Assessment of Talaromyces Marneffei Infection of the Intestine in Three Patients and a Systematic Review of Case Reports

Abstract

Background Hematogenous dissemination of Talaromyces marneffei can result in multiorgan involvement (skin, lung, and reticuloendothelial system involvement); however, few studies have reported intestinal T marneffei infections. We investigated clinical features, management, and patient outcomes concerning Talaromyces-related intestinal infections. Methods Patients with Talaromycosis between August 2012 and April 2019 at The First Affiliated Hospital of Guangxi Medical University, China, were retrospectively analyzed. Patients presenting with intestinal Talaromycosis and endoscopy-confirmed diagnoses were investigated. We also undertook a systematic review of the relevant English and Chinese literature. Results Of 175 patients diagnosed with Talaromycosis, 33 presented with gastrointestinal symptoms, and 31 underwent stool cultures, 1 of which tested positive. Three patients had gastrointestinal symptoms and negative stool cultures, and endoscopic tissue biopsy confirmed a pathological diagnosis. A systematic review of 14 reports on human Talaromycosis identified an additional 16 patients. Fever, weight loss, and anemia were the most common symptoms, along with abdominal pain, diarrhea, and bloody stools. Abdominal computed tomography showed intestinal wall edema and thickening and/or abdominal lymphadenopathy. Endoscopy showed erosion, hyperemia, edema, and multiple intestinal mucosal ulcers. Of the 19 patients, 16 received antifungal therapy, 14 of whom recovered and 2 died. Three patients received no therapy and died. Conclusions Gastrointestinal disseminated Talaromycosis is not rare and can affect the stomach, duodenum, and colon, and may involve the entire digestive tract. Colon is the most common site. Endoscopy is needed for patients presenting with gastrointestinal symptoms in T marneffei-infected endemic areas. Systemic application of effective antifungal therapy can improve the prognosis.

Gastrointestinal manifestations of Talaromyces marneffei infection in an HIV-infected patient rapidly verified by metagenomic next-generation sequencing: a case report

“…Although gastrointestinal symptoms (e.g., diarrhea) are relatively common with a prevalence of approximately 25% [6], the prevalence of colonic involvement caused by Talaromyces marneffei infection is only 1.9% [7]. Including the present case, prominent abdominal involvement from Talaromyces marneffei infection has been reported in a total of 14 patients (Table 1) [4][5][6][7][8][9][10][11][12][13]. The main macroscopic pathological changes include multiple gastrointestinal ulcers and mesenteric lymphadenitis.…”

Clinical features of patients with talaromycosis marneffei and microbiological characteristics of the causative strains

“…It has been documented that T. marneffei enters the blood system by invading the reticuloendothelial system and then spreads to other organs through the lymphatic system and blood circulation. 12,13 T. marneffei mainly invades organs and sites related to Although lymphoid tissue is extensive throughout the digestive tract, talaromycosis marneffei infection of the intestine is uncommon. 13 The atypical and nonspecific clinical presentation of fungal infections in T. marneffei often adds to the difficulty of early diagnosis, resulting in diagnostic delay and increased mortality.…”

“…12,13 T. marneffei mainly invades organs and sites related to Although lymphoid tissue is extensive throughout the digestive tract, talaromycosis marneffei infection of the intestine is uncommon. 13 The atypical and nonspecific clinical presentation of fungal infections in T. marneffei often adds to the difficulty of early diagnosis, resulting in diagnostic delay and increased mortality.…”

“…The original route of infection is currently unknown, but it could be through skin lesions or conidia inhalation. It has been documented that T. marneffei enters the blood system by invading the reticuloendothelial system and then spreads to other organs through the lymphatic system and blood circulation 12,13 . T. marneffei mainly invades organs and sites related to the monocyte–macrophage reticuloendothelial system.…”

“…It has been documented that T. marneffei enters the blood system by invading the reticuloendothelial system and then spreads to other organs through the lymphatic system and blood circulation. 12 , 13 T. marneffei mainly invades organs and sites related to the monocyte–macrophage reticuloendothelial system. T. marneffei infections can be divided into disseminated and focal types; focal type infections are often confined to the site of invasion, and the clinical manifestations are dominated by the symptoms of the original disease.…”