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Non-HIV disseminated penicillium marneffei in children: A clinical retrospective analysis of 15 cases

??Objective??To analyze the characteristics of disseminated penicillium marneffei??PSM?? in children and to deepen the understanding of PSM in the context of non-HIV. Methods??The clinical data??treatment program and prognosis of 15 children were retrospectively analyzed??who were diagnosed with non-HIV disseminated PSM in the First Affiliated Hospital of Guangzhou Medical University from Jan. 2005 to June 2016. Results??The 15 children??male??female??9??6?? had a median age of 23 months with a range of 3 months to 4 years and 10 months of age. All of them had clinical manifestations of fever and hepatomegaly on admission??which were often associated with cough??tachypnea??splenomegaly and lymphadenectasis. ESR was elevated by 93.3%??14/15?? in laboratory tests??80%??8/10?? was positive in fungal G tests??and 87.5%??7/8?? in fungal GM tests. Chest imaging studies revealed that the lungs were all involved and showed various forms. Bone marrow culture and lymph node biopsy showed the highest positive rate of PM??more than 90%. The prognosis was related to the duration of the disease and anti-fungal treatment. The duration of the death group??n??7?? was significantly longer than that of the cured group??n??8????P??0.05??. The duration of anti-fungal treatment for death groups was less than 2 weeks with the main death reason of septic shock and multiple organ failure. The cured group was given amphotericin B or voriconazole intravenously 2-4 weeks and later it was changed to itraconazole for oral maintenance??there was no recurrence after six months of follow-up. Conclusion??Non-HIV disseminated PSM in children occurs more often in infants under 3 years of age??and clinical and laboratory diagnosis lack specificity. Multi-site culture or biopsy??especially bone marrow culture and lymph node biopsy?? can help confirm the diagnosis. Patients with long course of disease without timely anti-fungal treatment are associated with infectious shock and multiple organ failure??which are the main cause of death.