PDF(Pubmed)
Abstract：
Disseminated ankle mycosis is a life-threatening systemic infection caused by the emerging opportunistic and lethal fungal pathogen Talaromyces marneffei which is more common in HIV-positive patients. However, an increasing number of infections are occurring in HIV-negative patients. Here, we report a case of Talaromyces marneffei infection in HIV-negative patient. A 50s HIV-negative male patient with fever, cough, bloody sputum expectoration, pulmonary sarcoidosis and body rashes was hospitalized at Zhejiang Provincial People\'s Hospital. CT scanning showed pulmonary multiple nodules with apical bronchial occlusion, patchy infiltration and pathological biopsy demonstrated bronchiolitis obliterans with organized pneumonia and chronic active inflammation of lung tissue with infiltration of numerous lymphocytes, plasma cells, phagocytes and neutrophils. Laboratory tests revealed significantly increased white blood cells count 18.3 ×109/L, neutrophil count 15.34 ×109/L, monocyte count 0.66 ×109/L, platelet count 517 ×109/L, C-reactive protein 116 mg/L, erythrocyte sedimentation rate 112mm/h. The β-D-glucan test was negative (33.06 pg/mL) while fungal culture of broncho alveolar lavage fluid revealed colonies with temperature-dependent dimorphic growth character and Talaromyces marneffei was confirmed by ITS sequencing of the colonies. The patient exhibited radiological improvement and clinical recuperation after intravenously guttae of voriconazole. Talaromycosis in immunocompetent and HIV-negative individuals is relatively rare and is characterized by an insidious onset, various clinical manifestations, and is clinically challenging. Fungal culture and ITS sequencing are warranted for diagnosis Talaromyces marneffei infection. This is the first report on identification of Talaromyces marneffei infection in an HIV-negative patient with skin involvement by ITS sequencing in Zhejiang.
摘要：
播散性踝部真菌病是由新兴的机会性和致死性真菌病原体马尔尼菲Talaromyces引起的危及生命的全身性感染，在HIV阳性患者中更为常见。然而,越来越多的感染发生在HIV阴性患者中。这里,我们报告了一例HIV阴性患者的马尔尼菲塔拉菌感染病例。一名50多岁的HIV阴性男性发烧患者，咳嗽,血痰咳痰,在浙江省人民医院住院的肺结节病和皮疹。CT扫描显示肺部多发结节伴心尖支气管闭塞，斑片状浸润和病理活检显示闭塞性细支气管炎伴组织性肺炎和肺组织慢性活动性炎症伴大量淋巴细胞浸润，浆细胞,吞噬细胞和中性粒细胞。实验室检查显示白细胞计数显著增加18.3×109/L,中性粒细胞计数15.34×109/L,单核细胞计数0.66×109/L,血小板计数517×109/L,C反应蛋白116mg/L,红细胞沉降率112mm/h。β-D-葡聚糖试验为阴性（33.06pg/mL），而支气管肺泡灌洗液的真菌培养物显示菌落具有温度依赖性的双态生长特性，并且通过对菌落的ITS测序证实了马尔尼菲塔拉酵母。静脉注射伏立康唑后，患者表现出放射学改善和临床恢复。在有免疫能力和HIV阴性的个体中，塔拉真菌病相对罕见，其特征是发病隐匿。各种临床表现，并且在临床上具有挑战性。真菌培养和ITS测序对于诊断马尔尼菲塔拉酵母感染是必要的。这是浙江通过ITS测序鉴定HIV阴性患者皮肤受累的马尔尼菲塔拉菌感染的第一份报告。
