Comparison of pleural effusion features and biomarkers between talaromycosis and tuberculosis in non-human immunodeficiency virus-infected patients

Abstract

Background: Due to the similar clinical, lung imaging, and pathological characteristics, talaromycosis is most commonly misdiagnosed as tuberculosis. This study aimed to identify the characteristics of talaromycosis pleural effusion (TMPE) and to distinguish TMPE from tuberculosis pleural effusion (TPE). Methods: We enrolled 19 cases each of TMPE and TPE from Guangxi, China. Patients' clinical records, pleural effusion tests, biomarker test results, and receiver operating characteristic curves were analyzed. Results: In total, 39.8% (65/163) of patients exhibited serous effusion, of whom 61 were non-human immunodeficiency virus (HIV)-infected patients; 68.85% of the non-HIV-infected patients (42/61) had TMPE. Thoracentesis was performed only in 19 patients, all of whom were misdiagnosed with tuberculosis and received long-term anti-tuberculosis treatment. In four of these patients, interleukin (IL)-23, IL-27, and interferon-gamma (IFN-γ) measurements were not performed since pleural effusion samples could not be collected because the effusion had been drained prior to the study. In the remaining 15 patients, pleural effusion samples were collected. Talaromyces marneffei was isolated from the pleural effusion and pleural nodules. Most TMPEs were characterized by yellowish fluid, with marked elevation of protein content and nucleated cell counts. However, neutrophils were predominantly found in TMPEs, and lymphocytes were predominantly found in TPEs (both p < 0.05). Adenosine deaminase (ADA) and IFN-γ levels in TMPEs were significantly lower than those in TPEs (all p < 0.05) and provided similar accuracies for distinguishing TMPEs from TPEs. IL-23 concentration in TMPEs was significantly higher than that in TPEs (p < 0.05), and it provided similar accuracy for diagnosing TMPEs. IL-27 concentrations in TMPEs were significantly lower than those in TPEs (all p < 0.05) but was not useful for distinguishing TMPE from TPE. Conclusions: Talaromycosis can infringe on the pleural cavity via the translocation of T. marneffei into the pleural space. Nonetheless, this phenomenon is still commonly neglected by clinicians. TMPE is a yellowish fluid with exudative PEs and predominant neutrophils. Higher neutrophil counts and IL-23 may suggest talaromycosis. Higher lymphocyte counts, ADA activity, and IFN-γ concentration may suggest tuberculosis.

Clinical findings of Talaromyces marneffei infection among patients with anti-interferon-γ immunodeficiency: a prospective cohort study

“…As a result, the lungs were the dominant organs involved, whereas anti-IFN-γ autoAb-positive patients were more likely to develop systemic dissemination of T. marneffei infection and pleural effusion [ 8 ]. Most patients with T. marneffei infection had pleural effusion characterized by yellowish exudates, with marked elevation of protein levels and nucleated cell counts [ 23 ]. Multiple organs might also be involved, especially the bone and skin, which might readily predispose patients to the development of Sweet syndrome [ 24 ].…”

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

“…It is estimated that there will be 4951 TM cases per year in patients with AIDS in southern China by 2050, and the endemic areas are increasing [ 12 ]. The disease is mostly localized to the lungs and skin and is related to exposure by inhalation or direct contact TM [ 14 , 15 ]. However, in clinical settings, because the onset of the disease is relatively insidious and mild, the clinical symptoms are non-specific, and patients often experience delayed diagnosis or misdiagnosis by doctors who are not familiar with the symptoms of TM disease.…”

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

“…Tm was grown from biopsied tissue [59]. b Computed tomography (CT) angiogram of the neck demonstrating an ill-defined mass along the right lateral aspect of the hypopharynx involving the base of the tongue, right lingual tonsil, and right vallecula extending along the right palatine tonsil and into the pharyngeal space, in a 63 year-old man with HIV [27] from China, 42/61 (69%) had pleural effusions; all cases were initially misdiagnosed as tuberculosis [37]. Compared to tuberculous pleural effusions, talaromycosis effusions have a lower protein content and lymphocyte count, and a higher neutrophil count.…”