Determinants of prognosis in Talaromyces marneffei infections with respiratory system lesions

Abstract

Background: Little study has investigated the differences between Talatomyces marneffei ( T. marneffei ) respiratory infection and tuberculosis and the prognostic factors of such infection. This study investigated the characteristics and prognostic factors of T. marneffei infections with respiratory lesions and the causes of misdiagnosis. Methods: Clinical characteristics and prognoses of patients with T. marneffei infections with respiratory system lesion were investigated. T. marneffei diagnosis followed isolation from clinical specimens using standard culture, cytology, and histopathology. Survival curves were estimated by using Kaplan-Meier analysis, with log-rank test to compare differences in survival rates between groups. Univariate and multivariate Cox regression analyses were also performed to assess significant differences in clinical characteristics of overall survival. Results: Of 126 patients diagnosed with T. marneffei infections, 63 (50.0%) had T. marneffei respiratory system infections; 38.1% (24/63) were misdiagnosed as having tuberculosis. Human immunodeficiency virus (HIV) infection, CD4/CD8 < 0.5, percentage of CD4 + T cells <42.8%, and length of time from onset to confirmation of diagnosis >105 days were potential risk factors for poor prognoses. Length of time from onset to confirmation of diagnosis persisted as an independent predictor of all-cause mortality in multivariate analysis (odds ratio: 0.083, 95.0% confidence interval: 0.021–0.326, P < 0.001). However, the size of the lung lesions, dyspnea, thoracalgia, mediastinal lymphadenopathy, and pleural effusion did not significantly predict overall survival. There was no significant difference in prognosis according to the type of treatment. Conclusions: T. marneffei infections involving the respiratory system are common. The critical determinants of prognosis are HIV infection, CD4/CD8, percentage of CD4 + T cells, type of treatment, and the time range from onset to confirmation of diagnosis. Rapid and accurate diagnosis is crucial for improving prognosis.

Disseminated Talaromyces marneffei Infection in a Non-HIV Infant With a Homozygous Private Variant of RELB

“…However, it was later reported in patients with other immunodeficiencies such as autoimmune diseases, solid organ or hematopoietic stem cell transplantation, hematology, and those receiving novel targeted therapies ( Wang et al., 2003 ; Woo et al., 2005 ; Chan et al., 2013 ; Chan et al., 2015 ; Lei et al., 2018 ). T. marneffei infection involves multiple organ systems, such as the lungs, skin, bone marrow, digestive system, and disseminated infections ( Samson et al., 2011 ; Qiu et al., 2019 ). Amphotericin B, itraconazole, voriconazole, and posaconazole are effective in the management of T. marneffei infection ( Lei et al., 2018 ).…”

“…Amphotericin B, itraconazole, voriconazole, and posaconazole are effective in the management of T. marneffei infection ( Lei et al., 2018 ). Unfortunately, the mortality rate of T. marneffei infection is very high, especially for non-AIDS patients due to delayed diagnosis ( Le et al., 2011 ; Lee et al., 2012 ; Lei et al., 2018 ; Qiu et al., 2019 ).…”

<p>Talaromycosis-Associated Secondary Hemophagocytic Lymphohistiocytosis in Nine Human Immunodeficiency Virus-Negative Patients: A Multicenter Retrospective Study</p>

“…Common clinical features of T.M infection among these non-HIV-infected patients include fever, malaise, weight loss, skin and soft tissue lesions, hepatosplenomegaly, lymphadenopathy, cough, and dyspnea 1. T.M infection is associated with high mortality because it is commonly misdiagnosed during the early stages of the disease 2. Moreover, secondary hemophagocytic lymphohistiocytosis (SHLH),3 a rare clinical syndrome characterized by hyperinflammatory responses, high morbidity, acute onset, rapid progression, and high mortality, occurs as a comorbidity with other infections, particularly Epstein-Barr virus (EBV) and bacterial infections 4.…”

Multicentre derivation and validation of a prognostic scoring system for mortality assessment in HIV‐infected patients with talaromycosis

“…A retrospective study conducted in Shanghai (unfortunately with a relatively small sample size) indicated that low C0D4 + T‐cell counts and low haemoglobin levels were associated with higher mortality of talaromycosis among HIV‐infected patients 11 . A recent study indicated that CD4 + T‐cell counts and CD4+/CD8 + ratios are critical determinants of prognosis in T. marneffei ‐infected patients with respiratory system lesions 12 . However, most patients in these cohorts had CD4 + T‐cell counts less than 50 cells/μL, and there was no statistically significant difference in CD4 + T‐cell counts between the survival group and the non‐survival group.…”