Clinical epidemiology and outcome of HIV‐associated talaromycosis in Guangdong, China, during 2011–2017

Abstract

Objectives Talaromycosis is an invasive mycosis endemic to Southeast Asia. This study aimed to investigate the epidemiology, clinical features and prognostic factors of HIV‐associated talaromycosis in Guangdong, China. Methods We retrospectively evaluated HIV patients hospitalized with histopathology‐ or culture‐confirmed talaromycosis between 2011 and 2017. Factors associated with poor prognosis were identified using logistic regression. Results Overall, 1079 patients with HIV‐associated talaromycosis were evaluated. Both the number and prevalence of talaromycosis among HIV admissions increased from 125 and 15.7% in 2011 to 253 and 18.8% in 2017, respectively, reflecting the increase in HIV admissions. Annual admissions peaked during the rainy season between March and August. Common clinical manifestations included fever (85.6%), peripheral lymphadenopathy (72.3%), respiratory symptoms (60.8%), weight loss (49.8%), skin lesions (44.5%) and gastrointestinal symptoms (44.3%). Common laboratory abnormalities were hypoalbuminaemia (98.6%), anaemia (95.6%), elevated aspartate aminotransferase level (AST) (76.9%), elevated alkaline phosphatase level (55.8%) and thrombocytopenia (53.7%). The median CD4 count was 9 cells/μL. Talaromyces marneffei was isolated from blood and bone marrow cultures of 66.6% and 74.5% of patients, respectively. The rate increased to 86.6% when both cultures were performed concurrently. At discharge, 14% of patients showed worsening conditions or died. Leucocytosis, thrombocytopenia, elevated AST, total bilirubin, creatinine and azole monotherapy independently predicted poor prognosis. Conclusions The incidence of HIV‐associated talaromycosis has increased in Guangdong with the high HIV burden in China. Skin lesions were seen in less than half of patients. Induction therapy with azole alone is associated with higher mortality. Findings from this study should help to improve treatment of the disease.

Talaromyces Marneffei Mp1p Antigen Detection May Play an Important Role in The Early Diagnosis of Talaromycosis in Patients with Acquired Immunodeficiency Syndrome

“…Identi cation was based on the morphological and microscopic observation of the colonies, demonstration of mould-toyeast conversion, and presence of a red diffusible pigment production at 25°C. Histopathological diagnosis was based on the identi cation of characteristic yeast cells with a midline septum in the tissue sections [1,8].…”

“…It is mainly prevalent in Southern China and Southeast countries, including Thailand, Vietnam, India, and Malaysia [3][4][5][6][7]. In Southern China, the prevalence of talaromycosis in hospitalized patients with AIDS has increased by 65% within 5 years [8]. Talaromycosis is a lifethreatening disease with a high mortality rate of up to 50.6% without timely antifungal treatment [6,9,10].…”

Hematological toxicity of amphotericin B deoxycholate-based induction therapy in patients with HIV-associated talaromycosis.

“…Anemia is commonly present in HIV patients with talaromycosis, and its prevalence is between 80-95.6% [5,6]. This could lead to negative outcomes, such as prolonged hospitalization, a requirement for close monitoring, and eventually the requirement for blood or platelet transfusion [7].…”

“…This could lead to negative outcomes, such as prolonged hospitalization, a requirement for close monitoring, and eventually the requirement for blood or platelet transfusion [7]. The prevalence of leukopenia in HIV patients with talaromycosis approaches 40% [5]. The occurrence of leukopenia in these patients may compromise the host immune system, and thus increase their susceptibility to opportunistic infections [8], which could affect progression of HIVassociated talaromycosis.…”

Future Directions for Clinical Respiratory Fungal Research

“…Respiratory fungal diseases have risen in prominence in recent years, as a consequence of improved diagnostics, advocacy, research and greater awareness [1][2][3][4][5][6]. However, our understanding of whether there has been a genuine increase in the prevalence of respiratory fungal diseases is less clear.…”