HIV阴性儿童马尔尼菲篮状菌病2例临床分析并文献复习
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1.湖南省儿童医院急救中心(急诊综合一科), 湖南 长沙 410007;2.南华大学儿科学院, 湖南 衡阳 421000

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罗海燕  E-mail: luohaiyan0429@126.com

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Clinical analysis of Talaromycesis marneffei in HIV-negative children: 2 case report and literature review
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1.Pediatric Emergency Center[Emergency Department I], Hunan Children's Hospital, Changsha 410007, China;2.Pedia-tric College, University of South China, Hengyang 421000, China

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    摘要:

    目的 总结2例人类免疫缺陷病毒(HIV)阴性儿童马尔尼菲篮状菌病(TSM)患儿的临床特征。 方法 分析某儿童医院收治的2例HIV阴性TSM患儿的临床特点及实验室资料、存在的基础疾病,并复习相关文献,总结TSM感染患儿的临床特征及诊治经验。 结果 2例HIV阴性TSM患儿中病例1以右下肢肿块为首发症状,1个月余后才出现发热及咳嗽,误诊为结核感染;病例2以发热、三系减少及肝脾、淋巴结大等表现起病。病例1行基因检测为STAT1基因突变,病例2有反复灰指甲及口腔溃疡病史,均行血、骨髓培养及淋巴结活检确诊。病例1先后予以伏立康唑、两性霉素B脂质体静脉滴注,伊曲康唑口服维持治疗,共治疗1年后停药;病例2一直予以伏立康唑治疗(先静脉滴注后口服),共7个月后停药,均无复发。 结论 TSM可发生在HIV阴性儿童,且可存在STAT1基因突变。对于治疗效果差的患儿,应尽早行培养或组织活检以明确诊断,并积极查找TSM可能存在的基础疾病,以到达早期诊断、早期治疗和改善预后的目的。

    Abstract:

    Objective To summarize the clinical characteristics of 2 cases of human immunodeficiency virus (HIV)-negative children suffered from Talaromycesis marneffei (TSM). Methods Clinical characteristics, laboratory data and underlying diseases of 2 HIV-negative children with TSM and treated in a children's hospital were analyzed, relevant literatures were reviewed to summarize the clinical characteristics as well as diagnosis and treatment experience of children with TSM. Results Among 2 HIV-negative children with TSM, case 1 presented the initial symptom of mass in the right lower limb, developed fever and cough more than 1 month later, and was misdiagnosed as tuberculosis infection; case 2 began with fever, with pancytopenia, hepatosplenomegaly and lymph node enlargement. Gene test of case 1 presented STAT1 gene mutation, case 2 had a history of recurrent onychomycosis and oral ulcer, which were confirmed by blood, bone marrow culture and lymph node biopsy. Case 1 was treated with intravenous drip of voriconazole and amphotericin B liposome as well as oral medications of itraconazole for maintenance therapy, medication was stopped after 1 year of treatment; case 2 had been treated with voriconazole (intravenous drip first, then oral medication) for 7 months, and there was no recurrence. Conclusion TSM can occur in HIV-negative children, and there may be STAT1 gene mutation. For children with poor treatment effect, culture or tissue biopsy should be performed as early as possible to make a confirmed diagnosis, and actively find the possible underlying diseases of TSM, so as to achieve early diagnosis, early treatment and prognosis improvement.

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范江花,罗海燕,杨龙贵,等. HIV阴性儿童马尔尼菲篮状菌病2例临床分析并文献复习[J]. 中国感染控制杂志,2021,(8):754-758. DOI:10.12138/j. issn.1671-9638.20217705.
Jiang-hua FAN, Hai-yan LUO, Long-gui YANG, et al. Clinical analysis of Talaromycesis marneffei in HIV-negative children: 2 case report and literature review[J]. Chin J Infect Control, 2021,(8):754-758. DOI:10.12138/j. issn.1671-9638.20217705.

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  • 收稿日期:2020-11-30
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  • 在线发布日期: 2021-09-06
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