First‐in‐man observation of <i>Talaromyces marneffei</i>‐transmission by organ transplantation

Hermans, Frederik; Ombelet, Sien; Degezelle, Karlien; Testelmans, Dries; Raemdonck, Dirk Van; Verleden, Geert M.; Verbeken, Eric; Bleyenbergh, Pascal Van; Lagrou, Katrien; Vos, Robin

doi:10.1111/myc.12574

Cited by 21 publications

(17 citation statements)

References 18 publications

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“…These are usually patients receiving immunosuppressive therapies associated with transplantation or autoimmune diseases and hematology patients treated with novel targeted therapies, including anti-CD20 monoclonal antibodies and kinase inhibitors 234 – 236 , but also patients with primary adult-onset immunodeficiency due to anti-interferon-gamma auto-antibodies 237 . A donor-related transmission in a lung transplant recipient was also recently reported 238 . Bamboo rats are considered the only identified natural reservoir so far, and transmission is believed to occur through conidia inhalation 234 , 235 .…”

Section: Rare and Emerging Dimorphic Fungimentioning

confidence: 81%

Rare fungal infectious agents: a lurking enemy

2017

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In the expanding population of immunocompromised patients and those treated in intensive care units, rare fungal infectious agents have emerged as important pathogens, causing invasive infections associated with high morbidity and mortality. These infections may present either as de novo or as breakthrough invasive infections in high-risk patients with hematologic malignancies receiving prophylactic or empirical antifungal therapy or in patients with central venous catheters. Diagnosis and treatment are challenging. Physicians should have a high index of suspicion because early diagnosis is of paramount importance. Conventional diagnostic methods such as cultures and histopathology are still essential, but rapid and more specific molecular techniques for both detection and identification of the infecting pathogens are being developed and hopefully will lead to early targeted treatment. The management of invasive fungal infections is multimodal. Reversal of risk factors, if feasible, should be attempted. Surgical debridement is recommended in localized mold infections. The efficacy of various antifungal drugs is not uniform. Amphotericin B is active against most yeasts, except Trichosporon, as well as against Mucorales, Fusarium, and some species of Paecilomyces and dimorphic fungi. The use of voriconazole is suggested for the treatment of trichosporonosis and scedosporiosis. Combination treatment, though recommended as salvage therapy in some infections, is controversial in most cases. Despite the use of available antifungals, mortality remains high. The optimization of molecular-based techniques, with expansion of reference libraries and the possibility for direct detection of resistance mechanisms, is awaited with great interest in the near future. Further research is necessary, however, in order to find the best ways to confront and destroy these lurking enemies.

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Section: Rare and Emerging Dimorphic Fungimentioning

confidence: 81%

Rare fungal infectious agents: a lurking enemy

2017

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“…However, other patients with altered immunity, including children with primary immunodeficiency syndromes, adults with anti‐interferon gamma antibodies, and patients receiving anti‐CD20 monoclonal antibodies and/or kinase inhibitors have been diagnosed with T marneffei . Direct transmission of T marneffei via organ transplantation has also been reported . A single case report exists describing a woman with multiple myeloma who developed a pulmonary infection with Talaromyces purpurogenus…”

Section: Discussionmentioning

confidence: 99%

Cytologic identification of fungal arthritis in a Labrador Retriever with disseminated Talaromyces helicus infection

Whipple

Shmalberg

Joyce

et al. 2019

Veterinary Clinical Pathol

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An 8‐year‐old, neutered male Labrador Retriever presented with acute forelimb lameness. Clinical signs progressed over one week. On physical examination, right cubital joint effusion and bilateral axillary lymphadenomegaly were noted, and severe internal lymphadenomegaly was observed ultrasonographically. Granulomatous lymphadenitis with intralesional fungi was noted cytologically, and the dog was ultimately diagnosed with disseminated Talaromyces helicus infection via PCR of a pure isolate. Extensive medical therapy was pursued, and months later, an arthrocentesis was performed due to continued lameness and severe cubital joint effusion. The synovial fluid contained increased numbers of neutrophils, macrophages, and multinucleated giant cells. Frequent fungal hyphae were found both intracellularly and extracellularly. These basophilic organisms were 2‐4 µm in width with internal eosinophilic granules, roughly parallel walls, and occasional to frequent septa. Round to oval yeast‐like forms with thin, clear halos were also occasionally identified. Due to the severity of clinical signs, the right thoracic limb was amputated. Histologic examination of the cubital joint revealed marked granulomatous synovitis, fasciitis, panniculitis, and osteomyelitis, all with intralesional fungi. Talaromyces helicus is a very rare cause of disease, reported only in one other dog. Granulomatous lymphadenitis appears to be a feature of this disease, but this report is the first to describe a significant synovial component.

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“…Since Chan and Chow first reported the case of a Hong Kong renal transplant patient who presented with disseminated T. marneffei infection 6 years after transplantation, we discovered an additional 9 reported cases of T. marneffei in renal transplant recipients by a comprehensive search of published English‐language literature (Table ). A recent report has confirmed the donor organ as a route of T. marneffei infection transmission in a lung transplant recipient …”

Section: Discussionmentioning

confidence: 85%

Recovery from Talaromyces marneffei involving the kidney in a renal transplant recipient: A case report and literature review

Peng

Chen

Cai

et al. 2017

Transplant Infectious Dis

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Talaromyces marneffei is an emerging opportunistic infection among immunocompromised patients. We observe the first native case of disseminated T. marneffei involving the kidney in a renal transplant recipient in mainland China. We describe the comprehensive clinical course, and ultrasound imaging of renal transplant biopsy, pathologic images, and electron microscopy observation of the biopsy specimen, highlighting the relevance of biopsy findings and the blood culture. We also focus on the treatment and good outcome of the patient. Then we review the literature and show the additional 10 reported cases of T. marneffei in renal transplant recipients. In addition, we discuss the new methods of rapid diagnosis of T. marneffei. In brief, timely diagnosis and proper treatment of T. marneffei infection is important in renal transplant recipients.

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First‐in‐man observation of Talaromyces marneffei‐transmission by organ transplantation

Cited by 21 publications

References 18 publications

Rare fungal infectious agents: a lurking enemy

Rare fungal infectious agents: a lurking enemy

Cytologic identification of fungal arthritis in a Labrador Retriever with disseminated Talaromyces helicus infection

Recovery from Talaromyces marneffei involving the kidney in a renal transplant recipient: A case report and literature review

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