HIV阴性儿童马尔尼菲篮状菌病2例临床分析并文献复习

 目的 总结2例人类免疫缺陷病毒（HIV）阴性儿童马尔尼菲篮状菌病（TSM）患儿的临床特征。方法 分析某儿童医院收治的2例HIV阴性TSM患儿的临床特点及实验室资料、存在的基础疾病，并复习相关文献，总结TSM感染患儿的临床特征及诊治经验。结果 2例HIV阴性TSM患儿中病例1以右下肢肿块为首发症状，1个月余后才出现发热及咳嗽，误诊为结核感染；病例2以发热、三系减少及肝脾、淋巴结大等表现起病。病例1行基因检测为STAT1基因突变，病例2有反复灰指甲及口腔溃疡病史，均行血、骨髓培养及淋巴结活检确诊。病例1先后予以伏立康唑、两性霉素B脂质体静脉滴注，伊曲康唑口服维持治疗，共治疗1年后停药；病例2一直予以伏立康唑治疗（先静脉滴注后口服），共7个月后停药，均无复发。结论 TSM可发生在HIV阴性儿童，且可存在STAT1基因突变。对于治疗效果差的患儿，应尽早行培养或组织活检以明确诊断，并积极查找TSM可能存在的基础疾病，以到达早期诊断、早期治疗和改善预后的目的。

Clinical analysis of Talaromycesis marneffei in HIV-negative children: 2 case report and literature review

Objective To summarize the clinical characteristics of 2 cases of human immunodeficiency virus (HIV)-negative children suffered from Talaromycesis marneffei (TSM). Methods Clinical characteristics, laboratory data and underlying diseases of 2 HIV-negative children with TSM and treated in a children''s hospital were analyzed, relevant literatures were reviewed to summarize the clinical characteristics as well as diagnosis and treatment experience of children with TSM. Results Among 2 HIV-negative children with TSM, case 1 presented the initial symptom of mass in the right lower limb, developed fever and cough more than 1 month later, and was misdiagnosed as tuberculosis infection; case 2 began with fever, with pancytopenia, hepatosplenomegaly and lymph node enlargement. Gene test of case 1 presented STAT1 gene mutation, case 2 had a history of recurrent onychomycosis and oral ulcer, which were confirmed by blood, bone marrow culture and lymph node biopsy. Case 1 was treated with intravenous drip of voriconazole and amphotericin B liposome as well as oral medications of itraconazole for maintenance therapy, medication was stopped after 1 year of treatment; case 2 had been treated with voriconazole (intravenous drip first, then oral medication) for 7 months, and there was no recurrence. Conclusion TSM can occur in HIV-negative children, and there may be STAT1 gene mutation. For children with poor treatment effect, culture or tissue biopsy should be performed as early as possible to make a confirmed diagnosis, and actively find the possible underlying diseases of TSM, so as to achieve early diagnosis, early treatment and prognosis improvement.