Clinical characteristics and risk factors of Talaromyces marneffei infection in human immunodeficiency virus-negative patients: A retrospective observational study

BACKGROUND: To investigate the clinical characteristics and risk factors of human immunodeficiency virus(HIV)-negative patients with Talaromyces marneffei(T. marneffei) infection.METHODS: We retrospectively collected the clinical information of HIV-negative patients with T. marneffei infection from January 1, 2010 to June 30, 2019, and analyzed the related risk factors of poor prognosis.RESULTS: Twenty-five cases aging 22 to 79 years were included. Manifestations of T. marneffei infection included fever, cough, dyspnea, chest pain or distress, lymphadenopathy, ear, nose, and throat(ENT) and/or skin lesions, bone or joint pain, edema and pain in the lower extremities, digestive symptoms, icterus, malaise, and hoarseness. Two cases had no comorbidity, while 23 cases suff ered from autoimmune disease, pulmonary disease, cancer, and other chronic diseases. Sixteen cases had a medication history of glucocorticoids, chemotherapy or immunosuppressors. Pulmonary lesions included interstitial infiltration, nodules, atelectasis, cavitary lesions, pleural effusion or hydropneumothorax, bronchiectasis, pulmonary fibrosis, pulmonary edema, and consolidation. The incidence of osteolytic lesions was 20%. Eight patients received antifungal monotherapy, and 11 patients received combined antifungal agents. Fifteen patients survived and ten patients were dead. The Cox regression analysis showed that reduced eosinophil counts, higher levels of blood urea nitrogen(BUN), alanine aminotransferase(ALT), aspartate aminotransferase(AST), lactic dehydrogenase(LDH), myoglobin(Mb), procalcitonin(PCT), and galactomannan were related to poor prognosis(hazard ratio [HR]>1, P<0.05).CONCLUSIONS: Bone destruction is common in HIV-negative patients with T. marneffei infection. Defective cell-mediated immunity, active infection, multiple system, and organ damage can be the risk factors of poor prognosis.

Comparison of Talaromyces marneffei Infection in Human Immunodeficiency Virus-positive and Human Immunodeficiency Virus-negative Patients from Fujian, China

Background： Talaromyces （Penicillium） marneffei （TIM） is an emerging dimorphic human pathogenic fungus that is endemic to Southeast Asia. TM mostly occurs as an opportunistic infection in patients with human immunodeficiency virus （HIV）. The objective of this study was to compare the clinical and laboratory parameters of patients with TM infections who were HIV-positive and HIV-negative and to assess therapies and outcomes. Methods： This was a retrospective analysis of 26 patients diagnosed with disseminated TM infection from September 2005 to April 2014 at Fujian Provincial Hospital, China. Results： Patients with TM infection tend to present with fever, weight loss, and anemia. The time from symptom onset to confirmed diagnosis was greater for HlV-negative patients （n 7; median： 60 days, range： 14-365 days） than for HIV-positive patients （n = 19; median： 30 days, range： 3-90 days, Mann-Whitney U= 31.50, P = 0.041）. HIV-negative patients were more likely to have dyspnea （57.1% vs. 5.3%, Z： = 8.86, P = 0.010）, low neutrophil count （Mann-Whitney U = 27.00, P = 0.029）, high CD4 count （Mann-Whitney U= 0.00, P 0.009）, and high lymphocyte count （Mann-Whitney U = 21.00, P = 0.009）. There were no significant differences in other demographic, clinical, or biochemical characteristics. Among all the patients, 12 HIV-positive patient and 1 HlV-negative patient received amphotericin and fluconazole treatment, 9 of whom improved, l died, 2 had kidney damage, 1 had hypokalemia due to exceeded doses. Conclusions： HIV-negative patients with TM infections tend to have a longer diagnostic interval, a higher percentage of dyspnea, higher levels of CD4 and lymphocytes, and lower neutrophil counts than TM infection in HIV-positive patients. Treatment programs with amphotericin and fluconazole are mostly effective.