Abstract:

Objective To explore clinical characteristics and treatment of Talaromyces marneffei (T. marneffei) infection in HIV-negative children, so as to improve the diagnosis of T. marneffei infection in children. Methods The clinical data of 23 HIV-negative children with T. marneffei infection were retrospectively analyzed, and the demographic characteristics, clinical manifestations, laboratory tests, complications, treatment and outcome were summarized. Results Twenty-three children (15 boys and 8 girls) were included, with a median age of 22 months (3 months to 13 years). The main clinical features were fever (22/23, 95.7%), cough (18/23,78.3%) and hepatomegaly (18/23,78.3%), and skin involvement was found in 9 cases (39.1%). Common severe complications included septic shock (13/23, 56.5%), hemophagocytic syndrome (12/23, 52.2%), acute respiratory distress syndrome (11/23, 47.8%) and multiple organ dysfunction syndrome (10/23, 43.5%). Serum IgG decreased in 7 cases, IgM increased in 6 cases, IgE increased in 9 cases, and NK cell count decreased in 13 cases. Eleven children were tested by genetic testing and 6 of them were found to have primary immunodeficiency disease. T. marneffei was cultured from specimens of blood in 87% cases (20/23). Nine of them were also confirmed by bone marrow culture. Another two cases were diagnosed by skin biopsies and next-generation sequencing (NGS) of alveolar lavage fluid, respectively. Twenty cases received antifungal therapy. Twelve cases (52.2%) died at last, though 9 of them had received antifungal therapy. Conclusions The clinical manifestations of HIV-negative children with T. marneffei infection were not typical with serious complications and high mortality rate. Early identification and blood culture and bone marrow culture can improve the detection rate, and fluid NGS, especially alveolar lavage fluid, is a promising detection method. Early detection and timely treatment may help to improve the prognosis of T. marneffei infection.

Key words: Talaromyces marneffei, diagnosis, treatment, child