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Morris AJ, Kim HY, Nield B, Dao A, McMullan B, Alastruey-Izquierdo A, Colombo AL, Heim J, Wahyuningsih R, Le T, Chiller TM, Forastiero A, Chakrabarti A, Harrison TS, Bongomin F, Galas M, Siswanto S, Dagne DA, Roitberg F, Gigante V, Beardsley J, Sati H, Alffenaar JW, Morrissey CO. Talaromyces marneffei, Coccidioides species, and Paracoccidioides species-a systematic review to inform the World Health Organization priority list of fungal pathogens. Med Mycol 2024; 62:myad133. [PMID: 38935909 PMCID: PMC11210613 DOI: 10.1093/mmy/myad133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/18/2023] [Accepted: 12/11/2023] [Indexed: 06/29/2024] Open
Abstract
The World Health Organization, in response to the growing burden of fungal disease, established a process to develop a fungal pathogen priority list. This systematic review aimed to evaluate the epidemiology and impact of infections caused by Talaromyces marneffei, Coccidioides species, and Paracoccidioides species. PubMed and Web of Sciences databases were searched to identify studies published between 1 January 2011 and 23 February 2021 reporting on mortality, complications and sequelae, antifungal susceptibility, preventability, annual incidence, and trends. Overall, 25, 17, and 6 articles were included for T. marneffei, Coccidioides spp. and Paracoccidioides spp., respectively. Mortality rates were high in those with invasive talaromycosis and paracoccidioidomycosis (up to 21% and 22.7%, respectively). Hospitalization was frequent in those with coccidioidomycosis (up to 84%), and while the duration was short (mean/median 3-7 days), readmission was common (38%). Reduced susceptibility to fluconazole and echinocandins was observed for T. marneffei and Coccidioides spp., whereas >88% of T. marneffei isolates had minimum inhibitory concentration values ≤0.015 μg/ml for itraconazole, posaconazole, and voriconazole. Risk factors for mortality in those with talaromycosis included low CD4 counts (odds ratio 2.90 when CD4 count <200 cells/μl compared with 24.26 when CD4 count <50 cells/μl). Outbreaks of coccidioidomycosis and paracoccidioidomycosis were associated with construction work (relative risk 4.4-210.6 and 5.7-times increase, respectively). In the United States of America, cases of coccidioidomycosis increased between 2014 and 2017 (from 8232 to 14 364/year). National and global surveillance as well as more detailed studies to better define sequelae, risk factors, outcomes, global distribution, and trends are required.
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Affiliation(s)
- Arthur J Morris
- Department of Microbiology, Auckland City Hospital, Te Toku Tumai, Grafton, Auckland, New Zealand
| | - Hannah Yejin Kim
- The University of Sydney, Infectious Diseases Institute (Sydney ID), New South Wales, Australia
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Westmead Hospital, Westmead, New South Wales, Australia
| | - Blake Nield
- Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Aiken Dao
- The University of Sydney, Infectious Diseases Institute (Sydney ID), New South Wales, Australia
- Westmead Hospital, Westmead, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Brendan McMullan
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Infectious Diseases, Sydney Children’s Hospital, Randwick, New South Wales, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Arnaldo Lopes Colombo
- Departamento de Medicina, Division of Infectious Diseases, Hospital São Paulo, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Jutta Heim
- Global Antibiotics Research and Development Partnership, Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Retno Wahyuningsih
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Parasitology, Faculty of Medicine, Universitas Kristen, Jakarta, Indonesia
| | - Thuy Le
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
- Tropical Medicine Research Center for Talaromycosis, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Tom M Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Agustina Forastiero
- Department of Communicable Diseases Prevention, Control and Elimination, Pan American Health Organization,Washington, DC, USA
| | | | - Thomas S Harrison
- Institute for Infection and Immunity, and Clinical Academic Group in Infection and Immunity, St. George’s, University of London, and St. George’s University Hospitals NHS Foundation Trust, London, UK
- MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Marcelo Galas
- Antimicrobial Resistance Special Program, Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington, DC, USA
| | - Siswanto Siswanto
- World Health Organization, South-East Asia Region Office, New Delhi, India
| | - Daniel Argaw Dagne
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Felipe Roitberg
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Valeria Gigante
- Impact Initiatives and Research Coordination Unit, Global Coordination Department, Antimicrobial Resistance Division, World Health Organization, Geneva, Switzerland
| | - Justin Beardsley
- The University of Sydney, Infectious Diseases Institute (Sydney ID), New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Hatim Sati
- Impact Initiatives and Research Coordination Unit, Global Coordination Department, Antimicrobial Resistance Division, World Health Organization, Geneva, Switzerland
| | - Jan-Willem Alffenaar
- The University of Sydney, Infectious Diseases Institute (Sydney ID), New South Wales, Australia
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Westmead Hospital, Westmead, New South Wales, Australia
| | - Catherine Orla Morrissey
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
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Wu L, Pan Y, Xu K. Clinical Characteristics Associated with Poor Prognosis of Acquired Immunodeficiency Syndrome Patients Complicated with Disseminated Talaromycosis marneffei. Infect Drug Resist 2023; 16:7097-7108. [PMID: 37954504 PMCID: PMC10638893 DOI: 10.2147/idr.s434695] [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: 08/09/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023] Open
Abstract
Purpose To analyze the clinical characteristics of AIDS with dTSM, especially in patients with poor prognosis. Patients and Methods One hundred and seventy AIDS patients were enrolled in this single-center retrospective study. The epidemiological characteristics, clinical manifestations, laboratory tests, imaging examination, and treatment outcome were collected. Logistic regression analysis was used to estimate the risk of mortality in AIDS patients with dTSM. The predictive value was evaluated using the receiver operating characteristic (ROC) curve. Results From 2015 to 2022, the incidence of AIDS with dTSM in the Wenzhou region increased yearly, mainly in young adults. The mortality rate was 16.47%. The most common clinical manifestations were lymph-node enlargement (92.35%) and fever (78.24%). Multivariate logistic regression analysis showed that procalcitonin (PCT), blood urea nitrogen (BUN), shock, and antiretroviral therapy (ART) were the risk factors for poor outcomes. The model comprised four risk factors and showed an excellent prediction performance, with an AUC of 0.987 in the training cohort (95% CI: 0.946-0.999) and 0.976 in the validation cohort (95% CI: 0.887-0.999). Conclusion This study suggested that PCT, BUN, shock, and ART were associated with the prognosis and outcome of AIDS with dTSM and had a specific predictive value.
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Affiliation(s)
- Lianpeng Wu
- Department of Clinical Laboratory Medicine, The Ding Li Clinical College of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
- Department of Clinical Laboratory Medicine, Wenzhou Central Hospital, Wenzhou, 325000, People’s Republic of China
- Key Laboratory of Diagnosis and Treatment of New and Recurrent Infectious Diseases of Wenzhou, Wenzhou, 325000, People’s Republic of China
| | - Yong Pan
- Department of Clinical Laboratory Medicine, The Ding Li Clinical College of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
- Department of Clinical Laboratory Medicine, Wenzhou Central Hospital, Wenzhou, 325000, People’s Republic of China
| | - Ke Xu
- Department of Clinical Laboratory Medicine, The Ding Li Clinical College of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
- Department of Clinical Laboratory Medicine, Wenzhou Central Hospital, Wenzhou, 325000, People’s Republic of China
- Key Laboratory of Diagnosis and Treatment of New and Recurrent Infectious Diseases of Wenzhou, Wenzhou, 325000, People’s Republic of China
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Wu L, Xia D, Xu K. Multi-Clinical Factors Combined with an Artificial Intelligence Algorithm Diagnosis Model for HIV-Infected People with Bloodstream Infection. Infect Drug Resist 2023; 16:6085-6097. [PMID: 37719647 PMCID: PMC10503519 DOI: 10.2147/idr.s423709] [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: 05/31/2023] [Accepted: 08/29/2023] [Indexed: 09/19/2023] Open
Abstract
Purpose Although highly active antiretroviral therapy (HA-ART) can effectively suppress the disease process in patients with acquired immunodeficiency syndrome (AIDS), opportunistic infections, mainly bloodstream infections (BSI), are still the main cause of death in people living with HIV. There is no effective diagnostic strategy for HIV-infected people with BSI. This study aimed to develop an AI diagnostic model with high sensitivity to improve the early detection of HIV-infected people with BSI. Patients and Methods This study retrospectively analyzed the 40 clinical factors of 498 HIV-infected people (171 with BSI positive and 327 with BSI negative) who admitted to Wenzhou Central Hospital from September 2014 to July 2021. This study used the hospital information management system to collect the clinical characteristics, laboratory and imaging examination results, and clinical diagnosis of the two groups. The diagnostic results of all patients were in line with the diagnostic criteria of the Chinese Guidelines for the Diagnosis and Treatment of AIDS (2021 Edition), and the BSI diagnosis was in line with the diagnostic criteria of sepsis and bacteremia in Practical Internal Medicine (13th Edition). On this basis, various risk prediction models were established by combining 8 artificial intelligence (AI) algorithms in the training set and validating the diagnosis performance in the testing set. The model with the best diagnostic performance was selected as the final diagnostic model. Results The clinical characteristics of HIV-infected people with BSI are atypical, and the pathogens in this area are mainly fungi. Ten risk factors were selected: low level of hemoglobin, CD4+T cell and platelets, high level of lactate dehydrogenase and blood urea nitrogen, splenomegaly, without ART treatment, strip shadow, nodular shadow, and shock. The combination of the ten risk factors, age, gender and the "svmRadial" model can identify the HIV-infected people with BSI from the HIV-infected people without BSI with an area under the curve of 0.916 and a sensitivity and specificity of 0.824 and 0.855, respectively. Conclusion The model showed excellent performance in diagnosing HIV-infected people with BSI. Internal and external validation showed that the diagnosis model had high clinical application value.
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Affiliation(s)
- Lianpeng Wu
- Department of Clinical Laboratory Medicine, The Ding Li Clinical College of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
- Department of Clinical Laboratory Medicine, Wenzhou Central Hospital, Wenzhou, 325000, People’s Republic of China
- Key Laboratory of Diagnosis and Treatment of New and Recurrent Infectious Diseases of Wenzhou, Wenzhou, 325000, People’s Republic of China
| | - Dandan Xia
- Department of Clinical Laboratory Medicine, The Ding Li Clinical College of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
- Department of Clinical Laboratory Medicine, Wenzhou Central Hospital, Wenzhou, 325000, People’s Republic of China
- Key Laboratory of Diagnosis and Treatment of New and Recurrent Infectious Diseases of Wenzhou, Wenzhou, 325000, People’s Republic of China
| | - Ke Xu
- Department of Clinical Laboratory Medicine, The Ding Li Clinical College of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China
- Department of Clinical Laboratory Medicine, Wenzhou Central Hospital, Wenzhou, 325000, People’s Republic of China
- Key Laboratory of Diagnosis and Treatment of New and Recurrent Infectious Diseases of Wenzhou, Wenzhou, 325000, People’s Republic of China
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Dong RJ, Li J, Zhang Y, Li JS, Yang LH, Kuang YQ, Wang RR, Li YY. Thalidomide promotes NLRP3/caspase-1-mediated pyroptosis of macrophages in Talaromyces marneffei infection. Microb Pathog 2023:106168. [PMID: 37224982 DOI: 10.1016/j.micpath.2023.106168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 05/26/2023]
Abstract
Macrophage-derived inflammatory cytokines are critical for host defense against Talaromyces marneffei (T. marneffei) infection among HIV/AIDS patients, and excessive inflammatory cytokines are associated with poor outcomes of AIDS-associated talaromycosis. However, the underlying mechanisms of macrophage-caused pyroptosis and cytokine storm are poorly understood. Here, in the T. marneffei-infected mice and macrophages, we show that T. marneffei induced pyroptosis in macrophages through the NLRP3/caspase-1 pathway. The immunomodulatory drug thalidomide could promote the pyroptosis of macrophages infected T. marneffei. In T. marneffei-infected mice, the splenic macrophages underwent increasing pyroptosis as talaromycosis deteriorated. Thalidomide ameliorated inflammation of mice, while amphotericin B (AmB) in combination with thalidomide did not improve overall survival compared with AmB alone. Taken together, our findings suggest that thalidomide promotes NLRP3/caspase-1-mediated pyroptosis of macrophages in T. marneffei infection.
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Affiliation(s)
- Rong-Jing Dong
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China; Hubei Provincial Key Laboratory of Occurrence and Intervention of Kidney Diseases, Medical College, Hubei Polytechnic University, Huangshi, China
| | - Jun Li
- College of Pharmaceutical Sciences, Yunnan University of Traditional Chinese Medicine, Kunming, 650500, China
| | - Yi Zhang
- College of Pharmaceutical Sciences, Yunnan University of Traditional Chinese Medicine, Kunming, 650500, China
| | - Jia-Sheng Li
- College of Pharmaceutical Sciences, Yunnan University of Traditional Chinese Medicine, Kunming, 650500, China
| | - Lu-Hui Yang
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - Yi-Qun Kuang
- Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming650032, China.
| | - Rui-Rui Wang
- College of Pharmaceutical Sciences, Yunnan University of Traditional Chinese Medicine, Kunming, 650500, China.
| | - Yu-Ye Li
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China.
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Yang Q, Wu Y, Li X, Bao Y, Wang W, Zheng Y. Talaromyces marneffei infection and complicate manifestation of respiratory system in HIV-negative children. BMC Pulm Med 2023; 23:100. [PMID: 36978020 PMCID: PMC10053456 DOI: 10.1186/s12890-023-02390-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Respiratory symptoms are the earliest clinical manifestation of Talaromyces marneffei (TM) infection. In this study, we aimed to improve the early identification of TM infection in human immunodeficiency virus (HIV)-negative children with respiratory symptoms as the first manifestation, analyze the risk factors, and provide evidence for diagnosis and treatment. METHODS We retrospectively analyzed six cases of HIV-negative children with respiratory system infection symptoms as the first presentation. RESULTS All subjects (100%) had cough and hepatosplenomegaly, and five subjects (83.3%) had a fever; other symptoms and signs included lymph node enlargement, rash, rales, wheezing, hoarseness, hemoptysis, anemia, and thrush. Additionally, 66.7% of the cases had underlying diseases (three had malnutrition, one had severe combined immune deficiency [SCID]). The most common coinfecting pathogen was Pneumocystis jirovecii, which occurred in two cases (33.3%), followed by one case of Aspergillus sp. (16.6%). Furthermore, the value of β-D-glucan detection (G test) increased in 50% of the cases, while the proportion of NK decreased in six cases (100%). Five children (83.3%) were confirmed to have the pathogenic genetic mutations. Three children (50%) were treated with amphotericin B, voriconazole, and itraconazole, respectively; three children (50%) were treated with voriconazole and itraconazole. All children were tested for itraconazole and voriconazole plasma concentrations throughout antifungal therapy. Two cases (33.3%) relapsed after drug withdrawal within 1 year, and the average duration of antifungal treatment for all children was 17.7 months. CONCLUSION The first manifestation of TM infection in children is respiratory symptoms, which are nonspecific and easily misdiagnosed. When the effectiveness of anti-infection treatment is poor for recurrent respiratory tract infections, we must consider the condition with an opportunistic pathogen and attempt to identify the pathogen using various samples and detection methods to confirm the diagnosis. It is recommended the course for anti-TM disease be longer than one year for children with immune deficiency. Monitoring the blood concentration of antifungal drugs is important.
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Affiliation(s)
- Qin Yang
- Department of Respiratory Diseases, Shenzhen Children's Hospital, Shantou University Medical College, Shenzhen, 518038, China
| | - Yue Wu
- Department of Clinical Pharmacy, Shenzhen Children's Hospital, Shantou University Medical College, Shenzhen, 518038, China
| | - Xiaonan Li
- Department of Respiratory Diseases, Shenzhen Children's Hospital, Shantou University Medical College, Shenzhen, 518038, China
| | - Yanmin Bao
- Department of Respiratory Diseases, Shenzhen Children's Hospital, Shantou University Medical College, Shenzhen, 518038, China
| | - Wenjian Wang
- Department of Respiratory Diseases, Shenzhen Children's Hospital, Shantou University Medical College, Shenzhen, 518038, China
| | - Yuejie Zheng
- Department of Respiratory Diseases, Shenzhen Children's Hospital, Shantou University Medical College, Shenzhen, 518038, China.
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Yang LH, Dong RJ, Lu YW, Wang HM, Kuang YQ, Wang RR, Li YY. Integration of metabolomics and transcriptomics analyses reveals sphingosine-1-phosphate-mediated S1PR2/PI3K/Akt pathway involved in Talaromyces marneffei infection of macrophages. Microb Pathog 2023; 175:105985. [PMID: 36638850 DOI: 10.1016/j.micpath.2023.105985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/12/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
Talaromycosis is a fatal mycosis caused by the thermally dimorphic fungus Talaromyces marneffei (T. marneffei). The pathogenic mechanisms of talaromycosis are still poorly understood. This work combined metabolomics, transcriptomics, and verification experiments in vivo and in vitro to detect metabolic profiles and differentially expressed genes (DEGs) in T. marneffei infected and uninfected macrophages to explore possible pathogenesis and underlying mechanisms. A total of 256 differential metabolites (117 up-regulated and 148 down-regulated) and 1320 DEGs (1286 up-regulated and 34 down-regulated) were identified between the two groups. Integrative metabolomics and transcriptomics analysis showed sphingolipid signaling pathway is the most influential. Verification experiments showed that compared with the control group, the production of sphingosine-1-phosphate (S1P) and the expression of the S1PR1, S1PR2, phosphor-PI3K, and phosphor-Akt genes involved in the sphingolipid signaling pathway have significantly increased in the T. marneffei infection group (p < 0.05). T. marneffei activates the S1PR2/PI3K/Akt pathways in J774A.1 macrophage, regulation of the S1P singling might serve as a promising therapeutic strategy for talaromycosis.
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Affiliation(s)
- Lu-Hui Yang
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Rong-Jing Dong
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, China; Hubei Provincial Key Laboratory of Occurrence and Intervention of Kidney Diseases, Medical College, Hubei Polytechnic University, Huangshi, China
| | - You-Wang Lu
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, China; Hubei Provincial Key Laboratory of Occurrence and Intervention of Kidney Diseases, Medical College, Hubei Polytechnic University, Huangshi, China
| | - Hong-Mei Wang
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yi-Qun Kuang
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China; Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China.
| | - Rui-Rui Wang
- School of Chinese Materia Medica, Yunnan University of Chinese Medicine, Kunming, China.
| | - Yu-Ye Li
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, China.
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Xu L, Chen X, Yang X, Jiang H, Wang J, Chen S, Xu J. Disseminated Talaromyces marneffei infection after renal transplantation: A case report and literature review. Front Cell Infect Microbiol 2023; 13:1115268. [PMID: 36816584 PMCID: PMC9932035 DOI: 10.3389/fcimb.2023.1115268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
We reported a 31-year-old man who received renal transplantation for more than 2 years. He was admitted to our hospital on 9 March 2022 due to intermittent diarrhea accompanied by leukopenia for more than 1 month. The patient successively developed high fever, cough, anemia, weight loss, gastrointestinal bleeding, and liver function impairment. Computed tomography (CT) revealed a slight inflammation in the lower lobes of both lungs, enlargement of the lymph nodes in the retroperitoneal and the root of mesenteric areas, and hepatosplenomegaly. Talaromyces marneffei was detected by metagenomics next-generation sequencing (mNGS) in blood and bronchoalveolar lavage fluid, and the pathogen was subsequently verified by blood culture. After endoscopic hemostatic therapy and antifungal therapy with voriconazole and amphotericin B cholesteryl sulfate complex, the patient was successfully discharged. Oral voriconazole was given regularly after discharge. Diarrhea, fever, enlargement of the lymph nodes, and endoscopic evidence of erosion may indicate intestinal T. marneffei infection. Although the mortality of T. marneffei infection after renal transplantation is very high, timely and effective antifungal therapy with amphotericin B cholesteryl sulfate complex is still expected to improve its prognosis.
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Affiliation(s)
- Liang Xu
- Department of Organ Transplantation, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Xiuxiu Chen
- The Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Xuying Yang
- Department of Scientific Affairs, Hugobiotech Co., Ltd., Beijing, China
| | - Hongtao Jiang
- Department of Organ Transplantation, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Jianli Wang
- Department of Organ Transplantation, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Shaowen Chen
- Department of Clinical Laboratory, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Jian Xu
- Department of Organ Transplantation, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
- *Correspondence: Jian Xu,
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Yang Q, Wu Y, Li X, Bao Y, Wang W, Zheng Y. Respiratory system Talaromyces marneffei infection in HIV-negative children.. [DOI: 10.21203/rs.3.rs-2294600/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Background
Respiratory symptoms are the earliest clinical manifestation of Talaromyces marneffei (TM) infection. In this study, we aimed to improve the early identification of TM infection in human immunodeficiency virus (HIV)-negative children with respiratory symptoms as the first manifestation, analyze the risk factors, and provide evidence for diagnosis and treatment.
Methods
We retrospectively analyzed six cases of HIV-negative children with respiratory system infection symptoms as the first presentation.
Results
All subjects (100%) had cough and hepatosplenomegaly, and five subjects (83.3%) had a fever; other symptoms included lymph node enlargement, rash, rales, wheezing, hoarseness, hemoptysis, anemia, and thrush. Additionally, 66.7% of the cases had underlying diseases (three had malnutrition, one had severe combined immune deficiency [SCID]). The most common coinfecting pathogen was Pneumocystis carinii, which occurred in two cases (33.3%), followed by one case of Aspergillus (16.6%). Furthermore, the value of β-D-glucan detection (G experimental) increased in 50% of the cases, while the proportion of NK decreased in six cases (100%). Five children (83.3%) were confirmed to have the pathogenic genetic mutations. Three children (50%) were treated with amphotericin B, voriconazole, and itraconazole, respectively; three children (50%) were treated with voriconazole and itraconazole. All children were tested for itraconazole and voriconazole plasma concentrations throughout antifungal therapy. Two cases (33.3%) relapsed after drug withdrawal within 1 year, and the average duration of antifungal treatment for all children was 17.7 months.
Conclusion
The first manifestation of TM infection in children is respiratory symptoms, which are nonspecific and easily misdiagnosed. When the effectiveness of anti-infection treatment is poor for recurrent respiratory tract infections, we must consider the condition with an opportunistic pathogen and attempt to identify the pathogen using various samples and detection
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Affiliation(s)
- Qin Yang
- Shenzhen Children's Hospital, Shantou University Medical College
| | - Yue Wu
- Shenzhen Children's Hospital, Shantou University Medical College
| | - Xiaonan Li
- Shenzhen Children's Hospital, Shantou University Medical College
| | - Yanmin Bao
- Shenzhen Children's Hospital, Shantou University Medical College
| | - Wenjian Wang
- Shenzhen Children's Hospital, Shantou University Medical College
| | - Yuejie Zheng
- Shenzhen Children's Hospital, Shantou University Medical College
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Expression of Cytokine Profiles in Human THP-1 Cells during Phase Transition of Talaromyces marneffei. Pathogens 2022; 11:pathogens11121465. [PMID: 36558799 PMCID: PMC9783046 DOI: 10.3390/pathogens11121465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/25/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Talaromyces marneffei, a dimorphic fungus, exhibits temperature-dependent growth, existing in a filamentous form at 25 °C and as a yeast at 37 °C. Several studies have highlighted the important roles of macrophages in defense against T. marneffei infection. However, the immune responses to the interaction of macrophages with T. marneffei cells during phase transition require further investigation. This study reports the expression of cytokine profiles in human THP-1 cells during infection by T. marneffei. THP-1 cells were infected with T. marneffei conidia at different multiplicity of infections (MOIs). Surviving conidia transformed into yeasts after phagocytosis by macrophages, and the number of yeasts gradually increased over 36 h. The transcription and secretion levels of pro- and anti-inflammatory cytokines were examined at different times by qRT-PCR and ELISA. Transcription levels of IL-8, IL-12, IL-1β, and TNF-α increased significantly at 12 or 24 h and then slightly decreased at 36 h. In contrast, the transcription levels of IL-6, IL-10, and TGF-β gradually increased at all MOIs. The levels of IL-6 and IL-10 secretion corresponded to their levels of transcription. These results indicated that as the number of intracellular yeasts increased, the infected macrophages first underwent slight M1 polarization before shifting to M2 polarization. This polarization transition was confirmed by the fungicidal ability and the expression of macrophage surface markers. By inducing the M2-type polarization of macrophages, the intracellular T. marneffei cells can successfully evade the immune response. Our study provides a novel insight into the immune characterization during the transition of T. marneffei infection and could further contribute to possible diagnostic and therapeutic interventions for this infection.
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Chen R, Yang D, Shen L, Fang J, Khan R, Liu D. Overexpression of CD86 enhances the ability of THP-1 macrophages to defend against Talaromyces marneffei. Immun Inflamm Dis 2022; 10:e740. [PMID: 36444627 PMCID: PMC9673424 DOI: 10.1002/iid3.740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Macrophages are the first line of defense against Talaromyces marneffei. CD86 is a surface molecule expressed on antigen-presenting cells, such as macrophages, that provide costimulatory signals necessary for T cell activation and survival. In a prior study, it was shown that as infection progressed, CD86 expression levels in macrophages considerably declined while CD86 concentrations in the supernatant significantly increased. Additionally, M1 macrophage polarization was insufficient and switched to M2 macrophage polarization. Besides costimulation, however, additional roles of CD86 are not known or well-studies. Therefore, we hypothesized that upregulating CD86 on macrophages might promote T. marneffei defense. METHODS A lentivirus vector, called Lenti-CD86, was used to infect THP-1 cells to overexpress secretory CD86. Through killing assay, nitric oxide detection, and cytokine detection, the capacity of THP-1 macrophages to phagocytose and kill T. marneffei was examined. RESULTS In the current study, Lenti-CD86 transfection of THP-1 cells resulted in a signifant expression of CD86. Additionally, the THP-1 macrophages stably transfected with Lenti-CD86 showed higher nitric oxide and IL-1β production, faster polarization, and stronger phagocytosis and killing capabilities than the non-transfected or control virus transfected cells. CONCLUSION Our study shows that lentivirus-mediated CD86 overexpression improves THP-1 macrophages' capacity to phagocytose and eliminate T. marneffei.
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Affiliation(s)
- Rifeng Chen
- Department of DermatologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningPeople's Republic of China
| | - Di Yang
- Department of DermatologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningPeople's Republic of China
| | - Linxia Shen
- Department of DermatologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningPeople's Republic of China
| | - Jinling Fang
- Department of DermatologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningPeople's Republic of China
| | - Raqib Khan
- Department of DermatologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningPeople's Republic of China
| | - Donghua Liu
- Department of DermatologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningPeople's Republic of China
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11
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Peng L, Shi YB, Zheng L, Hu LQ, Weng XB. Clinical features of patients with talaromycosis marneffei and microbiological characteristics of the causative strains. J Clin Lab Anal 2022; 36:e24737. [PMID: 36268985 DOI: 10.1002/jcla.24737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Talaromyces marneffei (T. marneffei) is a temperature-dependent dimorphic fungus that is mainly prevalent in Southeast Asia and South China and often causes disseminated life-threatening infections. This study aimed to investigate the clinical features and improve the early diagnosis of talaromycosis marneffei in nonendemic areas. METHODS We retrospectively analyzed the medical records of six cases of T. marneffei infection. We describe the clinical manifestations, laboratory tests, and imaging manifestations of the six patients. RESULTS Talaromyces marneffei infection was confirmed by sputum culture, blood culture, tissue biopsy, and metagenomic next-generation sequencing (mNGS). In this study, there were five disseminated-type patients and two HIV patients. One patient died within 24 h, and the others demonstrated considerable improvement after definitive diagnosis. CONCLUSIONS Due to the lack of significant clinical presentations of talaromycosis marneffei, many cases may be easily misdiagnosed in nonendemic areas. It is particularly important to analyze the imaging manifestations and laboratory findings of infected patients. With the rapid development of molecular biology, mNGS may be a rapid and effective diagnostic method.
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Affiliation(s)
- Lei Peng
- School of Medicine, Ningbo University, Ningbo, China
| | - Yu-Bo Shi
- Department of Medical Laboratory, Ningbo First Hospital, Ningbo, China
| | - Lin Zheng
- Department of Medical Laboratory, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Li-Qing Hu
- Department of Medical Laboratory, Ningbo First Hospital, Ningbo, China
| | - Xing-Bei Weng
- School of Medicine, Ningbo University, Ningbo, China.,Department of Medical Laboratory, Ningbo First Hospital, Ningbo, China
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Höft MA, Duvenage L, Hoving JC. Key thermally dimorphic fungal pathogens: shaping host immunity. Open Biol 2022; 12:210219. [PMID: 35259948 PMCID: PMC8905152 DOI: 10.1098/rsob.210219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 02/09/2022] [Indexed: 01/09/2023] Open
Abstract
Exposure to fungal pathogens from the environment is inevitable and with the number of at-risk populations increasing, the prevalence of invasive fungal infection is on the rise. An interesting group of fungal organisms known as thermally dimorphic fungi predominantly infects immunocompromised individuals. These potential pathogens are intriguing in that they survive in the environment in one form, mycelial phase, but when entering the host, they are triggered by the change in temperature to switch to a new pathogenic form. Considering the growing prevalence of infection and the need for improved diagnostic and treatment approaches, studies identifying key components of fungal recognition and the innate immune response to these pathogens will significantly contribute to our understanding of disease progression. This review focuses on key endemic dimorphic fungal pathogens that significantly contribute to disease, including Histoplasma, Coccidioides and Talaromyces species. We briefly describe their prevalence, route of infection and clinical presentation. Importantly, we have reviewed the major fungal cell wall components of these dimorphic fungi, the host pattern recognition receptors responsible for recognition and important innate immune responses supporting adaptive immunity and fungal clearance or the failure thereof.
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Affiliation(s)
- Maxine A. Höft
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town 7925, South Africa
- Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
- MRC Centre for Medical Mycology at the University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter EX4 4QD, UK
| | - Lucian Duvenage
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town 7925, South Africa
- Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
- MRC Centre for Medical Mycology at the University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter EX4 4QD, UK
| | - J. Claire Hoving
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town 7925, South Africa
- Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
- MRC Centre for Medical Mycology at the University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter EX4 4QD, UK
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Talaromyces marneffei Infection: Virulence, Intracellular Lifestyle and Host Defense Mechanisms. J Fungi (Basel) 2022; 8:jof8020200. [PMID: 35205954 PMCID: PMC8880324 DOI: 10.3390/jof8020200] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 12/02/2022] Open
Abstract
Talaromycosis (Penicilliosis) is an opportunistic mycosis caused by the thermally dimorphic fungus Talaromyces (Penicillium) marneffei. Similar to other major causes of systemic mycoses, the extent of disease and outcomes are the results of complex interactions between this opportunistic human pathogen and a host’s immune response. This review will highlight the current knowledge regarding the dynamic interaction between T. marneffei and mammalian hosts, particularly highlighting important aspects of virulence factors, intracellular lifestyle and the mechanisms of immune defense as well as the strategies of the pathogen for manipulating and evading host immune cells.
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Ma Y, Wang X, Li R. Cutaneous and subcutaneous fungal infections: recent developments on host-fungus interactions. Curr Opin Microbiol 2021; 62:93-102. [PMID: 34098513 DOI: 10.1016/j.mib.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/27/2021] [Accepted: 05/07/2021] [Indexed: 02/07/2023]
Abstract
The incidence of skin fungal infections is increasing at an alarming rate worldwide, presenting a major challenge to health professionals. Cutaneous and subcutaneous fungal infections are caused by pathogenic or opportunistic organisms varying from mold, yeasts, to dimorphic fungi. Recently, skin fungal have been increasingly reported and studied, giving rise to crucial breakthroughs in etiology and pathogenesis. This review aims to summarize recent insights into the clinical and etiological characteristics of common skin fungal infections according to different fungal species, as well as remarkable advances in the immune mechanisms. We hope it will be helpful to understand these diverse skin fungal infections, and bring about the latest developments that may facilitate novel diagnostic and therapeutic approaches to improve the outcomes in these patients.
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Affiliation(s)
- Yubo Ma
- Department of Dermatology and Venerology, Peking University First Hospital, China; Research Center for Medical Mycology, Peking University, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, China; National Clinical Research Center for Skin and Immune Diseases, Beijing 100034, China
| | - Xiaowen Wang
- Department of Dermatology and Venerology, Peking University First Hospital, China; Research Center for Medical Mycology, Peking University, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, China; National Clinical Research Center for Skin and Immune Diseases, Beijing 100034, China.
| | - Ruoyu Li
- Department of Dermatology and Venerology, Peking University First Hospital, China; Research Center for Medical Mycology, Peking University, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, China; National Clinical Research Center for Skin and Immune Diseases, Beijing 100034, China.
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Yang B, Wang J, Jiang H, Lin H, Ou Z, Ullah A, Hua Y, Chen J, Lin X, Hu X, Zheng L, Wang Q. Extracellular Vesicles Derived From Talaromyces marneffei Yeasts Mediate Inflammatory Response in Macrophage Cells by Bioactive Protein Components. Front Microbiol 2021; 11:603183. [PMID: 33488545 PMCID: PMC7819977 DOI: 10.3389/fmicb.2020.603183] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 12/02/2020] [Indexed: 12/12/2022] Open
Abstract
Extracellular vesicles (EVs) loaded with proteins, nucleic acids, membrane lipids, and other virulence factors could participate in pathogenic processes in some fungi such as Cryptococcus neoformans and Candida albicans. However, the specific characteristics of EVs derived from Talaromyces marneffei (TM) still have not been figured out yet. In the present study, it has been observed that TM-derived EVs were a heterogeneous group of nanosized membrane vesicles (30–300 nm) under nanoparticle tracking analysis and transmission electron microscopy. The DiI-labeled EVs could be taken up by RAW 264.7 macrophage cells. Incubation of EVs with macrophages would result in increased expression levels of reactive oxygen species, nitric oxide, and some inflammatory factors including interleukin-1β, interleukin-6, interleukin-10, and tumor necrosis factor. Furthermore, the expression of co-stimulatory molecules (CD80, CD86, and MHC-II) was also increased in macrophages stimulated with EVs. The level of inflammatory factors secreted by macrophages showed a significant decrease when EVs were hydrolyzed by protease, while that of DNA and RNA hydrolase treatment remained unchanged. Subsequently, some virulence factors in EVs including heat shock protein, mannoprotein 1, and peroxidase were determined by liquid chromatography–tandem mass spectrometry. Taken together, our results indicated that the TM-derived EVs could mediate inflammatory response and its protein would play a key role in regulating the function of RAW 264.7 macrophage cells.
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Affiliation(s)
- Biao Yang
- Center for Clinical Laboratory, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jingyu Wang
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Engineering and Technology Research Center for Rapid Diagnostic Biosensors, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hongye Jiang
- Shunde Hospital, The First People's Hospital of Shunde, Southern Medical University, Foshan, China
| | - Huixian Lin
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Engineering and Technology Research Center for Rapid Diagnostic Biosensors, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zihao Ou
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Engineering and Technology Research Center for Rapid Diagnostic Biosensors, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Amir Ullah
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Engineering and Technology Research Center for Rapid Diagnostic Biosensors, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yuneng Hua
- Center for Clinical Laboratory, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Juanjiang Chen
- Center for Clinical Laboratory, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaomin Lin
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Engineering and Technology Research Center for Rapid Diagnostic Biosensors, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiumei Hu
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Engineering and Technology Research Center for Rapid Diagnostic Biosensors, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lei Zheng
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Engineering and Technology Research Center for Rapid Diagnostic Biosensors, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qian Wang
- Center for Clinical Laboratory, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Characterization of a novel yeast phase-specific antigen expressed during in vitro thermal phase transition of Talaromyces marneffei. Sci Rep 2020; 10:21169. [PMID: 33273617 PMCID: PMC7713699 DOI: 10.1038/s41598-020-78178-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023] Open
Abstract
Talaromyces marneffei is a dimorphic fungus that has emerged as an opportunistic pathogen particularly in individuals with HIV/AIDS. Since its dimorphism has been associated with its virulence, the transition from mold to yeast-like cells might be important for fungal pathogenesis, including its survival inside of phagocytic host cells. We investigated the expression of yeast antigen of T.marneffei using a yeast-specific monoclonal antibody (MAb) 4D1 during phase transition. We found that MAb 4D1 recognizes and binds to antigenic epitopes on the surface of yeast cells. Antibody to antigenic determinant binding was associated with time of exposure, mold to yeast conversion, and mammalian temperature. We also demonstrated that MAb 4D1 binds to and recognizes conidia to yeast cells’ transition inside of a human monocyte-like THP-1 cells line. Our studies are important because we demonstrated that MAb 4D1 can be used as a tool to study T.marneffei virulence, furthering the understanding of the therapeutic potential of passive immunity in this fungal pathogenesis.
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Li YY, Dong RJ, Shrestha S, Upadhyay P, Li HQ, Kuang YQ, Yang XP, Zhang YG. AIDS-associated Talaromyces marneffei central nervous system infection in patients of southwestern China. AIDS Res Ther 2020; 17:26. [PMID: 32456686 PMCID: PMC7249401 DOI: 10.1186/s12981-020-00281-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 05/15/2020] [Indexed: 12/12/2022] Open
Abstract
Background The clinical and laboratory characteristics of AIDS-associated Talaromyces marneffei infection, a rare but a fatal mycosis disease of the central nervous system, remain unclear. Case presentation Herein, we conducted a retrospective study of ten AIDS patients with cerebrospinal fluid culture-confirmed central nervous system infection caused by Talaromyces marneffei. All 10 patients were promptly treated with antifungal treatment for a prolonged duration and early antiviral therapy (ART). Among them, seven patients were farmers. Nine patients were discharged after full recovery, while one patient died during hospitalization, resulting in a mortality rate of 10%. All patients initially presented symptoms and signs of an increase in intracranial pressure, mainly manifesting as headache, dizziness, vomiting, fever, decreased muscle strength, diplopia or even altered consciousness with seizures in severe patients. Nine patients (90%) showed lateral ventricle dilatation or intracranial infectious lesions on brain CT. Cerebrospinal fluid findings included elevated intracranial pressure, increased leukocyte count, low glucose, low chloride and high cerebrospinal fluid protein. The median CD4+ T count of patients was 104 cells/μL (IQR, 36–224 cells/μL) at the onset of the disease. The CD4+ T cell counts of three patients who eventually died were significantly lower (W = 6.00, p = 0.020) than those of the patients who survived. Conclusions The common clinical symptoms of T. marneffei central nervous system infection are associated with high intracranial pressure and intracranial infectious lesions. Earlier recognition and diagnosis and a prolonged course of amphotericin B treatment followed by itraconazole combined with early ART might reduce the mortality rate.
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