HIV阴性马尔尼菲篮状菌病研究进展

Research progress of talaromycosis in HIV-negative patients

马尔尼菲篮状菌是真菌界、子囊菌门、散囊菌纲、散囊菌目、发菌科、篮状菌属中唯一已知的对包括人类在内的哺乳动物具有致病性的温度双相型真菌。其在自然环境中作为腐生霉菌生长,但在哺乳动物生理温度(37℃)下发生向致病性酵母相的转变。一直以来,马尔尼菲篮状菌病被认为与HIV/AIDS完全相关,并与结核病和隐球菌病并列为三大AIDS机会性感染之一。随着HIV/AIDS治疗进展及有效控制措施的开展,HIV阳性马尔尼菲篮状菌病发病数量逐年递减,但非HIV感染马尔尼菲篮状菌病患者数量和比例逐年增加,这些患者均有不同的危险因素,包括各种类型的免疫缺陷、恶性肿瘤、自身免疫性疾病、器官移植等。然而,只有少量的回顾性研究关注这些患者的临床特征和危险因素,缺乏对这类患者的全面认识。因此,本文对HIV阴性马尔尼菲篮状菌病患者的流行病学、致病机理、危险因素、临床表现、诊断、治疗及预后研究进展进行综述,并展望了关于该病的前沿研究方向,以期提高对这类患者的诊治率并最终改善预后。

Talaromyces marneffei stands out as the sole thermobiphasic fungus pathogenic to mammals,including humans,belonging to Ascomycota,Eurotiomycetes,Eurotiales,Trichocomaceae,and Talaromyces.Thriving as a saprophytic fungus in its natural habitat,it transitions into a pathogenic yeast phase at the mammalian physiological temperature of 37℃.Historically,talaromycosis has been predominantly associated with HIV/AIDS,classified among the three primary opportunistic infections linked with AIDS,alongside tuberculosis and cryptococcosis.As advancements are made in HIV/AIDS treatment and control measures,the incidence of talaromycosis co-infection with HIV is declining annually,whereas the population of non-HIV-infected talaromycosis patients is steadily increasing.These patients exhibit diverse risk factors such as various types of immunodeficiency,malignant tumors,autoimmune diseases,and organ transplantation,among others.Yet,a limited number of retrospective studies have centered on the clinical characteristics and risk factors of HIV-negative talaromycosis patients,resulting in an inadequate understanding of this patient cohort.A comprehensive review is conducted encompassing the epidemiology,pathogenesis,risk factors,clinical manifestations,diagnosis,treatment,and prognosis of HIV-negative talaromycosis patients,together with a prospect of the disease’s frontier research direction to enhance comprehension and advancements in the diagnosis and treatment rates for these patients,ultimately improving their prognosis.