Objective To explore the clinical features,treatment and prognosis of Talaromyces marneffei(TM) infection in non-HIV-associated children.Methods The clinical data of 9 HIV-negative pediatric patients with TM infection who were admitted to Department of Pediatrics,the First Affiliated Hospital of Guangzhou Medical University from October 2015 to October 2023 were retrospectively analyzed.The clinical data of the pediatric patients included clinical manifestations,lung imaging,pathogen detection,histopathological features,treatment and prognosis.Results Among the 9 non-HIV-associated pediatric patients with TM infection,the most patients were male,with a median age of 40(3-164)months.The main clinical manifestations of the pediatric patients included fever,cough,large superficial lymph nodes,skin rash,hepatosplenomegaly,abdominal pain or rare diarrhea.Elevated C-reactive protein,procalcitonin and erythrocyte sedimentation rate,with a decrease in hemoglobin were found in most of the pediatric patients.Immunoglobulin G and immunoglobulin A levels were reduced to varying degrees in 8 pediatric patients with TM infection.The results of chest computed tomography(CT) scan showed diffuse or solid lesions in the lungs of the pediatric patients.The TM culture of sputum/blood showed positive results in 8 pediatric patients.Six pediatric patients underwent bronchoscopic lung tissue biopsy( one of them undergoing lymph node biopsy simultaneously),and among the 6 pediatric patients,2 pediatric patients had granulation tissue formation in lung tissue pathology,and 1 pediatric patient had circular or sausage-like and spore-like substance with transverse septate in lymph node and lung tissue cytoplasm,and the other 3 pediatric patients had non-specific inflammatory lesion tissues in lung tissue pathology.Eight pediatric patients underwent whole-exome sequencing,and 5 of them were found to have clear pathogenic genes.All the 9 pediatric patients were treated with intravenous voriconazole in the initial treatment,among whom 4 pediatric patients had a good prognosis,and 2 pediatric patients were improved after switching to amphotericin B treatment,and 3 pediatric patients died due to disease progression.Conclusion The onset of TM in non-HIV-associated pediatric patients is obscure and the course of the disease is long,so attention should be paid to the tracking of the primary disease in the pediatric patients.Blood and bronchoalveolar lavage fluid culture can help to diagnose TM infection as early as possible,and antifungal treatment as early as possible can improve the prognosis.
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