Case Study: Talaromyces Marneffei in a Child with AIDS

Talaromyces Marneffei (Penicillium marneffei, T.marneffei) has been frequently reported in patients with adult acquired immunodeficiency syndrome. Still, cases of children with HIV combined with T.marneffei infection are very rare. Researchers from China report an interesting case of a 7-year-old girl with AIDS from China, who was infected with T.marneffei.

The child presented with fever and paroxysmal abdominal pain to the Emergency room. On examination, the child was noted to have ecchymosis of the left lower extremity and clusters of firm, tender lymph nodes measuring 4-7mm were palpable around the jaw, neck, armpits, and groin. On abdominal examination, there was distension with hepatosplenomegaly. The child was started on cefoperazone-sulbactam and other supportive medications. Detailed medical history was remarkable for the mother being HIV positive at the time of birth and did not receive antiretroviral therapy; also, the child was neither diagnosed nor treated at birth.

Investigations revealed:

• Anemia (Hb: 9.7 gm%)
• Leucopenia and normal platelet count
• Decreased CD3, CD4, and CD8 counts
• Elevated cytokines and IFN-gamma levels
• Deranged liver function tests
• Abnormal coagulation profile with elevated D-dimer and FDP values

Chest and whole abdomen CT showed:

• Multiple enlarged lymph nodes in the abdomen, pelvic cavity, bilateral inguinal region, and axillary region
• Cholecystitis with effusion in the gallbladder fossa
• Lower lobe infection of both lungs
• Bilateral pleural, abdominal, and pelvic effusion

Hence, the patient additionally received:

• Creatine phosphate to nourish the myocardium
• Reduced glutathione to protect the liver
• Oral ursodeoxycholic acid to treat cholestasis
• Albumin infusion to correct hypoproteinemia
• Infusion of fresh frozen plasma 200 ml
• Platelet treatment volume to improve coagulation function

Clinical laboratory screening was positive for HIV by ELISA, which was confirmed by Western Blot. Talaromyces Marneffei was seen in peripheral blood smear and bone marrow smear, and blood culture confirmed the growth of the same organism.

With the treatment, the child did not show any signs of improvement and developed multiple episodes of bloody stools. The child's family refused all treatment and signed the consent to withdraw treatment, after which the child was discharged. Follow-up showed the patient died 3 days after discharge.

Penicillosis (caused by T.marneffei) is the second most common invasive deep mycosis of AIDS patients in southern China and Southeast Asia. T.marneffei mainly invades the reticuloendothelial system, and the main clinical manifestations of these patients are fever, anemia, respiratory symptoms, weight loss, hepatosplenomegaly, systemic lymphadenopathy, and skin damage. Childhood AIDS patients with T.marneffei are not typical in clinical practice. After children are infected with T.marneffei, the disease develops very rapidly, and the mortality rate significantly increases.

Authors conclude: "This case suggested that children with AIDS suffering from fever, lymphadenopathy, and coagulation dysfunction, penicilliosis should be suspected. Clinicians should diagnose the disease early through laboratory and imaging results, which can help reduce the mortality, prolong the survival time, and improve the quality of life of children."

Source: BMC Pediatrics.