目的 探讨儿童重症监护室(pediatric intensive care unit,PICU)收治的马尔尼菲篮状菌(Talaromyces marnef-fei,TM)感染患儿的临床资料,以期提高儿童TM感染的诊疗水平.方法 回顾性分析2013年1月—2022年12月中国南方4家医院PICU诊治的23例TM感染患儿的临床资料,包括临床特征、实验室检查、治疗方案及转归.结果 23例患儿中,男14例,女9例,中位年龄24个月,起病至入室时间15(10～30)d,1例存在免疫缺陷病.常见症状为发热(91.3%,21例)、咳嗽(78.3%,18例)和肝脾肿大(78.3%,18例).严重临床并发症包括多器官功能障碍(69.6%,16例),脓毒性休克(65.2%,15例)及急性呼吸窘迫综合征(65.2%,15例).所有患者C-反应蛋白(C-reactive protein,CRP)升高,69.2%(9/13)G试验阳性,53.3%(8/15)免疫球蛋白E升高,17.6%(3/17)CD4/CD8倒置,84.2%(16/19)自然杀伤细胞细胞减少.HIV检测均阴性.TM最常通过血液及骨髓培养检出.7例通过基因检测诊断免疫缺陷.采用两性霉素B或伏立康唑单药,或联合用药改口服续贯治疗,最终13例(56.5%)患儿死亡.结论 HIV阴性儿童TM感染临床表现不典型,入住重症监护室者病情进展快,严重并发症多,死亡率高.多途径、多手段检测TM,结合免疫功能及基因检测,有助于早诊断.抗真菌治疗策略有待深入研究.
Clinical characteristics of children with Talaromyces marneffei infection in the intensive care unit
Objective To explore the clinical data of children with Talaromyces marneffei(TM)infection admitted to the pediatric intensive care unit(PICU)to improve the diagnosis and treatment of TM infection in children.Methods The clinical data of 23 children with TM infection treated in four PICUs in southern China from January 2013 to December 2022 were retrospectively analyzed,including clinical characteristics,laboratory tests,treatment regimens,and outcomes.Results Among the 23 children,there were 14 boys and 9 girls,with a median age of 24 months.The time from onset to admission was 15(range 10-30)days,and one patient had immunodeficiency disease.Common symptoms included fever(91.3%,21 cases),cough(78.3%,18 cases),and hepatosplenomegaly(78.3%,18 cases).Severe clinical complications included multiorgan dysfunction(69.6%,16 cases),septic shock(65.2%,15 cases),and acute respiratory distress syndrome(65.2%,15 cases).All patients elevated CRP levels,and 69.2%(9/13)had a positive G test.Elevated IgE levels were observed in 53.3%(8/15)cases,CD4/CD8 inversion in 17.6%(3/17)cases,and reduced NK cells in 84.2%(16/19)cases.HIV tests were negative in all cases.TM was most frequently detected by blood and bone marrow cultures.Seven cases were diagnosed with immunodeficiency by genetic testing.With monotherapy or combination of amphotericin B or/and voriconazole,followed by oral medication,13(56.5%)children died.Conclusions TM infection is clinically atypical in HIV-negative children,and patients admitted to PICU have rapidly deteriorated,with severe complications and a high mortality rate.Early use of multiple samples,and multiple methods to detect TM,combined with immune function and genetic test,is helpful to early diagnosis.The antifungal treatment strategies still need further study.
Talaromyces marneffeimultiple organ dysfunction syndromechildrenintensive care unitrespiratory system
万方数据
维普
