Successful treatment of Talaromyces marneffei pneumonia in a HIV-negative renal transplantation recipient: A case report

Cai, De-Han; Wang, Jun; Fang, Xiaolin

doi:10.1097/md.0000000000030958

Cited by 7 publications

(9 citation statements)

References 12 publications

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“…The median time to presentation was 12 months after SOT (range, 0.5–140 months). The majority of transplant recipients were on MMF (17 of 22 [77.3%]) [ 4 , 189–191 , 215–218 , 222–225 , 227 , 229 , 230 ]. A history of acute (2) [ 190 , 215 ] or chronic (1) rejection [ 189 ] was seen in few patients.…”

Section: Resultsmentioning

confidence: 99%

“…The majority of transplant recipients were on MMF (17 of 22 [77.3%]) [ 4 , 189–191 , 215–218 , 222–225 , 227 , 229 , 230 ]. A history of acute (2) [ 190 , 215 ] or chronic (1) rejection [ 189 ] was seen in few patients. The majority presented with fever (15 of 24 [62.5%]) [ 4 , 189 , 191–193 , 214–218 , 222 , 225 , 227 , 229 ] and disseminated disease (19 of 25 [76.0%]) [ 4 , 188–190 , 214–220 , 222 , 223 , 225–229 ].…”

Section: Resultsmentioning

confidence: 99%

“…A history of acute (2) [ 190 , 215 ] or chronic (1) rejection [ 189 ] was seen in few patients. The majority presented with fever (15 of 24 [62.5%]) [ 4 , 189 , 191–193 , 214–218 , 222 , 225 , 227 , 229 ] and disseminated disease (19 of 25 [76.0%]) [ 4 , 188–190 , 214–220 , 222 , 223 , 225–229 ]. Many patients with disseminated disease (13 of 19 [68.4%]) had fungemia [ 189 , 190 , 214 , 215 , 218–220 , 222 , 223 , 225 , 226 , 229 ].…”

Section: Resultsmentioning

confidence: 99%

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Clinical Characteristics and Outcomes of Endemic Mycoses After Solid Organ Transplantation: A Comprehensive Review

Abad,

Razonable

2024

Open Forum Infectious Diseases

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Background Geographically endemic fungi can cause significant disease among solid organ transplant (SOT) recipients. We provide an update on the epidemiology, clinical presentation and outcomes of 5 endemic mycoses in SOT recipients. Methods Multiple databases were reviewed from inception through May 2023 using key words for endemic fungi (e.g. Coccidioidomycosis or Coccidioides, Histoplasmosis or histoplasma, etc.). We included adult SOT recipients and publications in English or with English translation. Results Among 16 cohort studies that reported on blastomycosis (n=3), coccidioidomycosis (n=5), histoplasmosis (n=4), and various endemic mycoses (n=4), the incidence rates varied: coccidioidomycosis (1.2-5.8%); blastomycosis (0.14-0.99%) and histoplasmosis (0.4-1.1%). There were 204 reports that described 268 unique cases of endemic mycoses, including 172 histoplasmosis, 31 blastomycosis, 34 coccidioidomycosis, 6 paracoccidioidomycosis, and 25 talaromycosis. The majority of patients were male (176/261, 67.4%). Transplanted allografts were mostly kidney (191/268, 71.3%), followed by liver (n=39, 14.6%), heart (n=18, 6.7%), lung (n=13, 4.9%), combined kidney-liver, and kidney-pancreas (n=6, 2.7%). In all five endemic mycoses, most patients presented with fever (162/232, 69.8%) and disseminated disease (179/268, 66.8%). Cytopenias were frequently reported for histoplasmosis (71/91, 78.0%), coccidioidomycosis (8/11, 72.7%) and talaromycosis (7/8, 87.5%). Graft loss was reported in 12/136 patients (8.8%). All-cause mortality was reported in 71/267 (26.6%); half (n=34, 50%) of the deaths were related to the underlying mycoses. Conclusions Endemic mycoses commonly present with fever, cytopenias and disseminated disease in SOT recipients. There is a relatively high rate of all-cause mortality, including many that were attributed to endemic mycoses.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Clinical Characteristics and Outcomes of Endemic Mycoses After Solid Organ Transplantation: A Comprehensive Review

Abad,

Razonable

2024

Open Forum Infectious Diseases

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“… 47/F Chang sha, China kidney elevated serum creatinine After diagnose of talaromycosis: Tac (1 mg bid to 0.5 mg bid); Tac dose was adjusted according to its blood concentration Voriconazole (200 mg bid); then changed to itraconazole (200 mg/day) N/A Li Y, et al [ 34 ], 2022. 51/M Jiangxi, China kidney coughing, fever After admission: MMF (750 mg qd, 1000 mg qn to 250 mg bid); Tac dose was adjusted according to its blood concentration Voriconazole (200 mg bid) Cured Cai DH, et al [ 35 ], 2022. 61/M Guangxi, China kidney coughing, fever and expectoration After admission: Glucocorticoids were stopped; Tac was adjusted according to its blood concentration Voriconazole (200 mg bid) N/A Xing S, et al [ 36 ], 2022.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

“…Among the two T. marneffei -infected kidney transplant cases, including our case, patients started using fluconazole or amphotericin B approximately 12 days after admission, and they all experienced gastrointestinal bleeding [ 30 ]. On the other hand, other renal transplant patients who had timely confirmed T. marneffei infection through mNGS after admission and started taking medications within 5 days did not show significant gastrointestinal symptoms, and the treatment process went relatively smoothly [ 35 – 37 ]. Hence, early mNGS or other molecular biology tests (such as Mp1p assessment) should be conducted on transplant patients with unexplained fever, cough, rash, abdominal pain, and diarrhea, and prophylactic medication should be implemented to prevent disease deterioration and improve prognosis.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Disseminated Talaromyces marneffei infection initially presenting as cutaneous and subcutaneous lesion in an HIV-Negative renal transplant recipient: a case report and literature review

Yang,

Lou,

et al. 2024

BMC Infect Dis

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Background The incidence of Talaromyces marneffei (T. marneffei) infection has increased in recent years with the development of organ transplantation and the widespread use of immunosuppressive agents. However, the lack of clinical suspicion leading to delay or misdiagnosis is an important reason for the high mortality rate in non-human immunodeficiency virus (HIV) and non-endemic population. Herein, we report a case of disseminated T. marneffei infection in a non-HIV and non-endemic recipient after renal transplant, who initially presented with skin rashes and subcutaneous nodules and developed gastrointestinal bleeding. Case presentation We describe a 54-year-old renal transplantation recipient presented with scattered rashes, subcutaneous nodules and ulcerations on the head, face, abdomen, and right upper limb. The HIV antibody test was negative. The patient had no obvious symptoms such as fever, cough, etc. Histopathological result of the skin lesion sites showed chronic suppurative inflammation with a large number of fungal spores. Subsequent fungal culture suggested T. marneffei infection. Amphotericin B deoxycholate was given for antifungal treatment, and there was no deterioration in the parameters of liver and kidney function. Unfortunately, the patient was soon diagnosed with gastrointestinal bleeding, gastrointestinal perforation and acute peritonitis. Then he rapidly developed multiple organ dysfunction syndrome and abandoned treatment. Conclusions The risk of fatal gastrointestinal bleeding can be significantly increased in kidney transplant patients with T. marneffei infection because of the long-term side effects of post-transplant medications. Strengthening clinical awareness and using mNGS or mass spectrometry technologies to improve the detection rate and early diagnosis of T. marneffei are crucial for clinical treatment in non-HIV and non-endemic population.

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Emergence and Rapid Diagnosis of Talaromyces marneffei Infections in Renal Transplant Recipients by Next-Generation Sequencing

Xing,

Deng,

Zou

et al. 2024

Mycopathologia

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In the last few years, next-generation sequencing (NGS) has emerged as a technology for laboratory diagnosis of many culture-negative infections and slow-growing microorganisms. In this study, we describe the use of metagenomic NGS (mNGS) for rapid diagnosis of T. marneffei infection in a 37-year-old renal transplant recipient who presented with chronic pneumonia syndrome. Bronchoalveolar lavage for mNGS was positive for T. marneffei sequence reads. Prolonged incubation of the bronchoalveolar lavage revealed T. marneffei colonies after 6 days of incubation. Analysis of 23 cases of T. marneffei infections in renal transplant recipients from the literature revealed that the number of cases ranged from 1 to 4 cases per five years from 1990 to 2020; but increased rapidly to 9 cases from 2021 to 2023, with 7 of them diagnosed by NGS. Twenty of the 23 cases were from T. marneffei-endemic areas [southern part of mainland China (n = 9); Hong Kong (n = 4); northeastern India (n = 2); Indonesia (n = 1) and Taiwan (n = 4)]. For the 3 patients from non-T. marneffei-endemic areas [United Kingdom (n = 2) and Australia (n = 1)], they had travel histories to China and Vietnam respectively. The time taken for diagnosis by mNGS [median 1 (range 1 to 2) day] was significantly shorter than that for fungal culture [median 6 (range 3 to 15) days] (P = 0.002). mNGS is useful for picking up more cases of T. marneffei infections in renal transplant recipients as well as providing a rapid diagnosis. Talaromycosis is an emerging fungal infection in renal transplant recipients.

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Successful treatment of Talaromyces marneffei pneumonia in a HIV-negative renal transplantation recipient: A case report

Cited by 7 publications

References 12 publications

Clinical Characteristics and Outcomes of Endemic Mycoses After Solid Organ Transplantation: A Comprehensive Review

Clinical Characteristics and Outcomes of Endemic Mycoses After Solid Organ Transplantation: A Comprehensive Review

Disseminated Talaromyces marneffei infection initially presenting as cutaneous and subcutaneous lesion in an HIV-Negative renal transplant recipient: a case report and literature review

Emergence and Rapid Diagnosis of Talaromyces marneffei Infections in Renal Transplant Recipients by Next-Generation Sequencing

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