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

Abstract

Objectives This study aimed to investigate the influencing factors of delayed clearance of Talaromyces marneffei (T. marneffei) in blood culture of patients with acquired immune deficiency syndrome (AIDS) complicated with talaromycosis after antifungal therapy. Methods The patients with AIDS complicated with talaromycosis were retrospectively enrolled, and divided into two groups according to the blood T. marneffei culture results in two weeks after antifungal therapy. The baseline clinical data were collected and the antifungal susceptibility of T. marneffei was tested. Results A total of 190 patients with AIDS and talaromycosis were enrolled, of whom 101 cases remained positive for T. marneffei (Pos-group) while the other 89 cases were negative in blood culture (Neg-group) after two weeks’ antifungal treatment. The Pos-group had a higher baseline Aspartate aminotransferase (AST, 78.5 vs. 105 U/L; P = 0.073) and lower CD4+ T cells level (11 vs. 7 cells/μl; P = 0.061). The percentage of isolates with higher MICs of voriconazole (VOR) and fluconazole (FLU) in the Pos-group were significantly higher than those in the Neg-group (χ2 = 12.623, P < 0.001 and χ2 = 9.356, P = 0.002, respectively). By multivariate logistic regression, the MIC value for VOR was identified as the prognostic variable that may influence the clearance of T. marneffei in blood culture after antifungal therapy among AIDS patients with talaromycosis. Conclusions The delayed negative conversion of blood T. marneffei-culture may be associated with some factors especially higher MIC of VOR, indicatingthe possibility of drug resistance of T. marneffei.

Voriconazole trough concentration and clinical outcomes in patients with Talaromycosis

“…The ROC curve indicates that the risk of failure in VRC treatment signi cantly increases when the APACHE II score is greater than 10. In these patients, delayed fungal load clearance was also observed through qPCR, which was similar to previously reported results [20] . We consider that VRC has a high probability of failure in the treatment of critically ill patients with T. marneffei infection.…”

Endemic mycoses – are we making progress in management?

“…There have been reports using voriconazole or fluconazole for treatment with success although higher MIC values have been reported and seem to correlate with delayed blood culture clearance with these agents [77,78]. Further, in an open label, nonrandomized trial comparing AmBD and voriconazole among 410 patients with disseminated talaromycosis ( n = 269 AmBD, n = 141 voriconazole), although there was no difference in mortality, there was improved clinical resolution and fungal clearance among those who received AmB [79].…”