Clinical characteristics and risk factors for poor prognosis among HIV patients with Talaromyces marneffei bloodstream infection

Abstract

Background Talaromyces marneffei (TM) bloodstream infection is common in Acquired Immunodeficiency Syndrome (AIDS) patients with extreme immunodeficiency in Southeast Asia and South China, however, clinical case study on TM bloodstream infection is scarce. We retrospectively analyzed the clinical characteristics of TM bloodstream infection in hospitalized AIDS patients and determined the outcomes of hospitalization after diagnosis in our hospital over the past 5 years. Methods From January 2015 to July 2020, 87 cases of TM detected by blood culture in patients admitted to our center were collected. The admission complaints, blood cells, biochemistry, CD4 and CD8 cell counts and 1,3-β-D-glucan (BDG), procalcitonin (PCT), CRP level on the day of blood culture test, and outcomes during hospitalization were analyzed. Logistic regression analysis was performed for the risk factors for poor prognosis (60 cases). Spearman correlation analysis was used to analyze the correlation between peripheral blood cells, albumin and the time required for TM turnaround in blood culture. The difference was statistically significant when the P value was < 0.05. Results A total of 87 patients were collected, with a median age of 34 years, a median hemoglobin of 94 g/L and CD4 count of 7/μl. The rate of TM bloodstream infection among all in-hospital patients increased from 0.99% in 2015 to 2.09% in 2020(half year). Patients with TM bloodstream infection with CD8 count < 200/μl had a 12.6-fold higher risk of poor prognosis than those with CD8 count > 200/μl (p = 0.04), and those with BDG < 100 pg/mL had a 34.9-fold higher risk of poor prognosis than those with BDG > 100 pg/mL (p = 0.01). Conclusions TM bloodstream infection is becoming more common in advanced AIDS patients in endemic areas. For those patients with extremely low CD4 and CD8 cell counts below 200/μl is with an increased risk of poor prognosis.

DisseminatedTalaromyces marneffeiInfection With STAT3-Hyper-IgE Syndrome: A Case Series and Literature Review

“…They had a median age of 14 years, and nearly half of the patients were young adults, whereas it was previously believed that HIES mostly occurred in infants and children [ 26 ]. There were no typical symptoms different from other HIV-negative patients with talaromycosis [ 28 ], but the rate of gastrointestinal symptoms was higher than previously reported [ 29 ]. Most HIES patients are prone to infections from childhood onward.…”

Population pharmacokinetics of voriconazole and initial dosage optimization in patients with talaromycosis

“…C-reactive protein is an acute protein mainly produced by hepatocytes that increase dramatically in response to injury, infection, and inflammation, which plasma level can reflect the severity of inflammation ( Sproston and Ashworth, 2018 ). Invasive T. marneffei infection can cause multiple organ damage and CRP is significantly increased in patients with poor prognosis ( Sun et al, 2021 ; Shi et al, 2022 ). Studies have shown that drug-metabolizing enzymes, including cytochrome P450 (CYP) isoenzymes, are decreased at the transcriptional levels during infection or inflammation, which leading to reduce the metabolism of VRC ( Renton, 2004 ; Aitken and Morgan, 2007 ; van Wanrooy et al, 2014 ; Encalada Ventura et al, 2015 ; Veringa et al, 2017 ).…”

Serum Exosomal microRNA Profiling in AIDS Complicated with Talaromyces marneffei Infection

“…The subjects included in the experimental group and the control group had no significant differences in age and gender, white blood cell, neutrophil, lymphocyte, and platelet counts. The monocyte count, CD4 + T lymphocyte count, CD8 + T lymphocyte count, and the ratio of CD4/CD8 in the experimental group were lower than those in the control group, but this is related to the clinical characteristics of the patients in the experimental group 24,25 and this feature is inevitable in AIDS patients with TM infection. In addition, once TM invaded the human body and caused a systemic disseminated infection, it will first cause a mononuclear-macrophage system reaction, 26 and that may be responsible for the decrease in the number of monocytes of AIDS combined with TM infection.…”