HIV阴性患者（特别是儿童和血液系统恶性肿瘤患者）中肺孢子菌病研究进展：一篇综述
Advances in the understanding of talaromycosis in HIV-negative patients (especially in children and patients with hematological malignancies): A comprehensive review
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影响因子:2.3
分区:医学3区 / 兽医学2区 传染病学3区 真菌学3区
发表日期:2024 Oct 04
作者:
Haiyang He, Liuyang Cai, Yusong Lin, Fangwei Zheng, Wanqing Liao, Xiaochun Xue, Weihua Pan
DOI:
10.1093/mmy/myae094
摘要
肺孢子菌（Talaromyces marneffei，T. marneffei）是唯一能在哺乳动物（包括人类）中引起热相变的真菌，属于子囊菌门（Ascomycota）、Eurotium属、Fungiaceae科及蓝藻类。该真菌在自然环境中以腐生方式繁衍，当温度达到37°C时转变为致病性酵母菌相。历史上，肺孢子菌病主要与人类免疫缺陷病毒（HIV）/获得性免疫缺陷综合征（AIDS）相关，被列为AIDS的三大机会性感染之一，伴随结核病和隐球菌病。随着HIV/AIDS的治疗和控制措施的不断进步，HIV感染者中肺孢子菌病的发病率逐年下降，而非HIV感染者中肺孢子菌病患者的数量持续上升。这些患者具有多种免疫缺陷、恶性肿瘤、自身免疫疾病、器官移植等多样化的风险因素。然而，关于HIV阴性肺孢子菌病患者的临床特征和危险因素的回顾性研究较少，尤其是在儿童和血液恶性肿瘤患者中，导致对这一患者群体的认识不足。因此，本文对HIV阴性肺孢子菌病患者的流行病学、发病机制、危险因素、临床表现、诊断、治疗和预后进行了全面综述，并展望了该疾病的前沿研究方向，旨在提高认识，推动诊断和治疗水平的提升，改善患者预后。
Abstract
Talaromyces marneffei (T. marneffei) stands out as the sole thermobiphasic fungus pathogenic to mammals, including humans, within the fungal community encompassing Ascomycota, Eurotium, Eurotiumles, Fungiaceae, and Cyanobacteria. Thriving as a saprophytic fungus in its natural habitat, it transitions into a pathogenic yeast phase at the mammalian physiological temperature of 37°C. Historically, talaromycosis has been predominantly associated with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), classified among the three primary opportunistic infections linked with AIDS, alongside tuberculosis and cryptococcosis. As advancements are made in HIV/AIDS treatment and control measures, the incidence of talaromycosis co-infection with HIV is declining annually, whereas the population of non-HIV-infected talaromycosis patients is steadily increasing. These patients exhibit diverse risk factors such as various types of immunodeficiency, malignant tumors, autoimmune diseases, and organ transplantation, among others. Yet, a limited number of retrospective studies have centered on the clinical characteristics and risk factors of HIV-negative talaromycosis patients, especially in children and patients with hematological malignancies, resulting in an inadequate understanding of this patient cohort. Consequently, we conducted a comprehensive review encompassing the epidemiology, pathogenesis, risk factors, clinical manifestations, diagnosis, treatment, and prognosis of HIV-negative talaromycosis patients, concluding with a prospectus of the disease's frontier research direction. The aim is to enhance comprehension, leading to advancements in the diagnosis and treatment rates for these patients, ultimately improving their prognosis.