Clinical characteristics, rapid identification, molecular epidemiology and antifungal susceptibilities of Talaromyces marneffei infections in Shenzhen, China

Abstract

Summary Although case series of talaromycosis have been reported in China, their detailed clinical and microbiological characteristics have never been systematically profiled. In this study, we report the clinical characteristics, molecular epidemiology, rapid identification and antifungal susceptibilities of talaromycosis in The University of Hong Kong‐Shenzhen Hospital in Shenzhen. Seven cases of talaromycosis were observed since commencement of hospital service in 2012. Three patients were local Shenzhen residents, whereas the other four were immigrants from other parts of China. Two patients were HIV‐negative, but with underlying diseases requiring immunosuppressive therapy. Two of the seven patients succumbed. All the seven isolates were successfully identified as T. marneffei by MALDI–TOF MS using Bruker database expanded with in‐house generated T. marneffei mass spectra. MLST showed that the seven strains belonged to six different, novel sequences types. Phylogenetic analyses of the concatenated five‐locus sequence revealed that the seven strains were scattered amongst other T. marneffei strains. The MICs of itraconazole, isavuconazole, posaconazole and voriconazole against the seven clinical isolates were low but MICs of anidulafungin were high. Underlying diseases other than HIV infection are increasingly important risk factors of talaromycosis. MALDI–TOF MS is useful for rapid identification. Highly diverse T. marneffei sequence types were observed.

MALDI-TOF MS-Based Clustering and Antifungal Susceptibility Tests of Talaromyces marneffei Isolates from Fujian and Guangxi (China)

“…Herein, outcomes for antifungal drug sensitivity are in accordance with previous reports. 15 , 29 Among the tested azoles, posaconazole had the lowest MIC 50 and MIC 90 for T. marneffei yeasts. Results are consistent with previous reports demonstrating the activity of posaconazole against the yeast phase of T. marneffei .…”

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

“…As a referral center, we treat many kinds of opportunistic infections, including TM, and based on the etiology study of bloodstream infection among in-hospital patients in 2016 [ 3 ], TM bloodstream infection accounted for 18.8% (43/299), which was the second most common bloodstream infection pathogen. With the progress of AIDS treatment and physician awareness of TM, reports of AIDS with TM infection have become increasingly common, and the prognosis depends on a timely diagnosis [ 19 ] and proper antifungal treatment [ 20 , 21 ]. In this study, the mortality rate of patients with TM bloodstream infection was 17.2% (15/87), which is similar to 17.5% (191/1093) published by Jiang et al in 2019 [ 6 ] and 16.7% [ 17 ] in our hospital from 2014 to 2015.…”

The delayed clearance of Talaromyces marneffei in blood culture may be associated with higher MIC of voriconazole after antifungal therapy among AIDS patients with talaromycosis

“…Therefore, when there is a poor response to treatment for talaromycosis in patients with AIDS, attention should be paid to the T. marneffei resistance to fluconazole or voriconazole. With the increasing trend of other drug-resistant fungi, T. marneffei has gradually developed resistance to fluconazole [10][11][12]. Thus the sensitivity of TM to voriconazole should be closely monitored.…”

“…The underlying mechanism of poor therapeutic effects in patients with AIDS complicated with talaromycosis is still unclear. In this study, we analyzed the influencing factors of delayed clearance of T. marneffei in blood culture after two weeks' antifungal therapy, including the clinical features and the antifungal susceptibilities of T. marneffei in vitro, by testing the minimal inhibition concentrations (MICs) of the major antifungal agents [10][11][12].…”