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Background Talaromyces marneffei (T. marneffei) is a temperature‐dependent dimorphic fungus that is mainly prevalent in Southeast Asia and South China and often causes disseminated life‐threatening infections. This study aimed to investigate the clinical features and improve the early diagnosis of talaromycosis marneffei in nonendemic areas. Methods We retrospectively analyzed the medical records of six cases of T. marneffei infection. We describe the clinical manifestations, laboratory tests, and imaging manifestations of the six patients. Results Talaromyces marneffei infection was confirmed by sputum culture, blood culture, tissue biopsy, and metagenomic next‐generation sequencing (mNGS). In this study, there were five disseminated‐type patients and two HIV patients. One patient died within 24 h, and the others demonstrated considerable improvement after definitive diagnosis. Conclusions Due to the lack of significant clinical presentations of talaromycosis marneffei, many cases may be easily misdiagnosed in nonendemic areas. It is particularly important to analyze the imaging manifestations and laboratory findings of infected patients. With the rapid development of molecular biology, mNGS may be a rapid and effective diagnostic method.

Cryptococcosis is an invasive fungal disease with increased morbidity in China. Cryptococci can infect immunocompromised hosts as well as immunocompetent ones. In this study, we reviewed data of inpatients with cryptococcosis at Ningbo First Hospital from May 2010 to May 2020 and compared the clinical profiles of pulmonary cryptococcosis (PC) and extrapulmonary cryptococcosis (EPC). Of 71 patients enrolled, 70 were non-HIV with dramatically increased prevalence especially in PC. 77.46% of cases were PC confirmed by pathology. The rest were EPC including intracranial infection (15.49%) and cryptococcemia (7.04%). Comparing to PC, a larger proportion of EPC patients were found to have immunocompromised conditions including predisposing factors (p<0.01), or detectable humoral or cellular immunodeficiency. Fever and headache were more common in EPC patients (p<0.001). Patients with EPC had lower serum sodium level (p=0.041), lower monocyte counts (p=0.025) and higher C-reactive protein (p=0.012). Cryptococcal antigen tests for serum and cerebrospinal fluid showed 100% sensitivity in diagnosing EPC while serum lateral flow assay (LFA) tested negative in 25% of PC. All in all, underlying immunocompromised conditions may predict dissemination in PC without HIV which can be identified by LFA.

Carbapenem-resistant bacterial infections pose an urgent threat to public health worldwide. Horizontal transmission of the -lacatamase Klebsiella pneumoniae carbapenemase (blaKPC) multidrug resistance gene is a major mechanism for global dissemination of carbapenem resistance. Here, we investigated the effects of baicalein, an active ingredient of a Chinese herbal medicine, on plasmid-mediated horizontal transmission of blaKPC from a meropenem-resistant K. pneumoniae strain (JZ2157) to a meropenem-sensitive Escherichia coli strain (E600). Baicalein showed no direct effects on the growth of JZ2157 or E600. Co-cultivation of JZ2157 and E600 caused the spread of meropenem resistance from JZ2157 to E600. Baicalein at 40 and 400 g/mL significantly inhibited the spread of meropenem resistance. Co-cultivation also resulted in plasmid-mediated transmission of blaKPC from JZ2157 to E600, which was inhibited by baicalein. Therefore, baicalein may be used in clinical practice to prevent or contain outbreaks of carbapenem-resistant infections by inhibiting the horizontal transfer of resistance genes across bacteria species.

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