Abstract：
Knowledge about the clinical characteristics and prognostic factors of Talaromyces marneffei infection in children is limited, especially in HIV-positive children. We performed a retrospective study of all HIV-positive pediatric inpatients with T. marneffei infection in a tertiary hospital in Southern China between 2014 and 2019 and analyzed the related risk factors of poor prognosis using logistic regression. Overall, 28 cases were enrolled and the prevalence of talaromycosis in AIDS children was 15.3% (28/183). The median age of the onset was 8 years (range: 1-14 years). The typical manifestation of skin lesion with central umbilication was not common (21.4%). All the children had very low CD4+ cell counts (median 13.5 cells/μL, range: 3-137 cells/μL) on admission. 92.9% children were misdiagnosed and talaromycosis was only noted after positivity for HIV infection. 89.3% diagnoses of T. marneffei infections were based on positive blood cultures, with a long culture time (median 7 days, range from 3-14 days). The sensitivity of fungus 1,3-β-D-glucan assay was 63.2%. Amphotericin B was superior to itraconazole in the induction antifungal therapy of talaromycosis in HIV-positive children. A six-month follow-up revealed a 28.6% mortality. Lower ratio of CD4+/CD8+ and amphotericin B treatment not over 7 days predicted poor prognosis. Our retrospective study provided an overview and update on the current knowledge of talaromycosis in HIV-positive children. Pediatricians in endemic areas should be aware of mycoses to prevent misdiagnosis. 1,3-β-D-glucan assay did not show optimal sensitivity. Amphotericin B treatment over 7 days can improve poor prognosis.
摘要：
对儿童马尔尼菲塔拉菌感染的临床特征和预后因素的了解有限，尤其是HIV阳性儿童。我们对2014-2019年中国南方某三甲医院所有HIV阳性合并马尔尼菲梭菌感染的儿科住院患者进行回顾性研究,采用logistic回归分析不良预后的相关危险因素。总的来说,共纳入28例，艾滋病儿童中的talarycosis患病率为15.3％（28/183）。发病年龄中位数为8岁（范围：1-14岁）。典型的表现为皮肤病变伴中央脐部畸形并不常见(21.4%)。所有儿童的CD4+细胞计数都很低（中位数为13.5细胞/μL，范围：3-137个细胞/μL）。92.9％的儿童被误诊，仅在HIV感染阳性后才发现距骨真菌病。89.3%的马尔尼菲氏杆菌感染诊断是基于血培养阳性，培养时间长(中位数为7天，范围从3-14天)。真菌1,3-β-D-葡聚糖检测的灵敏度为63.2%。两性霉素B在HIV阳性儿童talaryomcosis的诱导抗真菌治疗中优于伊曲康唑。六个月的随访显示死亡率为28.6%。CD4+/CD8+和两性霉素B治疗不超过7天的较低比率预测预后不良。我们的回顾性研究提供了对HIV阳性儿童talarycosis的最新知识的概述和更新。流行地区的儿科医生应意识到真菌病，以防止误诊。1,3-β-D-葡聚糖测定未显示最佳灵敏度。两性霉素B治疗7天以上可改善不良预后。
