A case report of bone marrow smear and culture for the diagnosis of Talaromyces marneffei infection and literature review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

YANG Dan ¹ , SUN Xingcheng ² , HUANG Zhengxia ¹ , ZHANG Yan ¹ ,  QIN Qin ³ ,  ZHANG Wei ⁴

1. Department of Hematology, The First Affiliated Hospital of the Naval Medical University, Changhai Hospital, Shanghai 200433, P. R. China;
2. Department of Physical Emergency, The First Affiliated Hospital of the Naval Medical University, Changhai Hospital, Shanghai 200433, P. R. China;
3. Department of Pathogenic Microorganism, The First Affiliated Hospital of the Naval Medical University, Changhai Hospital, Shanghai 200433, P. R. China;
4. Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of the Naval Medical University, Changhai Hospital, Shanghai 200433, P. R. China;

Corresponding?author：

QIN Qin, Email: qinq78@163.com; ZHANG Wei, Email: zhangweismmu@126.com

Keywords：

Talaromyces marneffei; Bone marrow cell morphology; Bone marrow culture

DOI：

10.7507/1671-6205.201808055

Video：

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Objective To explore the clinical diagnosis and treatment of Talaromyces marneffei (TM) infection by bone marrow examination, and to clarify the important role and significance of bone marrow smear and pathogenic examination.Methods Retrospective analysis was conducted on a case of disseminated TM infection that was clearly diagnosed through bone marrow related examination. Literature review of TM infection was conducted by retrieving relevant case reports at home and abroad from 1990 to 2018.Results The patient was a 23-year-old man with recurrent cough and onset of fever, superficial lymph node enlargement in multiple parts of the body, no abnormal chest CT sign, and poor efficacy in anti-infection treatment. The patient developed progressive abdominal pain, accompanied by systemic papulosis, decreased consciousness, and progressive decline of blood cells. The patient underwent bone marrow puncture surgery in our hospital, and developed circulatory and respiratory failure half an hour after surgery. TM was confirmed bybone marrow smear and pathogenic culture. In the literature review, 2 855 cases of TM infection were retrieved, among which the majority of cases were confirmed through blood and bone marrow related examination. The positive rate of bone marrow culture was significantly higher than that of blood culture (72.4% and 66.8%, respectively, P=0.007). Compared with bone marrow culture, the misdiagnosis and missed diagnosis rate of bone marrow smear microscopy was 27.6%. Patients diagnosed with TM infection by bone marrow examination had the highest HIV positive rate (95.7%).Conclusions The examination of bone marrow cells and the culture are of great clinical significance for the diagnosis of TM infection. TM infection should be identified in patients suspected of HIV positive with fever, lymph node enlargement and abnormal blood routine.

Citation： YANG Dan, SUN Xingcheng, HUANG Zhengxia, ZHANG Yan, QIN Qin, ZHANG Wei. A case report of bone marrow smear and culture for the diagnosis of Talaromyces marneffei infection and literature review. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(3): 236-240. doi: 10.7507/1671-6205.201808055 Copy

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2.	Li JS, Pan LQ, Wu SX, et al. Disseminated penicilliosis marneffei in China. Chin Med J (Engl), 1991, 104(3): 247-251.
3.	Kawila R, Chaiwirith R, Supparatpinyo K. Clinical and laboratory characteristics of penicilliosis marneffei among patients with and without HIV infection in Northern Thailand: a retrospective study. BMC Infect Dis, 2013, 13: 464.
4.	Phuong HT, Tran VC, Nguyen TV, et al. Case of Penicillium marneffei infection in a non-AIDS patient. J Dermatol, 2018, 45(5): e104-e105.
5.	戴小英, 陳歡, 李梅華, 等. 健康宿主馬爾尼菲青霉病肺部受累三例報告并文獻復習. 中國呼吸與危重監護雜志, 2016, 15(1): 12-16.
6.	Vanittanakom N, Cooper CR Jr, Fisher MC, et al. Penicillium marneffei infection and recent advances in the epidemiology and molecular biologyaspect. Clin Microbiol Rev, 2006, 19(1): 95-110.
7.	張德平. 馬內菲青霉病的診斷和治療. 中華結核和呼吸雜志, 2009, 32(8): 634-636.
8.	Wong SS, Wong KH, Hui WT, et al. Differences in clinical and laboratory diagnostic characteristics of penicilliosis marneffei in human immunodeficieney virus (HIV) and non-HIV infected patients. J Clin Microbiol, 2001, 39(12): 4535-4540.
9.	Wu TC, Chan JW, Ng CK, et al. Clinical presentations and outcomes of Penicillium marneffoi infections: a series from 1994 to 2004. Hong Kong Med J, 2008, 14(2): 103-109.
10.	Supparatpinyo K, Khamwan C, Baosoung V, et al. Disseminated Penicillium marneffei infection in southeast Asia. Lancet, 1994, 344(8915): 110-113.
11.	Jiang X, Zhou D. Diagnosis of Penicillium marneffei infection from a blood film. Brit J Haematol, 2015, 171(5): 670.
12.	Nittayananta W. Penieilliosis marnefei: another AIDS defining illness in Southeast Asia. Oral Dis, 1999, 5(4): 286-293.
13.	韋善求, 蘇國生, 蘭江, 等. 免疫缺陷綜合征合并馬爾尼菲青霉病的實驗室診斷研究. 檢驗醫學, 2014, 29(4): 339-341.
14.	Chong YB, Tan LP, Robinson S, et al. Peniclliosis in lupus patients presenting with unresolved fever: a report of 2 cases and literature review. Trop Biomed, 2012, 29(2): 270-276.
15.	盧業成, 鄭師陵, 陳萬山, 等. 骨髓檢查在艾滋病合并播散性馬爾尼菲青霉菌感染早期診斷中的應用. 中華臨床感染病雜志, 2008, 1(2): 69-72.
16.	盧朝輝, 劉鴻瑞, 謝秀麗, 等. 馬爾尼菲青霉菌感染. 中華病理學雜志, 2004, 33(6): 536-540.
17.	林小晶, 孫寅耀. 骨髓涂片檢出馬爾尼菲青霉菌1例. 國際檢驗醫學雜志, 2014, 35(20): 2861-2862.

1. 李菊裳. 馬爾尼菲青霉病真菌學檢查. 中華醫學檢驗雜志, 1997, 20: 73-76.
2. Li JS, Pan LQ, Wu SX, et al. Disseminated penicilliosis marneffei in China. Chin Med J (Engl), 1991, 104(3): 247-251.
3. Kawila R, Chaiwirith R, Supparatpinyo K. Clinical and laboratory characteristics of penicilliosis marneffei among patients with and without HIV infection in Northern Thailand: a retrospective study. BMC Infect Dis, 2013, 13: 464.
4. Phuong HT, Tran VC, Nguyen TV, et al. Case of Penicillium marneffei infection in a non-AIDS patient. J Dermatol, 2018, 45(5): e104-e105.
5. 戴小英, 陳歡, 李梅華, 等. 健康宿主馬爾尼菲青霉病肺部受累三例報告并文獻復習. 中國呼吸與危重監護雜志, 2016, 15(1): 12-16.
6. Vanittanakom N, Cooper CR Jr, Fisher MC, et al. Penicillium marneffei infection and recent advances in the epidemiology and molecular biologyaspect. Clin Microbiol Rev, 2006, 19(1): 95-110.
7. 張德平. 馬內菲青霉病的診斷和治療. 中華結核和呼吸雜志, 2009, 32(8): 634-636.
8. Wong SS, Wong KH, Hui WT, et al. Differences in clinical and laboratory diagnostic characteristics of penicilliosis marneffei in human immunodeficieney virus (HIV) and non-HIV infected patients. J Clin Microbiol, 2001, 39(12): 4535-4540.
9. Wu TC, Chan JW, Ng CK, et al. Clinical presentations and outcomes of Penicillium marneffoi infections: a series from 1994 to 2004. Hong Kong Med J, 2008, 14(2): 103-109.
10. Supparatpinyo K, Khamwan C, Baosoung V, et al. Disseminated Penicillium marneffei infection in southeast Asia. Lancet, 1994, 344(8915): 110-113.
11. Jiang X, Zhou D. Diagnosis of Penicillium marneffei infection from a blood film. Brit J Haematol, 2015, 171(5): 670.
12. Nittayananta W. Penieilliosis marnefei: another AIDS defining illness in Southeast Asia. Oral Dis, 1999, 5(4): 286-293.
13. 韋善求, 蘇國生, 蘭江, 等. 免疫缺陷綜合征合并馬爾尼菲青霉病的實驗室診斷研究. 檢驗醫學, 2014, 29(4): 339-341.
14. Chong YB, Tan LP, Robinson S, et al. Peniclliosis in lupus patients presenting with unresolved fever: a report of 2 cases and literature review. Trop Biomed, 2012, 29(2): 270-276.
15. 盧業成, 鄭師陵, 陳萬山, 等. 骨髓檢查在艾滋病合并播散性馬爾尼菲青霉菌感染早期診斷中的應用. 中華臨床感染病雜志, 2008, 1(2): 69-72.
16. 盧朝輝, 劉鴻瑞, 謝秀麗, 等. 馬爾尼菲青霉菌感染. 中華病理學雜志, 2004, 33(6): 536-540.
17. 林小晶, 孫寅耀. 骨髓涂片檢出馬爾尼菲青霉菌1例. 國際檢驗醫學雜志, 2014, 35(20): 2861-2862.

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