Abstract
To date, Penicillium marneffei infection has mainly been reported in adults infected with human immunodeficiency virus (HIV); only a limited number of cases have been reported in children. The aim of the article is to study the clinical and laboratory characteristics of P. marneffei in pediatric patients without HIV infection. In this study, the medical records of 10 pediatric patients with P. marneffei infection at Guangzhou Women and Children's Medical Center were evaluated from May 2011 to November 2015. The duration of symptoms before admission ranged from 8 days to 1 month. Fever was found in all 10 patients. Hepatomegaly and splenomegaly were found in 9/10 and 8/10 patients, respectively. Two patients presented with skin lesions. The main life-threatening complications during hospitalization included hemophagocytic syndrome (8/10), acute respiratory distress syndrome (8/10), disseminated intravascular coagulation (DIC) (7/10), and septic shock (6/10). Two of the 10 patients had underlying immunodeficiencies characterized by an absence of IgG and decreased CD4 and CD8 cell counts, respectively. Phagocytosis in the bone marrow was observed in four patients. Eight patients had abnormal chest radiographs. Only two patients showed remission after treatment. The others died of multiple organ failure and DIC on days 1–17 of hospitalization. Our analysis suggests that P. marneffei infection is a severe disease causing high mortality even in infants and children without HIV. Pediatric clinicians should be vigilant in identifying this disease to ensure an early diagnosis and good prognosis. A systematic approach to immunological evaluations in pediatric patients with the disease is required. Further research is necessary to explore the pathogenesis of and appropriate therapy for this infection.
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