Rationale: Talaromyces marneffei causes life-threatening opportunistic fungal infections in immunocompromised patients. It often has a poorer prognosis in non-human immunodeficiency virus (HIV)-infected than in HIV-infected individuals because of delayed diagnosis and improper treatment.Patient concerns: A 51-year-old man presented with complaints of pyrexia, cough, and expectoration that had lasted for 15 day. This patient has been taking anti-rejection medication since kidney transplant in 2011.

Observational studies and randomized controlled studies propose that vitamin D plays a significant role in preventing acute respiratory tract infection (RTI); however, results are inconsistent and the optimal serum 25-hydroxyvitamin D (25-OH-D3) concentration remains unknown. This study explores the risk factors associated with acute RTI in patients with chronic kidney disease (CKD) and analyzes its correlation with serum 25-OH-D3 levels, to provide appropriate preventive treatment measures for CKD patients complicated with acute RTI. Seventy cases of CKD patients treated in the department of nephrology of Jiangxi Provincial People’s Hospital are recruited as the research objects and divided into a control group (CKD without RTI) and an observation group (CKD with RTI), with 35 cases in each group. The laboratory indexes and serum 25-OH-D3 levels are compared between the two groups. The area under the receiver operating characteristic curve (ROC) of 25-OH-D3 in the diagnosis of CKD patients complicated with RTI is 0.892, and the standard error is 0.038. The glomerular filtration rates (GFR) are 48.32 ± 9.87   mL / min and 50.18 ± 20.71   mL / min in the control group and the experimental group, respectively, with no statistical significance between the two groups ( P > 0.05 ). The serum 25-OH-D3 content in the control group ( 35.08 ± 6.2   nmol / L ) is dramatically higher than that in the observation group ( 20.71 ± 5.87   nmol / L ) ( P < 0.05 ). The proportion of patients with diabetes mellitus (DM) in the control group and observation group is 25.71% and 68.57%, respectively, with a considerable difference ( P < 0.05 ). In the control group and the experimental group, the proportion of patients with oral vitamin D receptor agonists is 54.29% and 11.43%, respectively, and the difference is significant ( P < 0.05 ). Results show that the serum 25-OH-D3 level is highly correlated with the occurrence of RTI in CKD patients. In addition, it is related to patients’ age, DM, and vitamin D receptor agonists.

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We present the case of a microscopic polyangiitis (MPA) patient who developed strongyloidiasis, nocardia and citrobacter freundii (CF) infection after corticosteroides and immunosuppressant therapy. When digestive, respiratory or other system symptoms consecutively occur in a immunocompromised host who lives in tropical or temperate zone and have close contact with soil, we should take strongyloidiasis into consideration despite absence of eosinophilia. Mixed infection with nocardia cannot be easily excluded. It is essential to search for the etiology proof with multiple approaches positively and repeatedly.