非人类免疫缺陷病毒感染马尔尼菲青霉病9例临床特征分析及文献复习

为探讨和总结非人类免疫缺陷病毒(human immunodeficiency virus，HIV)感染者发生马尔尼菲青霉病的临床特点，回顾性研究复旦大学附属华山医院感染科2007年1月-2017年8月收治的9例及同期发表文献中的马尔尼菲青霉病病例，分析其临床表现、实验室检查、治疗及转归。9例马尔尼菲青霉病患者的HIV检测均为阴性，5例CD4^＋ T细胞计数正常。非HIV感染马尔尼菲青霉病的起病较缓，临床表现与经典马尔尼菲青霉病类似，真菌血症较少见，病理特点以肉芽肿改变及化脓性炎症为主，诊断方法仍以培养为主(8/9)，1例通过病理及二代测序技术诊断。目前，非HIV感染马尔尼菲青霉病发病率有升高趋势，部分发生于免疫正常人群，需引起临床医师的重视。

Clinical characterization of 9 Talaromyces (Penicillium) marneffei cases in non-human immunodeficiency virus patients and literature review

The present paper aims to investigate the clinical characterization of Talaromyces (Penicillium) marneffei cases in non-human immunodeficiency virus (HIV) patients. Nine patients diagnosed as Penicillium marneffei infection at the Department of Infectious Diseases, Huashan Hospital, Fudan University, from January 2007 to August 2017 were retrospectively enrolled. The literatures published during the same time were also reviewed. The clinical presentation, laboratory results, diagnosis and treatment were analyzed. Some patients were immunocompetent. The clinical presentations of Penicillium marneffei infection were similar in non-HIV patients and HIV patients, but most cases had a slow onset, and less fungemia. Pathology was characterized by granuloma and suppurative inflammation. Most patients were diagnosed by culture (8/9), and one patient was diagnosed by pathology and next-generation sequencing. The results suggest that Penicillium marneffei infection in non-HIV patients was increasing, and the physicians should pay more attention.