1
|
Liu X, Xing H, Lin J, Sun J, Wang Y, Liu Y, Cao W, Liu Z, Li T. Coexisting of Primary Central Nervous System Lymphoma and Talaromyces marneffei Brain Abscess in an AIDS Patient, A Case Report and Review of the Literature. Infect Drug Resist 2024; 17:709-718. [PMID: 38410795 PMCID: PMC10896102 DOI: 10.2147/idr.s432697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/06/2024] [Indexed: 02/28/2024] Open
Abstract
Background Talaromyces marneffei is prevalent in South Asia. Latent Talaromyces marneffei infection of travellers make the diagnosis difficult. There are similarities in clinical manifestations between Talaromyces marneffei infection and lymphoma. Brain abscess is a rare form of Talaromyces marneffei infection. Case Presentation We reported a very rare case of a 19-year-old man with HIV infection who suffered from a brain mass and lymphadenopathy. His blood culture, bone marrow culture and sputum culture all grew Talaromyces marneffei. One month after treatment with voriconazole, the symptoms improved except brain mass. Surgical incision of the brain mass showed a compact mass, and pathological analysis showed the coexisting Talaromyces marneffei abscess and lymphoma. The patient is currently in a stable condition after receiving antifungal therapy and chemotherapy. Conclusion Based on a case report of a traveller who suffered from a brain mass of Talaromyces marneffei abscess and lymphoma after a visit to an endemic area, this review summarized the cases where there was confusion between lymphoma and the brain abscess of Talaromyces marneffei. Talaromyces marneffei infection can be found globally due to the increasing number of international travels. Talaromyces marneffei infection and lymphoma had similar characteristics which is easy to misdiagnose in clinic. Infection may also be accompanied by tumors, especially in patients infected with HIV. The manifestations and imaging of brain abscess of Talaromyces marneffei were not characteristic in different patients.
Collapse
Affiliation(s)
- Xinchao Liu
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Hao Xing
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
- Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Jing Lin
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
- Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Jian Sun
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Yu Wang
- Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Yaxu Liu
- Department of International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Wei Cao
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
| | - Zhengyin Liu
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Taisheng Li
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
- Tsinghua-Peking Center for Life Sciences, Beijing, People’s Republic of China
| |
Collapse
|
2
|
Zhou Y, Qin Y, Lu Y, Yuan J, Nie J, Liu M, Tian Q, Lan K, Zhou G, Qin Y, He K, Yu J, Jiang Z, Liu J, Liu S, Harypursat V, Chen Y. Efficacy and Safety of Voriconazole Versus Amphotericin B Deoxycholate Induction Treatment for HIV-Associated Talaromycosis: A Prospective Multicenter Cohort Study in China. Infect Dis Ther 2022; 11:1575-1590. [PMID: 35689792 PMCID: PMC9334509 DOI: 10.1007/s40121-022-00658-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/12/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Current guidelines recommend amphotericin B as the preferred drug for induction therapy; however, amphotericin B is not available in certain settings. Induction therapy with amphotericin B deoxycholate or voriconazole has been shown to be an effective treatment for talaromycosis. However, prospective clinical trials comparing these two antifungal drugs are absent from the literature. Methods In this open-labeled, multicenter, prospective controlled trial, we enrolled patients at 15 hospitals in China from 2019 to 2020. Participants received induction treatment with either amphotericin B deoxycholate intravenously at a dose of 0.5 to 0.7 mg per kilogram per day or voriconazole at a dose of 6 mg/kg intravenously twice daily for the first day, followed by 4 mg/kg intravenously twice daily for 3 days, and then voriconazole was given either intravenously (4 mg/kg intravenously twice daily) or orally (200 mg twice daily) for the remaining 10 days. The primary outcome was all-cause mortality during 48 weeks after baseline. Secondary outcomes were mortality at week 2 or week 24, clinical resolution of talaromycosis, and fungal clearance at week 2. A propensity score (PS) matching analysis was performed to control confounding factors. Results We observed no difference in the risk of death at week 2, at week 24, or at week 48 in either the unmatched cohort or the matched cohort. Both in the unmatched and the matched cohorts, logistic regression analysis revealed a significantly lower odds ratio of clinical resolution (OR 0.450, 95% CI 0.291–0.696, p < 0.001; OR 0.443, 95% CI 0.261–0.752, p = 0.003) and fungal clearance (OR 0.514, 95% CI 0.333–0.793, p = 0.003; OR 0.542, 95% CI 0.318–0.923, p = 0.024) in voriconazole users compared to amphotericin B deoxycholate users over the course of 2 weeks. In the induction therapy without ART subgroup patients in the amphotericin B deoxycholate group showed a significantly higher rate of clinical resolution and fungal clearance than those in the voriconazole group (56.1% vs. 30.4%, 95% CI 13.4–36.5, p = 0.000; 63.8% vs. 40.4%, 95% CI 11.1–34.7, p = 0.000), whereas there was no significant difference in clinical resolution and fungal clearance in the induction therapy combined with ART subgroup. Conclusions Induction therapy using voriconazole had a similar efficacy, in terms of all-cause mortality rate, to induction therapy using amphotericin B deoxycholate in HIV-infected patients with talaromycosis over a 48-week observation period. Amphotericin B deoxycholate contributed to earlier fungal clearance and earlier clinical resolution of symptoms in the induction therapy without ART subgroup, whereas amphotericin B deoxycholate use did not contribute to a significant difference in clinical resolution and fungal clearance in the induction therapy combination with ART subgroup. Trial Registration ChiCTR1900021195. Registered 1 February 2019, http://www.chictr.org.cn/showproj.aspx?proj=35362.
Collapse
Affiliation(s)
- Yihong Zhou
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba, Chongqing, 400036, China
| | - Yuanyuan Qin
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba, Chongqing, 400036, China
| | - Yanqiu Lu
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba, Chongqing, 400036, China
| | - Jing Yuan
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba, Chongqing, 400036, China
| | - Jingmin Nie
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba, Chongqing, 400036, China
| | - Min Liu
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba, Chongqing, 400036, China
| | - Qun Tian
- Division of Infectious Diseases, The Third People's Hospital of Guilin, Guangxi, China
| | - Ke Lan
- Division of Infectious Disease, Longtan Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Guoqiang Zhou
- Division of Infectious Diseases, The First Hospital of Changsha, Hunan, China
| | - Yingmei Qin
- Division of Infectious Diseases, the Fourth People's Hospital of Nanning, Guangxi, China
| | - Kaiyin He
- Division of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangdong, China
| | - Jianhua Yu
- Department of Infectious Diseases, Xixi Hospital of Hangzhou, Zhejiang, China
| | - Zhongsheng Jiang
- Division of Infectious Diseases, Liuzhou General Hospital, Guangxi, China
| | - Jun Liu
- Division of Infectious Diseases, Kunming Third People's Hospital, Yunnan, China
| | - Shuiqing Liu
- Division of Infectious Diseases, Guiyang Public Health Clinical Center, Guizhou, China
| | - Vijay Harypursat
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba, Chongqing, 400036, China
| | - Yaokai Chen
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba, Chongqing, 400036, China.
| |
Collapse
|
3
|
Pulmonary and Extrapulmonary Manifestations of Fungal Infections Misdiagnosed as Tuberculosis: The Need for Prompt Diagnosis and Management. J Fungi (Basel) 2022; 8:jof8050460. [PMID: 35628715 PMCID: PMC9143176 DOI: 10.3390/jof8050460] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 01/15/2023] Open
Abstract
Fungal infections commonly present with myriad symptoms that mimic other clinical entities, notable amongst which is tuberculosis. Besides histoplasmosis and chronic pulmonary aspergillosis, which can mimic TB, this review has identified several other fungal infections which also do. A total of 80 individual cases misdiagnosed as TB are highlighted: aspergillosis (n = 18, 22.5%), histoplasmosis (n = 16, 20%), blastomycosis (n = 14, 17.5%), cryptococcosis (n = 11, 13.8%), talaromycosis (n = 7, 8.8%), coccidioidomycosis (n = 5, 6.3%), mucormycosis (n = 4, 5%), sporotrichosis (n = 3, 3.8%), phaeohyphomycosis (n = 1, 1.3%) and chromoblastomycosis (n = 1, 1.3%). Case series from India and Pakistan reported over 100 cases of chronic and allergic bronchopulmonary aspergillosis had received anti-TB therapy before the correct diagnosis was made. Forty-five cases (56.3%) had favorable outcomes, and 25 (33.8%) died, outcome was unclear in the remainder. Seventeen (21.3%) cases were infected with human immunodeficiency virus (HIV). Diagnostic modalities were histopathology (n = 46, 57.5%), culture (n = 42, 52.5%), serology (n = 18, 22.5%), cytology (n = 2, 2.5%), gene sequencing (n = 5, 6.3%) and microscopy (n = 10, 12.5%) including Gram stain, India ink preparation, bone marrow smear and KOH mount. We conclude that the above fungal infections should always be considered or ruled out whenever a patient presents with symptoms suggestive of tuberculosis which is unconfirmed thereby reducing prolonged hospital stay and mortalities associated with a delayed or incorrect diagnosis of fungal infections.
Collapse
|
4
|
Characteristics and Prognosis of Talaromyces marneffei Infection in HIV-positive Children in Southern China. Mycopathologia 2022; 187:169-180. [DOI: 10.1007/s11046-021-00614-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
|
5
|
Pruksaphon K, Intaramat A, Simsiriwong P, Mongkolsuk S, Ratanabanangkoon K, Nosanchuk JD, Kaltsas A, Youngchim S. An inexpensive point-of-care immunochromatographic test for Talaromyces marneffei infection based on the yeast phase specific monoclonal antibody 4D1 and Galanthus nivalis agglutinin. PLoS Negl Trop Dis 2021; 15:e0009058. [PMID: 33945531 PMCID: PMC8096094 DOI: 10.1371/journal.pntd.0009058] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/22/2020] [Indexed: 11/29/2022] Open
Abstract
Talaromyces marneffei is a thermally dimorphic fungus that causes opportunistic systemic mycoses in patients with AIDS or other immunodeficiency syndromes. The purpose of this study was to develop an immunochromatographic strip test (ICT) based on a solid phase sandwich format immunoassay for the detection of T. marneffei antigens in clinical urine specimens. The T. marneffei yeast phase specific monoclonal antibody 4D1 (MAb4D1) conjugated with colloidal gold nanoparticle was used as a specific signal reporter. Galanthus nivalis Agglutinin (GNA) was adsorbed onto nitrocellulose membrane to serve as the test line. Similarly, a control line was created above the test line by immobilization of rabbit anti-mouse IgG. The immobilized GNA served as capturing molecule and as non-immune mediated anti-terminal mannose of T. marneffei antigenic mannoprotein. The MAb4D1–GNA based ICT showed specific binding activity with yeast phase antigen of T. marneffei, and it did not react with other common pathogenic fungal antigens. The limit of detection of this ICT for T. marneffei antigen spiked in normal urine was approximately 0.6 μg/ml. The diagnostic performance of the ICT was validated using 341 urine samples from patents with culture- confirmed T. marneffei infection and from a control group of healthy individuals and patients with other infections in an endemic area. The ICT exhibited 89.47% sensitivity, 100% specificity, and 97.65% accuracy. Our results demonstrate that the urine-based GNA–MAb4D1 based ICT produces a visual result within 30 minutes and that the test is highly specific for the diagnosis of T. marneffei infection. The findings validate the deployment of the ICT for clinical use. Talaromycosis (Penicilliosis marneffei) is a neglected disease that causes an opportunistic systemic mycoses in AIDS and other immune-deficient patients living in Southeast Asia, China and the Indian subcontinent. Although laboratory culture remains a gold standard diagnostic method, it lacks sensitivity and is time-consuming, which results in delayed patient’s treatment and needed care. In this study, we develop an immunochromatographic strip test (ICT) by utilizing a yeast phase specific monoclonal antibody 4D1 and Galanthus nivalis agglutinin for detection of T. marneffei antigens in clinical urine specimens. Our data showed that the assay exhibited high sensitivity (89.47%) and specificity (100%), with its result available within 30 minutes. In addition, this diagnostic assay is inexpensive, reproducible, and simple to perform. Therefore, the T. marneffei ICT should be considered for clinical application in the context of rapid and affordable point-of-care diagnostic test to reduce the burden of talaromycosis mortality in patients in low resource countries.
Collapse
Affiliation(s)
- Kritsada Pruksaphon
- Graduate Program in Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Akarin Intaramat
- Translational Research Unit, Laboratory of Immunology and Laboratory of Biotechnology, Chulabhorn Research Institute, Bangkok, Thailand
| | - Pavinee Simsiriwong
- Translational Research Unit, Laboratory of Immunology and Laboratory of Biotechnology, Chulabhorn Research Institute, Bangkok, Thailand
| | - Skorn Mongkolsuk
- Translational Research Unit, Laboratory of Immunology and Laboratory of Biotechnology, Chulabhorn Research Institute, Bangkok, Thailand
| | - Kavi Ratanabanangkoon
- Department of Microbiology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Joshua D. Nosanchuk
- Department of Medicine (Infectious Diseases), Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Anna Kaltsas
- Department of Medicine, Division of Infectious Diseases, Memorial Sloan Kettering Cancer Center, United States of America
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, United States of America
| | - Sirida Youngchim
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- * E-mail:
| |
Collapse
|
6
|
Caceres DH, Mohd Tap R, Alastruey-Izquierdo A, Hagen F. Detection and Control of Fungal Outbreaks. Mycopathologia 2020; 185:741-745. [PMID: 33037965 PMCID: PMC7588372 DOI: 10.1007/s11046-020-00494-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/20/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Diego H Caceres
- Mycotic Diseases Branch, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd. NE, Atlanta, GA, 30329, USA.
- Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands.
| | - Ratna Mohd Tap
- Mycology Laboratory, Institute for Medical Research, National Institute of Health, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Ana Alastruey-Izquierdo
- Medical Mycology Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Ferry Hagen
- Department of Medical Mycology, Westerdijk Fungal Biodiversity Institute, Uppsalalaan 8, 3584CT, Utrecht, The Netherlands.
- Department of Medical Microbiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
- Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, Shandong, People's Republic of China.
| |
Collapse
|