背景：马尔尼菲塔拉酵母(T.marneffei）感染与由于抗IFN-γ自身抗体引起的成人发作性免疫缺陷有关。我们旨在调查中国南方非HIV感染的马尔尼菲感染患者的临床特征。
方法：在2018年1月至2020年9月之间，我们招募了HIV阴性的马尔尼菲氏杆菌感染患者（TM组，n=42),包括抗IFN-γ自身抗体阳性（TMP组，n=22)和抗IFN-γ自身抗体阴性(TMN组，n=20）患者和健康对照（HC组，n=40)。通过ELISA检测抗IFN-γ自身抗体。记录临床特征和临床实验室参数。
结果：与抗IFN-γ自身抗体阴性的马尔尼菲感染患者相比，抗IFN-γ自身抗体阳性的患者没有潜在的呼吸系统疾病；更频繁地表现出全身感染的传播，伴有严重的胸腔积液；有更高的白细胞计数，C反应蛋白水平,红细胞沉降率，中性粒细胞和CD8+T细胞计数;血红蛋白水平较低;并且更可能有其他细胞内病原体感染。尽管进行了标准化的抗菌治疗，但大多数患者的预后较差。
结论：T.抗IFN-γ自身抗体滴度较高的马内菲感染患者的疾病更严重，临床状况更复杂。
BACKGROUND: Talaromyces marneffei (T. marneffei) infection has been associated with adult-onset immunodeficiency due to anti-IFN-γ autoantibodies. We aimed to investigate the clinical features of non-HIV-infected patients with T. marneffei infection in southern China.
METHODS: Between January 2018 and September 2020, we enrolled patients with T. marneffei infection who were HIV-negative (group TM, n = 42), including anti-IFN-γ autoantibody-positive (group TMP, n = 22) and anti-IFN-γ autoantibody-negative (group TMN, n = 20) patients and healthy controls (group HC, n = 40). Anti-IFN-γ autoantibodies were detected by ELISA. Clinical characteristics and clinical laboratory parameters were recorded.
RESULTS: Compared with anti-IFN-γ autoantibody-negative patients with T. marneffei infection, anti-IFN-γ autoantibody-positive patients did not have underlying respiratory disease; more frequently exhibited dissemination of systemic infections with severe pleural effusion; had higher WBC counts, C-reactive protein levels, erythrocyte sedimentation rates, and neutrophil and CD8+ T cell counts; had lower hemoglobin levels; and were more likely to have other intracellular pathogen infections. Most of these patients had poor outcomes despite standardized antimicrobial therapy.
CONCLUSIONS: T. marneffei-infected patients with higher anti-IFN-γ autoantibody titers have more severe disease and complex clinical conditions.
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