A case report of Talaromyces marneffei Oro-pharyngo-laryngitis: a rare manifestation of Talaromycosis

Wongkamhla, Thanyarak; Chongtrakool, Piriyaporn; Jitmuang, Anupop

doi:10.1186/s12879-019-4650-7

Cited by 11 publications

(8 citation statements)

References 23 publications

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“…It is believed that infection with T. marneffei results from the inhalation of fungal conidia into the alveolar spaces within the lungs, and the ability of the fungus to survive the killing process and replicate inside macrophage cells has an important role in its pathogenicity [ 18 , 19 ]. Infection of T. marneffei in those patients with immune dysfunction usually causes fungemia and disseminated disease to various organs involving the skin, lymph nodes, lung, spleen, bone and central nervous system [ 20 , 21 ]. The radiological appearance is variable, including interstitial to alveolar infiltrates, or both, and reticulonodular consolidation [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Talaromyces Marneffei Infection in an HIV-Negative Child with a CARD9 Mutation in China: A Case Report and Review of the Literature

You

et al. 2021

Mycopathologia

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Section: Discussionmentioning

confidence: 99%

Talaromyces Marneffei Infection in an HIV-Negative Child with a CARD9 Mutation in China: A Case Report and Review of the Literature

You

et al. 2021

Mycopathologia

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“…How under-diagnosed are these auto-immune causes of reduced immunocompetency? Whilst other IFN autoantibodies have been implicated in atypical infections, notably non-tuberculous mycobacterial [12] and fungal infection [13], there is a paucity of evidence of anti-IFN-3 autoantibodies causing problems like this case. IFN-3 seems to help the neutrophil immune response [14] and to be of vital importance in mucosal immunity [15, 16].…”

Section: Discussionmentioning

confidence: 99%

Endogenous Klebsiella endophthalmitis as the presentation of both Klebsiella liver abscess and underlying anti-IFN-3 autoimmunity

Castle

Heath

2020

Access Microbiology

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This case study is one of the first ever reported examples of infection in a patient with anti-IFN-3 autoimmunity and demonstrates how overwhelming infection can sometimes present with visual symptoms. We report the case of a previously fit middle-aged patient presenting with painless loss of vision and loss of appetite. Examination showed choroidal abscess and a pan-uveitis, leading to admission for vitreous biopsy. Klebsiella pneumoniae was isolated both in the vitreous and in blood cultures. Subsequent investigation discovered a liver abscess which was treated with percutaneous drainage. Despite the administration of intravitreal antibiotics from the time of presentation, intravenous antibiotics and vitrectomy on the same day, the patient proceeded to need enucleation 19 days later, and now has only light perception in the remaining eye. The strong association between K. pneumoniae endophthalmitis and underlying liver abscess leads to a significant mortality rate. Early diagnosis is essential, with prompt aggressive treatment with antibiotics, but sadly the visual prognosis remains poor. In cases of suspected choroidal abscess, initiation of sepsis screen and immediate empirical treatment is vital to improve this prognosis. This patient had no significant past medical history, no known immunocompromise, was not diabetic and had no recent significant foreign travel. However, further immunological analysis demonstrated the presence of anti-IFN-3 antibodies, a hitherto under-reported potential cause of increased susceptibility to infection, and so cases of sepsis in previously healthy individuals should be considered for further immunology assessment.

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“…Pharyngeal and laryngeal lesions have been identified in patients presenting with odynophagia, dysphagia, hoarseness, soft tissue masses, papules, and mucosal ulceration (Fig. 1) [25][26][27][28]. Tracheal and endobronchial lesions are often accompanied by cervical lymphadenopathy, pulmonary infiltrates, or post-obstructive pneumonia [29,30].…”

Section: Upper Respiratory Tract Infectionmentioning

confidence: 99%

Pulmonary Talaromycosis: A Window into the Immunopathogenesis of an Endemic Mycosis

et al. 2021

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Talaromycosis is an invasive mycosis caused by the thermally dimorphic saprophytic fungus Talaromyces marneffei (Tm) endemic in Asia. Like other endemic mycoses, talaromycosis occurs predominantly in immunocompromised and, to a lesser extent, immunocompetent hosts. The lungs are the primary portal of entry, and pulmonary manifestations provide a window into the immunopathogenesis of talaromycosis. Failure of alveolar macrophages to destroy Tm results in reticuloendothelial system dissemination and multi-organ disease. Primary or secondary immune defects that reduce CD4+ T cells, INF-γ, IL-12, and IL-17 functions, such as HIV infection, anti-interferon-γ autoantibodies, STAT-1 and STAT-3 mutations, and CD40 ligand deficiency, highlight the central roles of Th1 and Th17 effector cells in the control of Tm infection. Both upper and lower respiratory infections can manifest as localised or disseminated disease. Upper respiratory disease appears unique to talaromycosis, presenting with oropharyngeal lesions and obstructive tracheobronchial masses. Lower respiratory disease is protean, including alveolar consolidation, solitary or multiple nodules, mediastinal lymphadenopathy, cavitary disease, and pleural effusion. Structural lung disease such as chronic obstructive pulmonary disease is an emerging risk factor in immunocompetent hosts. Mortality, up to 55%, is driven by delayed or missed diagnosis. Rapid, non-culture-based diagnostics including antigen and PCR assays are shown to be superior to blood culture for diagnosis, but still require rigorous clinical validation and commercialisation. Our current understanding of acute pulmonary infections is limited by the lack of an antibody test. Such a tool is expected to unveil a larger disease burden and wider clinical spectrum of talaromycosis.

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A case report of Talaromyces marneffei Oro-pharyngo-laryngitis: a rare manifestation of Talaromycosis

Cited by 11 publications

References 23 publications

Talaromyces Marneffei Infection in an HIV-Negative Child with a CARD9 Mutation in China: A Case Report and Review of the Literature

Talaromyces Marneffei Infection in an HIV-Negative Child with a CARD9 Mutation in China: A Case Report and Review of the Literature

Endogenous Klebsiella endophthalmitis as the presentation of both Klebsiella liver abscess and underlying anti-IFN-3 autoimmunity

Pulmonary Talaromycosis: A Window into the Immunopathogenesis of an Endemic Mycosis

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