Clinical Analysis Of 11 Cases Of Talaromycosis Of Trachea-bronchus-lung Involvement

Objective: To improve the understanding of Talaromycosis of tracheabronchus-lung involvement.Methods: Retrospective analysis was performed on the clinical data of 11 cases of Talaromycosis of the trachea or bronchus or lung admitted to the First Affiliated Hospital of Guangxi Medical Univers ity from January 1,2013 to January 1,2018.Results:(1)There were 6 males and 5 females in this study.The average age was 52.7 years(31-67 years old).One case was positive for human immunodefic iency virus(HIV)and 10 were HIV-negative.Five cases were misdiagnosed as pulmonary tuberculosis,and one case was misdiagnosed as infectious fever.The clinical manifestations were cough(100%),cough(100%),pleural effus ion(100%),lymphadenopathy(100%),fever(81.1%),weight loss(81.1%),anemia(81.1%),shortness of breath(45.5%),chest pain(36.4%),bone destruction(36.4%),skin rash(27.3%),hemoptysis(9.1%).The median count of leukocytes,neutrophil and lymphocyte counts were 12.88×109/L,8.8×109/L,and 2.03×109/L,respectively.All patients had decreased serum albumin,elevated ESR,and 3 liver function abnormalities,and 1 renal dysfunction.One HIV positive person had 4 CD4+ T cells/?L,and 9 HIV negative patients had a median of 744/?L(65-1202/?L)CD4+ T cells,of which 2 cases had a decrease.Five cases(50%)of Aspergillus galactomannan antigenemia(GM test)of serum were positive,and 3 cases(60%)of GM test of Bronchoalveolar lavage fluid were positive.Chest imaging abnormalities in all cases,including patchy shadows,lumps,cavities,pleural effus ions,mediastinal and hilar lymphadenopathy,etc.By bronchoscopy,tracheal and/or endobronchial lesion as a mass,polyp,nodule,uplift was seen,with or without mucosal edema,hypertrophy,stenosis or occlusion of the lumen,and purulent discharge.The specimen of TM detection inc luded bronchial lavage fluid c ulture(BALF)9/9(100%),bronchial mucosa culture 2/2(100%),lymph node biopsy 1/1(100%),and skin culture 2/3(66.7).%),bronchial mucosa biopsy 4/8(50%),sputum culture 1/9(11.1%),peripheral blood culture 1/10(10%).No TM were detected from Bone marrow culture and biopsy(2 cases)and skin biopsy(2 cases).Pathological features are mainly granulomatous inflammation,purulent inflammation.All patients were treated with antifungal therapy.Initial treatment: 4 patients were treated with amphoteric in B alone,2 patients were treated with voriconazole alone,1 patient were treated with amphotericin B and voriconazole,1 patient were treated with amphoteric in B and itraconazole;3 patients were treated with fluconazole alone with poor results.They were s witched to voriconazole and amphoteric in B,respectively.Maintenance therapy:8 cases of itraconazole 200 mg twice daily,2 cases of voriconazole 200 mg twice daily.Three cases of systemic antifungal treatment were combined with aspiration of amphotericin B.One case received highly active antiretroviral therapy,and one case received antitumor therapy.10 cases were discharged with improvement of their condition,1 case died.Conclusions :1.The clinical manifestations,imaging,and bronchoscopic gross changes of Talaromyces marneffei infection with tracheo-bronchial involvement are lack of specificity.2.Talaromycosis of trachea-bronchus-lung involvement may have the lymphatic endothelium system as the main dissemination pathway,involving local drainage of regional lymph nodes.The positive rate of peripheral blood culture is low,and the local clinical specimens have higher TM detection rate.3.Bronchoscopy is an indispensable means of examination and Bronchial lavage fluid,bronchial mycology and pathology are reliable definitive diagnosis methods.GM test examination is conducive to identification.4.Antifungal therapy of Talaromycosis of trachea-bronchus-lung involvement inc ludes systemic treatment and nebulizer inhalation.Patients with timely diagnosis and effective treatment have a better prognosis.