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Yang ZM, Huang J, Chen XM, Meng X, Qiu Y, Zeng W, Zhang JQ. [Advances in clinical characteristics of talaromycosis combined with other opportunistic infections]. Zhonghua Jie He He Hu Xi Za Zhi 2023; 46:503-506. [PMID: 37147814 DOI: 10.3760/cma.j.cn112147-20220807-00659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Talaromycosis (TSM) is an opportunistic deep mycosis prevalent in southeast Asia and southern China, affecting HIV-positive, anti-interferon-gamma autoantibody-positive and other immunodeficiency hosts. These hosts are often co-infected with mycobacterium tuberculosis, non-tuberculosis mycobacteria, bacteria, fungi, viruses and other opportunistic infections. The clinical characteristics and the pathogenic spectrum of TSM with opportunistic infections vary with different immune states. The rates of misdiagnosis, missed diagnosis and mortality are high. This review summarized the clinical characteristics of TSM with opportunistic infections in order to improve the level of clinical diagnosis and treatment.
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Affiliation(s)
- Z M Yang
- Department of Respiratory and Critical Medicine, the Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen 518033, China
| | - J Huang
- Department of Respiratory and Critical Care Medicine, the Fourth People's Hospital of Nanning, Nanning 530002, China
| | - X M Chen
- Department of Respiratory and Critical Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - X Meng
- Department of Respiratory and Critical Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Y Qiu
- Department of Respiratory and Critical Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - W Zeng
- Department of Respiratory and Critical Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - J Q Zhang
- Department of Respiratory and Critical Medicine, the Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen 518033, China
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Tang M, Pan M, Qiu Y, Huang J, Zeng W, Zhang J. Sweet’s Syndrome Accompanied by Coinfection with Multiple Pathogens and Disseminated Mycobacterium phlei Infection Presenting with Osteolytic Destruction During 12 Years of Follow-Up: A Rare Case Report. Infect Drug Resist 2022; 15:2459-2467. [PMID: 35592103 PMCID: PMC9112167 DOI: 10.2147/idr.s360063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/29/2022] [Indexed: 11/30/2022] Open
Abstract
Background Anti-IFN-γ autoantibodies (AIGAs) are closely related to the disseminated infection of multiple pathogens. Mycobacterium phlei (M. phlei) is a nonpathogenic nontuberculous mycobacteria (NTM), and M. phlei infection of the bone is extremely rare. We report a rare case of high-titer AIGAs presenting with Sweet’s syndrome (SS) accompanied by opportunistic coinfection with multiple pathogens during 12 years of follow-up. The patient in this case also developed disseminated M. phlei infection with osteolytic destruction after treatment for SS. Case Presentation A 68-year-old Chinese woman was admitted to our hospital in August 2009 due to fever and cough with expectoration for 3 months. The patient was successively infected with Klebsiella pneumoniae, herpes zoster virus and Candida. Chest computed tomography (CT) showed recurrent consolidations in different lung fields. After 15 months of antimicrobial treatment, the patient experienced partial recovery. In September 2010, the patient was pathologically diagnosed with SS due to the presence of multiple rashes. After prednisone and thalidomide treatment, the rashes subsided, and the pulmonary lesions had completely absorbed. In May 2011, the patient was diagnosed with disseminated tuberculosis and was administered anti-tuberculosis therapy for 3 months without improvement. NTM was subsequently cultured from her sputum and chest wall pus, and she improved after 20 months of anti-NTM therapy. In March 2016, the patient developed osteolytic destruction of the C7-T2 vertebral bodies with a back abscess. NTM was eventually cultured from the dorsal abscess pus and further identified as M. phlei. High-titer AIGAs were detected in the patient’s serum. After another round of aggressive anti-NTM therapy, the patient was finally cured. Conclusion Patients with AIGA-associated anti-cytokine autoantibody disease can present with multiple opportunistic infections and SS involving the lung. AIGA-associated immunodeficiency leads to infection with nonpathogenic M. phlei, which is refractory, can cause relapse, and even leads to osteolytic destruction.
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Affiliation(s)
- Mengxin Tang
- Department of Respiratory and Critical Medicine, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, Guangdong, 518000, People’s Republic of China
- Department of Respiratory and Critical Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People’s Republic of China
| | - Mianluan Pan
- Department of Respiratory and Critical Medicine, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, Guangdong, 518000, People’s Republic of China
| | - Ye Qiu
- Department of Respiratory and Critical Medicine, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, Guangdong, 518000, People’s Republic of China
| | - Jie Huang
- Department of Tuberculosis Ward, Nanning Fourth People’s Hospital, Nanning, Guangxi, 530021, People’s Republic of China
| | - Wen Zeng
- Department of Respiratory and Critical Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People’s Republic of China
- Correspondence: Wen Zeng, Department of Respiratory and Critical Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People’s Republic of China, Tel +8618589883694, Fax +86771-5350031, Email
| | - Jianquan Zhang
- Department of Respiratory and Critical Medicine, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, Guangdong, 518000, People’s Republic of China
- Jianquan Zhang, Department of Respiratory and Critical Medicine, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, Guangdong, 518000, People’s Republic of China, Tel +8613978123845, Fax +86755-23482484, Email
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Yang Z, Zeng W, Qiu Y, Liu G, Zhang J. Nodular Sclerosing Hodgkin Lymphoma Combined with Disseminated Talaromyces marneffei Infection: A Case Report. Infect Drug Resist 2021; 14:5671-5678. [PMID: 34992393 PMCID: PMC8713721 DOI: 10.2147/idr.s340192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background Talaromyces marneffei (TM) is the only temperature-biphasic pathogen among Penicillium spp. that causes talaromycosis marneffei (TSM). Clinical manifestations include fever, cough, expectoration, superficial and deep lymph node enlargement, hepatosplenomegaly, subcutaneous nodules, and bone and joint infections. Cases of TSM in Hodgkin lymphoma (HL) patients are uncommon. The clinical manifestations and imaging findings are similar in TSM and HL, which make it difficult for clinicians to distinguish between TSM and HL. Both diseases can present with symptoms, can involve the blood or the respiratory system and can include other symptoms. We report a rare case of HIV-negative nodular sclerosing Hodgkin lymphoma (NSHL) combined with T. marneffei infection to improve clinical knowledge. Case Presentation The patient was a 51-year-old man who presented with a 1-month history of cough, expectoration, intermittent fever in the afternoon and night, cervical lymph node enlargement, diabetes and previous lung surgery. He had markedly elevated serum inflammatory markers and moderate diffuse lung dysfunction. Chest computed tomography (CT) showed diffuse nodular lesions in both lungs with mediastinal lymph node enlargement. The patient did not respond to antibacterial and diagnostic antituberculosis therapy. After lymph node biopsy and lung culture, we obtained a definite diagnosis of NSLH with T. marneffei infection and administered antifungal therapy. His symptoms improved, and he was discharged for further treatment. Unfortunately, he died of Salmonella sepsis 7 months later. Conclusion It is rare for NSLH patients to be infected with T. marneffei. Both diseases can present with fever, lymphadenopathy, and hepatosplenomegaly and involve the blood and respiratory system or can cause other symptoms. Clinically, a misdiagnosis or missed diagnosis may occur. A multisite biopsy or culture should be performed to make a definitive diagnosis. Early antifungal therapy combined with standard chemotherapy can achieve satisfactory clinical efficacy.
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Affiliation(s)
- Zhenming Yang
- Department of Respiratory and Critical Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, 518000, People’s Republic of China
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People’s Republic of China
| | - Wen Zeng
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People’s Republic of China
| | - Ye Qiu
- Department of Comprehensive Internal Medicine, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People’s Republic of China
| | - Guangnan Liu
- Department of Respiratory Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530005, People’s Republic of China
| | - Jianquan Zhang
- Department of Respiratory and Critical Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, 518000, People’s Republic of China
- Correspondence: Jianquan Zhang Department of Respiratory and Critical Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, No. 3025, Shennan Middle Road, Shenzhen, 518000, Guangdong, People’s Republic of ChinaTel +8613978123845Fax +86755-23482484 Email
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