China.
BMC Pulm Med. 2023 Mar 28;23(1):100. doi: 10.1186/s12890-023-02390-y.
Respiratory symptoms are the earliest clinical manifestation of Talaromyces marneffei (TM) infection. In this study, we aimed to improve the early identification of TM infection in human immunodeficiency virus (HIV)-negative children with respiratory symptoms as the first manifestation, analyze the risk factors, and provide evidence for diagnosis and treatment.
We retrospectively analyzed six cases of HIV-negative children with respiratory system infection symptoms as the first presentation.
All subjects (100%) had cough and hepatosplenomegaly, and five subjects (83.3%) had a fever; other symptoms and signs included lymph node enlargement, rash, rales, wheezing, hoarseness, hemoptysis, anemia, and thrush. Additionally, 66.7% of the cases had underlying diseases (three had malnutrition, one had severe combined immune deficiency [SCID]). The most common coinfecting pathogen was Pneumocystis jirovecii, which occurred in two cases (33.3%), followed by one case of Aspergillus sp. (16.6%). Furthermore, the value of β-D-glucan detection (G test) increased in 50% of the cases, while the proportion of NK decreased in six cases (100%). Five children (83.3%) were confirmed to have the pathogenic genetic mutations. Three children (50%) were treated with amphotericin B, voriconazole, and itraconazole, respectively; three children (50%) were treated with voriconazole and itraconazole. All children were tested for itraconazole and voriconazole plasma concentrations throughout antifungal therapy. Two cases (33.3%) relapsed after drug withdrawal within 1 year, and the average duration of antifungal treatment for all children was 17.7 months.
The first manifestation of TM infection in children is respiratory symptoms, which are nonspecific and easily misdiagnosed. When the effectiveness of anti-infection treatment is poor for recurrent respiratory tract infections, we must consider the condition with an opportunistic pathogen and attempt to identify the pathogen using various samples and detection methods to confirm the diagnosis. It is recommended the course for anti-TM disease be longer than one year for children with immune deficiency. Monitoring the blood concentration of antifungal drugs is important.
呼吸道症状是马尔尼菲青霉（TM）感染的最早临床表现。本研究旨在提高对以呼吸道症状为首发表现的人类免疫缺陷病毒（HIV）阴性儿童 TM 感染的早期识别，分析其危险因素，并为诊断和治疗提供依据。
回顾性分析以呼吸系统感染症状为首发表现的 6 例 HIV 阴性儿童病例。
所有患儿（100%）均有咳嗽和肝脾肿大，5 例（83.3%）有发热；其他症状和体征包括淋巴结肿大、皮疹、啰音、喘鸣、声音嘶哑、咯血、贫血和鹅口疮。此外，66.7%的患儿（3 例有营养不良，1 例有严重联合免疫缺陷[SCID]）存在基础疾病。最常见的合并感染病原体是卡氏肺孢子菌，2 例（33.3%），其次是曲霉属 1 例（16.6%）。此外，50%的病例 β-D-葡聚糖检测（G 试验）值升高，6 例 NK 下降（100%）。5 例患儿（83.3%）均检测到致病性基因突变。3 例（50%）分别给予两性霉素 B、伏立康唑和伊曲康唑治疗，3 例（50%）给予伏立康唑和伊曲康唑治疗。所有患儿在抗真菌治疗过程中均进行了伊曲康唑和伏立康唑血药浓度检测。2 例（33.3%）患儿在停药后 1 年内复发，所有患儿抗真菌治疗的平均疗程为 17.7 个月。
儿童 TM 感染的首发表现为呼吸道症状，无特异性，易误诊。对于反复发生的呼吸道感染，抗感染治疗效果不佳时，必须考虑机会性病原体感染，并尝试通过各种样本和检测方法识别病原体，以明确诊断。建议免疫缺陷儿童 TM 疾病的疗程要长于 1 年。监测抗真菌药物的血药浓度非常重要。
