Rare misdiagnosed case of penicilliosis marneffei in an immunocompetent patient

Cheng, Dan; Ding, Xuhong

doi:10.1177/0300060520959484

Cited by 6 publications

(5 citation statements)

References 12 publications

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“…Moreover, two cases had hoarseness, wheezing, and hemoptysis separately when the infection involved the pharynx and airway. These features were consistent with previous reports [ 15 , 16 ]. Furthermore, TM infection involved the extra-pulmonary organs, including bone, skin, lymph nodes, and/or the central nervous system [ 17 ].…”

Section: Discussionsupporting

confidence: 94%

Talaromyces marneffei infection and complicate manifestation of respiratory system in HIV-negative children

Yang

et al. 2023

BMC Pulm Med

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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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Section: Discussionsupporting

confidence: 94%

Talaromyces marneffei infection and complicate manifestation of respiratory system in HIV-negative children

Yang

et al. 2023

BMC Pulm Med

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“…Moreover, two cases had hoarseness, wheezing, and hemoptysis separately when the infection involved the pharynx and airway. These features were consistent with previous reports [13,14]. Previous studies have con rmed that inhalation is the main mode of TM invasion into the body, and the lung is the most important organ for TM infection [15].…”

Section: Discussionsupporting

confidence: 92%

Respiratory system Talaromyces marneffei infection in HIV-negative children

Yang

et al. 2022

Preprint

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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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“… 10 It is rarely reported in immunocompetent patients. 11 However, the incidence of T. marneffei has been increasing in immunocompetent hosts. 8 , 9 , 12 A previous study reported that 22 out of 34 non-HIV patients infected with T. marneffei had no previously known diseases and no immunodeficiencies.…”

Section: Discussionmentioning

confidence: 99%

HIV-negative case of Talaromyces marneffei pulmonary infection with a TSC2 mutation

2021

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Talaromyces marneffei is a rare dimorphic pathogenic fungus that can induce severe infections in human immunodeficiency virus (HIV)-infected patients. However, such infections have also been reported in non-HIV hosts. This current case report describes a very rare case of a T. marneffei pulmonary infection in an HIV-negative patient with a mutation in the tuberous sclerosis complex subunit 2 ( TSC2) gene. A 24-year-old male patient presented with cough and expectoration for 6 months. Computed tomography showed multiple ground-glass opacities and cystic and cavitated lesions in both lungs. Next generation sequencing (NGS) of the bronchoalveolar lavage fluid was performed to confirm T. marneffei pulmonary infection. The results were further verified using bronchoscopy specimen cultures. This was an HIV-negative patient without a travel history to endemic zones and his blood exon sequencing results showed a mutation in the TSC2 gene. To date, he has recovered well with voriconazole therapy. In summary, patients with TSC2 mutations that induce bronchopulmonary dysplasia may be potential hosts for T. marneffei. Early and timely diagnosis is important for improving prognosis. NGS plays a critical role in the diagnosis of T. marneffei pulmonary infection.

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Rare misdiagnosed case of penicilliosis marneffei in an immunocompetent patient

Cited by 6 publications

References 12 publications

Talaromyces marneffei infection and complicate manifestation of respiratory system in HIV-negative children

Talaromyces marneffei infection and complicate manifestation of respiratory system in HIV-negative children

Respiratory system Talaromyces marneffei infection in HIV-negative children

HIV-negative case of Talaromyces marneffei pulmonary infection with a TSC2 mutation

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