Clinical characteristics and risk factors of Talaromyces marneffei infection in human immunodeficiency virus-negative patients: A retrospective observational study

Abstract

BACKGROUND: To investigate the clinical characteristics and risk factors of human immunodefi ciency virus (HIV)-negative patients with Talaromyces marneff ei (T. marneff ei) infection. METHODS:We retrospectively collected the clinical information of HIV-negative patients with T. marneff ei infection from January 1, 2010 to June 30, 2019, and analyzed the related risk factors of poor prognosis.RESULTS: Twenty-fi ve cases aging 22 to 79 years were included. Manifestations of T. marneff ei infection included fever, cough, dyspnea, chest pain or distress, lymphadenopathy, ear, nose, and throat (ENT) and/or skin lesions, bone or joint pain, edema and pain in the lower extremities, digestive symptoms, icterus, malaise, and hoarseness. Two cases had no comorbidity, while 23 cases suff ered from autoimmune disease, pulmonary disease, cancer, and other chronic diseases. Sixteen cases had a medication history of glucocorticoids, chemotherapy or immunosuppressors. Pulmonary lesions included interstitial infiltration, nodules, atelectasis, cavitary lesions, pleural effusion or hydropneumothorax, bronchiectasis, pulmonary fibrosis, pulmonary edema, and consolidation. The incidence of osteolytic lesions was 20%. Eight patients received antifungal monotherapy, and 11 patients received combined antifungal agents. Fifteen patients survived and ten patients were dead. The Cox regression analysis showed that reduced eosinophil counts, higher levels of blood urea nitrogen (BUN), alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactic dehydrogenase (LDH), myoglobin (Mb), procalcitonin (PCT), and galactomannan were related to poor prognosis (hazard ratio [HR]>1, P<0.05).CONCLUSIONS: Bone destruction is common in HIV-negative patients with T. marneffei infection. Defective cell-mediated immunity, active infection, multiple system, and organ damage can be the risk factors of poor prognosis.

Rapid diagnosis of Talaromyces marneffei infection by metagenomic next-generation sequencing technology in a Chinese cohort of inborn errors of immunity

“…The traditional standard for infection diagnosis relies on culture, histopathological staining and microscopy. Studies have shown that the combination of quantitative polymerase chain reaction (qPCR) and serum GM detection can be a valuable tool for the diagnosis of T. marneffei infection ( Li et al., 2020 ; Wei et al., 2021 ). Patients with fungemia often have high GM results, such as P1, P2, P5 and P6.…”

Risk factors and prediction model for mortality in HIV/Talaromyces marneffei co-infection: A retrospective cohort study

“…This study found no association between mortality and sex, but identified older age and elevated PCT levels as risk factors for mortality in patients with HIV/TM co-infection [ 6 , 15 ]. Globally, individuals living with HIV survive to an older age, and the predictive value of increasing age for prognosis should not be overlooked.…”

Talaromycosis from Wuhan: two-case report and literature review

“…At present, the main methods for diagnosing T. marneffei infection are smear, culture, and histopathological examination, but traditional methods such as culture are time-consuming and easy to delay diagnosis, resulting in early death of patients ( Zheng et al., 2015 ). GM test has a certain predictive value for T. marneffei infection ( Cao et al., 2019 ), especially for HIV-positive patients ( Zheng et al., 2015 ) and also has a certain predictive value for prognosis (long-term high GM test indicates poor prognosis) ( Wei et al., 2021a ), but the sensitivity of G test is not high ( Guo et al., 2019 ). Studie have found that the GM optical density of HIV-infected patients with T. marneffei fungemia is higher than that of HIV-infected patients without fungemia and fungemia caused by other fungi ( Huang et al., 2007 ).…”