| OBJECTIVE:To analyze the clinical features of host with HIV-negative of no other underlying diseases combined with Talaromyces marneffei(TM)and Non-tuberculous mycobacteria(NTM)infections.METHODS:The clinical datas of two Non-HIV patients without else basic illnes infected with talaromyces marneffei and nontuberculous mycobacterial were reviewed retrospectively from May 2012 to May 2017 in the First Affiliated Hospital of Guangxi Medical University.RESULTS:(1)Two patients were middle-aged women,one had a clear etiology,the other had the basis of TM etiology,accompanied by NTM for clinical diagnosis.all were misdiagnosed as tuberculosis and had a long course of disease(up to 6 years).Symptoms included fever,swollen lymph nodes,osteolytic destruction,skin lesions,and anemia etc.Peripheral blood leukocytes were high,along with low albumin,high ESR and CRP levels,in the meantime,normal values of CD4 T cells and CD8 T lymphocytes.One patient was positive result for anti-Interferon(IFN)-?autoantibodies,the rest of patient was not determined.Pathologically,neutrophil infiltration,suppurative,and granulomatous morphology were observed.Two cases were treated with itraconazole,or amphotericin B liposome for antifungal plan,anti-NTM regimen,including ethambutol,clarithromycin and moxifloxacin,all improved.(2)Literature search results:The search deadline was January 1,2019.3 Chinese and 5 English were gained,10 cases were classified.There were 6 males and 4females,with an average age of 51 years(42-72 years old).The two could be infected simultaneously(5 cases),or the first infected with TM,after NTM infection occured(2 cases),firstly patients,resulting from NTM then,anothers caused by TM infection(3 cases),5 cases were mistaken with tuberculosis.Lymph node enlargement,repeated fever,skin lesions,and osteolytic destruction were the main manifestations.The total number of white blood cells[(16.8~29.08)×10~9/L]were significantly increased,with neutrophils being obvious,as well as ESR,CRP values[respectively(81~113)mm/h,(54.7~192)mg/L]were high,CD4,CD8 cells were maintained in the normal range,autoantibodies against IFN-?were positive in 9 cases,only 1 case was not undertaken.Pathological features are typically seen with granuloma formation and suppurative inflammation.TM specimens were derived from 5 cases of peripheral blood,3 cases of skin lesions,2 cases of BLAF,and 1 case of bone marrow,lymph nodes,sputum and spleen abscess.The positive rate of NTM culture from high level to low degree were:lymph nodes,skin lesions,blood and so on.There were 3 cases of Mycobacterium chelonae,2 cases of Mycobacterium kansasii and Mycobacterium abscessus sepegrately,1 case of Mycobacterium fortuitum,Mycobacterium avium.Antifungal regimens,Containing itraconazole,voriconazole,and fluconazole or combined with amphotericin B for more than half a year.Anti-NTM theraphy were treated with clarithromycin,ethambutol,amikacin,imipenem,and moxifloxacin for about 2years.After treatment,7 recovered,2 continued,and 1 died.CONCLUSION:1?TM?NTM mixed with infection,can be infected simultaneously or successively,HIV-negative,non-fundamental illness hosts may exist potential immunodeficiency diseases,such as the positive result for anti-Interferon-?autoantibodies.2?TM?NTM infection,It is not easy to identify that there appear lymphadenopathy,fever,skin lesion,osteolytic destruction,white blood cells,inflammation indicators increased significantly,together with purulent inflammation,granuloma pathological changes.In which are easily misconsidered as tuberculosis.3?TM has a high positive rate of blood and skin culture,however,NTM has a high positive rate in lymph node,blood and skin culture,and varied mycobacteria can be infected.4?based on clarithromycin combined with moxifloxacin,ethambutol,amikacin,imipenem and other drugs against NTM treatment for about 2 years.Antifungal drugs such as itraconazole,amphotericin B,and voriconazole are effective for at least half a year. |
PDF Full Text Request