■脓毒症是由宿主对感染的功能失调反应引起的危及生命的疾病。感染性休克,败血症的一个子集,由马尔尼菲塔拉酵母感染(talaromycesmachei)引起的感染很少有报道。由于其培养速度慢,产量低,在HIV阴性患者中,talaryomcosis通常被误诊为其他感染,如肺结核,细菌性肺炎,肺癌,特别是在非流行地区。需要早期和准确的诊断以及有效的治疗方案来改善预后。
一名来自马尔尼菲非流行区的30岁HIV阴性中国妇女最初被误诊为肺结核。她对抗结核治疗反应不佳。2022年7月16日,她入院;患者在住院后第三天出现感染性休克,并最终通过宏基因组下一代测序(mNGS)诊断为塔拉真菌病。
■经两性霉素B适当治疗后,患者病情得到改善。酶联免疫吸附试验结果证实该患者具有高滴度的抗-干扰素γ(IFN-γ)自身抗体.
■具有抗IFN-γ自身抗体的HIV阴性个体通常会复发,耐火材料,和致命的感染,比如塔拉真菌病,通常在疾病的最初过程中被误诊。这可能导致感染性休克。临床医生应该意识到,在非流行地区,他们可能会遇到艾滋病毒阴性的马尔尼菲感染患者。因此,mNGS是检测马尔尼菲感染的有效技术。此外,在这些患者中检测抗IFN-γ自身抗体有助于了解他们对致命感染的易感性.
Sepsis is a life-threatening condition caused by a dysfunctional response to infection from the host. Septic shock, a subset of sepsis, caused by Talaromyces marneffei infection (talaromycosis) has rarely been reported. Owing to its slow culture and low yield, talaromycosis is typically misdiagnosed in HIV-negative patients as other infections, such as tuberculosis, bacterial pneumonia, and lung cancer, especially in non-endemic regions. Early and accurate diagnosis as well as efficient treatment options are required to improve prognosis.
A 30-year-old HIV-negative Chinese woman from a non-endemic area of T. marneffei was initially misdiagnosed with tuberculosis. She had a poor response to anti-tuberculosis treatment. On July 16, 2022, she was admitted to our hospital; the patient developed septic shock on the third day after hospitalization and was ultimately diagnosed with talaromycosis via metagenomic next-generation sequencing (mNGS).
The condition of the patient improved after appropriate treatment with amphotericin B. Furthermore, enzyme-linked immunosorbent assay results confirmed that the patient had a high-titer of anti-interferon gamma (IFN-γ) autoantibodies.
HIV-negative individuals with anti-IFN-γ autoantibodies typically have relapsing, refractory, and fatal infections, such as talaromycosis, which is typically misdiagnosed in the initial course of the disease. This can lead to septic shock. Clinicians should be aware that they may encounter HIV-negative patients with T. marneffei infection in non-endemic areas. Thus, mNGS is an effective technology for detecting T. marneffei infection. Additionally, the detection of anti-IFN-γ autoantibodies in these patients would aid in knowing their susceptibility to fatal infections.