Non-HIV talaromycosis

Li, Xinchun; Hu, Wenqing; Wan, Qing; Lei, Qiang; Sun, Chongpeng; Hou, Zhongjun; Shrestha, Nitesh

doi:10.1097/md.0000000000019185

Cited by 17 publications

(6 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Chest CT scan of pulmonary talaromycosis often lacks specificity. As is reported, it can be multiple cavities with uneven thick wall and clear edge, enlarged mediastinal lymph nodes, ground glass opacity, or pleural effusion (1,7). Thus, without enough suspicion, it is easy to be misdiagnosed as bacterial pneumonia, cancer, tuberculosis, and other fungal infection.…”

Section: Discussionmentioning

confidence: 95%

Case Report: Metagenomic Next-Generation Sequencing in Diagnosis of Talaromycosis of an Immunocompetent Patient

2021

View full text Add to dashboard Cite

Background: Talaromycosis is a serious fungal infection which is rare in immunocompetent people. Since its clinical manifestations lack specificity, it is easy to escape diagnosis or be misdiagnosed leading to high mortality and poor prognosis. It is necessary to be alert to the disease when broad-spectrum antibiotics do not work well in immunocompetent patients.Case Presentation: A 79-year-old man was admitted to our Infectious Diseases Department for recurrent fever and cough. Before admission he has been treated with piperacillin-tazobactam, moxifloxacin followed by antituberculous agents in other hospitals while his symptoms were not thoroughly eased. During the first hospitalization in another hospital, he has been ordered a series of examination including radionuclide whole body bone imaging, transbronchial needle aspiration for subcarinal nodes. However, the results were negative showing no neoplasm. After being admitted to our hospital, he underwent various routine examinations. The initial diagnosis was bacterial pneumonia, and he was given meropenem injection and tigecycline injection successively, but there were no improvement of symptoms and inflammatory indicators. In the end, the main pathogen Talaromyces marneffei was confirmed using Metagenomic Next-Generation Sequencing (mNGS), and his clinical symptoms gradually relieved after targeted antifungal treatment using voriconazole.Conclusion: When empirical anti-infective treatment is ineffective, it is necessary to consider the possibility of opportunistic fungal infections on immunocompetent patients. mNGS, as a new generation of pathogenic testing methods, can often detect pathogenic bacteria faster than traditional methods, providing important help for clinical decision-making.

show abstract

Section: Discussionmentioning

confidence: 95%

Case Report: Metagenomic Next-Generation Sequencing in Diagnosis of Talaromycosis of an Immunocompetent Patient

2021

View full text Add to dashboard Cite

show abstract

“…Diagnosis of these subacute or chronic pulmonary infections rely on antibody detection and culture. [54][55][56] Few of the antibody tests for endemic pathogens are commercialized and none listed as "Essential" by the WHO. Endemic fungi are all classed as Advisory Committee on Dangerous Pathogens Category 3 organisms, require fungal culture and prolonged incubation, preferably at 35°C or above to maintain them in the yeast form (except for Coccidioides spp., which is always a mold).…”

Section: Differential Diagnosismentioning

confidence: 99%

Chronic Pulmonary Aspergillosis: Clinical Presentation and Management

Evans,

Lawal,

Kosmidis

et al. 2023

Semin Respir Crit Care Med

View full text Add to dashboard Cite

Chronic pulmonary aspergillosis (CPA) refers to a number of clinical syndromes resulting from the presence and local proliferation of Aspergillus organisms in the lungs of patients with chronic lung disease. CPA is more common than was realized two decades ago. Recognition remains poor, despite recent studies from many countries highlighting the high prevalence in at-risk populations. In low- and middle-income countries, CPA may be misdiagnosed and treated as tuberculosis (TB). In addition, CPA may develop following successful TB treatment. The coronavirus disease pandemic has resulted in significant disruption to provision of TB care, likely leading to more extensive lung damage, which could increase the risk for CPA.Although CPA refers to various syndromes, the classic presentation is that of chronic cavitary pulmonary aspergillosis, which manifests as one or more progressive cavities with or without a fungal ball, accompanied by systemic and respiratory symptoms for at least 3 months. Diagnosis relies on Aspergillus immunoglobulin G in serum, as sputum culture lacks sensitivity. Differential diagnosis includes mycobacterial infection, bacterial lung abscess or necrotizing pneumonia, lung cancer, and endemic fungi.The aim of antifungal treatment in CPA is to improve symptoms and quality of life, and to halt progression, and possibly reverse radiological changes. Current recommendations suggest treatment for 6 months, although in practice many patients remain on long-term treatment. Improvement may manifest as weight gain and improvement of symptoms such as productive cough, hemoptysis, and fatigue. Surgical management should be considered in cases of diagnostic uncertainty, in significant hemoptysis, and when there is concern for lack of response to therapy. Itraconazole and voriconazole are the first-line azoles, with more experience now accumulating with posaconazole and isavuconazole. Side effects are frequent and careful monitoring including therapeutic drug monitoring is essential. Intravenous antifungals such as echinocandins and amphotericin B are used in cases of azole intolerance or resistance, which often develop on treatment. Relapse is seen after completion of antifungal therapy in around 20% of cases, mostly in bilateral, high-burden disease.Several research priorities have been identified, including characterization of immune defects and genetic variants linked to CPA, pathogenetic mechanisms of Aspergillus adaptation in the lung environment, the contribution of non-fumigatus Aspergillus species, and the role of new antifungal agents, immunotherapy, and combination therapy.

show abstract

“…Disseminated disease has traditionally been associated with advanced HIV infection and localised disease in non-HIV-infected hosts. However, evidence is emerging that both localised respiratory and disseminated disease can develop in HIV-infected and non-HIVinfected hosts and host immune function cannot be inferred from clinical presentation [3,17,19,20]. We will describe the pathology in the lungs based on anatomical location-upper respiratory and lower respiratory tracts-which have been associated with localised as well as disseminated disease.…”

Section: Pulmonary Manifestationsmentioning

confidence: 99%

“…2) [22,32,33]. Radiological characteristics are similarly diverse, including thick-and thin-walled cavitations, patchy consolidation, ground glass changes, reticular nodular changes, and hilar and mediastinal lymphadenopathy [20,34,35]. Cavitary disease had been thought to predominate in non-HIVinfected patients; however, a study found that talaromycosis was the most common cause of cavitary lung lesions in 81 patients with HIV/AIDS (23.5%), followed by cryptococcosis (13.6%) and tuberculosis (13.6%) [36].…”

Section: Lower Respiratory Tract Infectionmentioning

confidence: 99%

“…Talaromycosis has also been described in immunocompetent patients with chronic obstructive pulmonary disease and disruption of lung architecture from other cavitary diseases [41,42]. Cases of pneumonia and disseminated disease have been reported in immunocompetent hosts [20,43,44], suggesting that talaromycosis may be a more common cause of community-acquired pneumonia than currently recognised. At present, incidence of non-severe disease in immunocompetent hosts is not known, as diagnostic capabilities for talaromycosis are largely restricted to culture, which is poorly sensitive for diagnosis [45].…”

Section: Structural Lung Disease In Immunocompetent Hostsmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2021

View full text Add to dashboard Cite

Talaromycosis is an invasive mycosis caused by the thermally dimorphic saprophytic fungus Talaromyces marneffei (Tm) endemic in Asia. Like other endemic mycoses, talaromycosis occurs predominantly in immunocompromised and, to a lesser extent, immunocompetent hosts. The lungs are the primary portal of entry, and pulmonary manifestations provide a window into the immunopathogenesis of talaromycosis. Failure of alveolar macrophages to destroy Tm results in reticuloendothelial system dissemination and multi-organ disease. Primary or secondary immune defects that reduce CD4+ T cells, INF-γ, IL-12, and IL-17 functions, such as HIV infection, anti-interferon-γ autoantibodies, STAT-1 and STAT-3 mutations, and CD40 ligand deficiency, highlight the central roles of Th1 and Th17 effector cells in the control of Tm infection. Both upper and lower respiratory infections can manifest as localised or disseminated disease. Upper respiratory disease appears unique to talaromycosis, presenting with oropharyngeal lesions and obstructive tracheobronchial masses. Lower respiratory disease is protean, including alveolar consolidation, solitary or multiple nodules, mediastinal lymphadenopathy, cavitary disease, and pleural effusion. Structural lung disease such as chronic obstructive pulmonary disease is an emerging risk factor in immunocompetent hosts. Mortality, up to 55%, is driven by delayed or missed diagnosis. Rapid, non-culture-based diagnostics including antigen and PCR assays are shown to be superior to blood culture for diagnosis, but still require rigorous clinical validation and commercialisation. Our current understanding of acute pulmonary infections is limited by the lack of an antibody test. Such a tool is expected to unveil a larger disease burden and wider clinical spectrum of talaromycosis.

show abstract

Non-HIV talaromycosis

Cited by 17 publications

References 17 publications

Case Report: Metagenomic Next-Generation Sequencing in Diagnosis of Talaromycosis of an Immunocompetent Patient

Case Report: Metagenomic Next-Generation Sequencing in Diagnosis of Talaromycosis of an Immunocompetent Patient

Chronic Pulmonary Aspergillosis: Clinical Presentation and Management

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

Contact Info

Product

Resources

About