长沙市儿童艾滋病合并马尔尼菲篮状菌感染的临床特点分析

Clinical characteristics of children with AIDS complicated with Talaromyces marneffei infection in Changsha City

目的探讨长沙市14例AIDS合并马尔尼菲篮状菌(Talaromyces marneffei,TM)感染患儿的临床特点。方法回顾性分析长沙市第一医院2015年1月—2020年12月收治的14例AIDS合并TM感染患儿的临床特征、实验室检查、病原学依据、影像学表现以及疾病转归。结果14例(男12例,女2例)AIDS合并TM感染患儿中,入院时临床表现为:发热(100.0%)、咳嗽(85.7%)、乏力(71.4%)、食欲缺乏(71.4%)、皮疹(64.3%)、体重下降>5 kg(57.1%)、淋巴结肿大(50.0%)、骨关节痛(7.1%)。实验室检查显示贫血(92.9%),CD4T淋巴细胞<200 cells/μl(100.0%,12/12);血培养和骨髓培养TM阳性率分别为92.9%和75.0%;50.0%(7/14)患儿胸部影像学病变累及双肺,表现为斑片影、结节影、磨玻璃影及粟粒样改变。治疗上,使用抗真菌药物前发热持续中位时间15 d,抗真菌药物使用后发热持续中位时间3 d,且78.6%(11/14)最终好转,其余3例失访。结论儿童AIDS合并TM感染临床症状多样,其中皮疹是一个重要的特异性表现,骨骼受累在儿童并不常见,临床建议采取多部位不同标本类型进行培养以明确诊断;及时、有效的抗真菌治疗对预后具有重要影响。

Objective To explore the clinical characteristics of 14 children with AIDS complicated with Talaromyces marneffei(TM)infection in Changsha City.Methods We retrospectively analyzed clinical characteristics,laboratory examinations,etiological evidence,imaging findings and disease transformation of the 14 children with AIDS complicated with TM infection admitted to the First Hospital of Changsha City from January 2015 to December 2020.Results Among the 14 children(including 12 boys and 2 girls)with AIDS complicated with TM infection,the clinical manifestations at admission were as follows:fever(100%),cough(85.7%),fatigue(71.4%),anorexia(71.4%),rash(64.3%),body weight loss>5 kg(57.1%),lymphadenopathy(50.0%),and bone and joint pain(7.1%).The results of laboratory examinations revealed that anemia accounted for 92.9%,and CD4T cells were<200 cells/μl(100%,12/12).The positive rates of TM in blood and bone marrow cultures were 92.9%and 75.0%,respectively.50.0%(7/14)of the children’chest imaging lesions involved both lungs,presenting as patchy shadows,nodular shadows,ground glass shadows and miliary changes.In terms of treatment,the median duration of fever before the use of antifungal drugs was 15 days,the median duration of fever after the use of antifungal drugs was 3 days,and the final improvement accounted for 78.6%(11/14),with the remaining 3 cases lost to follow-up.Conclusion Clinical symptoms of the children with AIDS complicated with TM infection are diverse,of which rash is an important specific manifestation,but bone involvement is uncommon in the children.It is recommended to culture different types of specimens collected from multiple parts so as to make a clear diagnosis in clinical practice.Timely and effective antifungal therapy has an important impact on prognosis.