Table 1.
Reported coinfection cases of T. marneffei or P. jirovecii in children.
| No. | Sex | Age | Mixed infections | Methods | Clinical features | Genetic mutation | Antimicrobial treatments | Outcome | Ref. |
|---|---|---|---|---|---|---|---|---|---|
| P1 | M | 1y2m |
T. marneffei, P. jirovecii, S. pneumoniae |
Smear Culture PCR mNGS |
Fever, cough, shortness of breath, trachyphonia, laryngitis, pneumonia | STAT1 mutation | ITZ, TMP-SMX, Ceftriaxone, Cefoperazone sodium sulbactam sodium | Improved | This study |
| P2 | F | 7y11m | T. marneffei, S. pneumoniae, H. influenzae, Moraxella catarrhalis, EBV | Smear Culture mNGS |
Fever, pneumonia, weight loss, skin lesions, CMC, hepatosplenomegaly, lymphadenopathy | STAT1 mutation | VCZ, ITZ, AmB, Isoniazid, Fluconazole, Rifampicin, Pyrazinamide, Linezolid | Improved | (7) |
| P3 | M | 8y6m | T. marneffei, Candida albicans, M. catarrhalis, H. influenzae, Staphylococcus aureus, RHV | Smear Culture mNGS |
Fever, pneumonia, weight loss, CMC, osteolytic lesions, lymphadenopathy, hepatosplenomegaly, lymphopenia | STAT1 mutation | VCZ, ITZ | Improved | (7) |
| P4 | F | 2y4m | T. marneffei, M. pneumoniae, EBV | Smear Culture PCR |
Fever, weight loss, lower limbs swelling, hemophagocytic syndrome, hepatosplenomegaly | – | VCZ | Improved | (8) |
| P5 | F | 9y1m | T. marneffei, Candida spp., M. tuberculosis, EBV | – | Lymphadenectasis, chronic lung disease, hepatosplenomegaly, hypothyroidism | STAT1 mutation | ITZ, AmB, SMX, Oseltamivir | Improved | (9) |
| P6 | M | 1y5m | T. marneffei, K. pneumoniae, Enterobacter cloacae, Burkholderia cepacian, CMV | Smear Culture mNGS |
Fever, pneumonia, weight loss, thrush, diarrhea, hepatomegaly, hepatic failure, ARDS | ADA mutation | VCZ, AmB, Isoniazid, Rifampicin | Death | (7) |
| P7 | M | 1y1m | T. marneffei, Salmonella typhimurium, CMV | Smear Culture mNGS |
Fever, pneumonia, weight loss, hypothyroidism, hepatosplenomegaly, lymphadenopathy | CD40LG mutation | VCZ, ITZ, AmB | Death | (7) |
| P8 | F | 2y5m | T. marneffei, M. pneumoniae | Smear Culture mNGS |
Fever, pneumonia, weight loss, intracranial infection, respiratory failure, lymphadenopathy | STAT3 mutation | VCZ, ITZ, AmB, Micafungin, Isoniazid, Rifampicin, Pyrazinamide | Death | (7) |
| P9 | M | 8m | T. marneffei, RHV | Smear Culture mNGS |
Fever, pneumonia, hematuresis, rash, edema, diarrhea, hepatosplenomegaly | IL2RG mutation | VCZ, ITZ, AmB | Death | (7) |
| P10 | M | 4m | T. marneffei, Candida parapsilosis, M. Tuberculosis, RHV | Smear Culture mNGS |
Fever, pneumonia, weight loss, MODS, peritonitis hepatosplenomegaly, HLH | IL2RG mutation | VCZ, Isoniazid, Rifampicin, Pyrazinamide, Linezolid | Death | (7) |
| P11 | M | 4m | T. marneffei, C. albicans, K. pneumoniae, Escherichia coli, P. aeruginosa, HBV | Smear Culture PCR |
Erythema and papules on whole-body skin | – | VCZ | Death | (8) |
| P12 | F | 3.5m | T. marneffei, C. albicans, Staphylococcus hominis., HSV | Smear Culture PCR |
Fever, weight loss, hepatosplenomegaly, swelling in lower limbs, hemophagocytic syndrome | – | VCZ | Death | (8) |
| P13 | M | 2y4m | T. marneffei, C. albicans | Smear Culture PCR |
Fever, cough, weight loss, gasp, aerothorax, empyema | – | VCZ | Death | (8) |
| P14 | F | 2y | T. marneffei, S. pneumoniae | Culture | Fever, cough, abdominal, jaundice | STAT3 mutation | VCZ, AmB | Death | (10) |
| P15 | M | 2y6m | T. marneffei, C. tropicalis | Smear Culture PCR |
Fever, weight loss, bellyache, lymph node enlargement, hepatosplenomegaly | – | VCZ | – | (8) |
| P16 | M | 1y7m | T. marneffei, HBV | Smear Culture PCR |
Fever, cough, weight loss, lymph node enlargement (neck, armpit, mediastinal), hemophagocytic syndrome | – | VCZ | – | (8) |
| P17 | M | 4m | P. jirovecii, Stenotrophomonas maltophilia, CMV | mNGS | Fever, cough, pneumonia | CD40LG mutation | SMX, Ganciclovir | Improved | (11) |
| P18 | M | 10m | P. jirovecii, CMV | PCR mNGS |
Fever, cough, tachypnea, cyanosis, diffuse nonsegmental ground glass opacity in both lungs, left axillary lymph node calcification | CD40LG mutation | TMP-SMX, Meropenem, Ganciclovir | Improved | (12) |
| P19 | M | 2m | P. jirovecii, CMV | PCR mNGS |
Fever, scattered bleeding spots and mild skin yellowing, acute laryngitis, hydrocele, cholestatic hepatitis, ITP | – | Dexamethasone, Cefotaxime, Imipenem, Ganciclovir | Improved | (13) |
| P20 | M | 4y6m |
P. jirovecii, M. tuberculosis, CMV |
PCR | Fever, cough, diarrhea, bilateral lungs patchy infiltrates, respiratory failure, NS | – | Cotrimoxazole, Clindamycin, Primaquine, Ganciclovir | Improved | (14) |
| P21 | F | 12y | P. jirovecii, Aspergillus fumigatus | PCR | Acute chest pain, repeated pneumothorax, leukemia | – | ITZ, AmB, TMP-SMX | Improved | (15) |
| P22 | F | 7m | P. jirovecii, RHV | PCR | Fever, upper and lower respiratory tract infection, SCID | – | TMP-SMX | Improved | (16) |
| P23 | M | 9m | P. jirovecii, RHV | PCR | Lower respiratory tract infection, infantile NS | – | TMP-SMX | Improved | (16) |
| P24 | F | 6m |
P. jirovecii, P. aeruginosa
RHV |
PCR | Lower respiratory tract infection, SCID | – | TMP-SMX | Improved | (16) |
| P25 | F | 6m |
P. jirovecii, S. pneumoniae, H. influenzae, RHV |
PCR | Lower respiratory tract infection, asthma | – | TMP-SMX | Improved | (16) |
| P26 | M | 4m |
P. jirovecii, H. influenzae, RHV |
PCR | Lower respiratory tract infection, hyaline membrane disease, pulmonary fibrosis | – | TMP-SMX | Improved | (16) |
| P27 | F | 9m |
P. jirovecii, S. pneumoniae, H. influenzae, M. catharalis, RHV |
PCR | Upper respiratory tract infection, infectious sequelae, asthma | – | TMP-SMX | Improved | (16) |
| P28 | F | 14y | P. jirovecii, A. fumigatus | Smear mNGS |
Fever, cough, diffuse ground glass changes in the bilateral lungs, SLE | – | VCZ, TMP-SMX, Caspofungin acetate | Death | (17) |
| P29 | F | 8m | P. jirovecii, Legionella pneumophila | Culture PCR |
Severe acute respiratory distress syndrome, multiorgan failure, infantile spasm | – | Ceftriaxone, Azithromycin | Death | (18) |
| P30 | F | 1y |
P. jirovecii, P. aeruginosa, S. aureus |
PCR | Fever, Upper and lower respiratory tract infection, Pierre Robin Syndrome | – | TMP-SMX | Death | (16) |
| P31 | F | 3m | P. jirovecii, H. influenzae | PCR | Lower respiratory tract infection, right-sided pleural effusions, cardiopathy | – | TMP-SMX | Death | (16) |
EBV, Epstein-Barr virus; RHV, Rhinovirus; Cytomegalovirus, CMV; HBV, Hepatitis B virus; HSV, Herpes Simplex Virus; PCR, polymerase chain reaction; mNGS, metagenome next-generation sequencing; CMC, chronic mucocutaneous candidiasis; ARDS, acute respiratory distress syndrome; MODS, multiple organ dysfunction syndrome; HLH, hemophagocytic lymphohistiocytosis; ITP, immune thrombocytopenic purpura; NS, nephrotic syndrome; SCID, Severe combined immune deficiency; SLE, Systemic lupus erythematosus; ITZ, itraconazole; TMP-SMX, Trimethoprim-Sulfamethoxazole; VCZ voriconazole; AmB, amphotericin B.