Disseminated Talaromyces Marneffei Associated With Nontuberculous Mycobacteria Infection In A Human Immunodeficiency Virus-negative Patient:Report Of One Case And Literature Review

Objective:To study the clinical features and curative effect of rare disseminated T.marneffei associated with NTM infection in HIV negative patients,and improve the understanding of this type of disease,and achieve early diagnosis,early treatment.Methods:The clinical presentation,laboratory examination,treatment and prognosis of disseminated T.marneffei associated with NTM infection in HIV negative patient in our hospital were analyzed retrospectively in our study and were discussed on the basis of the review of relevant literatures at home and abroad.Design:Case report.Results:The clinical characteristics of this patient:1.A middle-aged woman came from Guangxi Province,without underlying diseases.2.She complained of fever,cough,chest pain and multiple skin lumps with long course at presentation.3.For the first time,T.marneffei was cultivated from the skin tissue,subcutaneous abscess and blood,Burkholderia cepacia was cultivated from blood.For the second time,acid-fast bacilli was found from the brush smear and bronchoalveolar lavage fluid,mycobacteria was found from the mucosal biopsy.Afterwards,she went to the Fourth People's Hospital of Nanning,the counts of T cell subset were detected in normal range,the culture of bronchoalveolar lavage fluid was showed NTM.The last time,the CD4~+T-cell counts,CD8~+T-cell counts,and CD4/CD8 ratio were decreased.HIV-antibody was negative.4.Her condition was changeable,her treatment was ineffective.Conclusions 1.T.marneffei and NTM are common infections in HIV postive patients,there are rare reports about disseminated T.marneffei associated with NTM infection in HIV negative patients without underlying diseases.2.For HIV-negative opportunistic infections,T cell subsets need to be monitored,T-cell dysfunction and immune deficiency or injury factors should be investigated,the anti-IFN-?antibody and related genes are tested if condition permits.3.T.marneffei and NTM should be identified with lung cancer and tuberculosis,and etiological detection should be carried out as early as possible.Strain identification should be performed for the patients with positive acid-fast bacilli.4.For CD4~+T cell depletion,treatment is mainly to prevent and treat opportunistic infections,and increase CD4~+T cell counts.