Retrospective analysis of 14 cases of disseminated Penicillium marneffei infection with osteolytic lesions

Abstract

BackgroundPenicillium marneffei disseminates hematogenously and can infect most organs, though infection leading to osteolysis is extremely rare. We describe the clinical and laboratory features, management, and outcomes of patients with penicilliosis marneffei (PSM) with osteolytic lesions.MethodsThis retrospective study was conducted between January 1, 2003 and May 1, 2014 at the First Affiliated Hospital of Guangxi Medical University. Patients who presented with culture and/or histopathologic proof of disseminated PSM within osteolytic lesions were included.ResultsP. marneffei infection was diagnosed in 100 patients (65 HIV-infected and 35 HIV-negative). Fourteen patients, all HIV-negative, (14/35, 40%) had osteolytic lesions. The most common comorbidity was diabetes mellitus, though previous glucocorticoid therapy, β-thalassemia, breast cancer, and Langerhans cell histiocytosis also occurred. Five patients had no comorbidity. Fever, malaise, ostealgia, weight loss, and anemia were the most common symptoms, followed by cutaneous lesions, lymphadenopathy, hepatosplenomegaly, cough, sputum, and stethalgia. Ostealgia, joint pain, and joint disorders were also recorded. White blood cell and neutrophil counts were increased (mean 22.3 ± 7.4 × 109 cells/L; mean 18.84 ± 4.5 × 109 cells/L, respectively). The most common sites were the vertebrae, skull and femur, ribs and ilium, though the clavicle, scapula, humerus, and tibia were also involved. Radiography and computed tomography (CT) showed multiple radiolucencies with moth-eaten bone destruction, periosteal proliferation, bone fracture, and surrounding soft-tissue swelling. Emission CT showed significantly increased uptake in many skeletal regions. Positron emission tomography/CT showed generalized lymphadenopathy, bone metabolic activity, and bone destruction. The 18 F-FDG standard uptake value was increased in the entire skeleton (mean 6.16). Twelve patients received antifungal therapy, four of whom died during treatment, and eight recovered, though four of these eight relapsed within 3–24 months. Two patients discontinued treatment because of severe multiple organ failure and died.ConclusionsOsteolysis is often overlooked in HIV-negative individuals with disseminated P. marneffei infection. However, P. marneffei involving the bone and leading to osteolysis may indicate severe systemic disturbance, and is characterized by a poor prognosis, high recurrence rate, and the need for prolonged antifungal treatment.

Comparison of pleural effusion features and biomarkers between talaromycosis and tuberculosis in non-human immunodeficiency virus-infected patients

“…marneffei is a thermally dimorphic pathogenic fungus that causes fatal systemic infection [1]. It can be disseminated to the lung, liver, spleen, skin, central nervous system, blood, and other organs or systems by spreading hematogenously [5,15]. Previously, TMPE was not described as a common manifestation of T. marneffei infections.…”

“…The following treatment schema can elicit good results: intravenous amphotericin B deoxycholate 0.6-1.0 mg/kg/day for 2 weeks, followed by oral itraconazole 400 mg/day for 8 to 10 weeks. Other antifungal agents such as fluconazole or voriconazole can also achieve therapeutic efficacy [1,15]. TMPE can be resorbed in one to 2 weeks following effective antifungal therapy.…”

Anemia in combined antiretroviral treatment-naive HIV-infected patients in China: A retrospective study of prevalence, risk factors, and mortality

“…marneffei (6) infection, administration of antiretroviral agents such as zidovudine (7), and myelosuppression by infiltrative malignancies (8) or infectious pathogens (6). Other mechanisms for HIV-related anemia included vitamin B12, folate, and iron deficiencies (9), and HIVdriven impairment of hematopoietic progenitor cells (10).…”

Two Unusual Cases of Human Immunodeficiency Virus–Negative Patients with Talaromyces marneffei Infection

“…10,14,15 However, systemic chemotherapy may lead to spreading of the infection, hampering its control. 8 The use of chemotherapy thus remains controversial. As for T. marneffei in patients with systemic lupus erythematosus, 16 the use of antifungals, together with prednisone for LCH, may be beneficial.…”

“…[1][2][3][4][5] The infection can disseminate hematogenously to the bone, bone marrow, joints, lymph nodes, pericardium, liver, trachea, spleen, etc. [6][7][8] Herein, we report the first case of T. marneffei complicated by Langerhans cell histiocytosis (LCH) and a case of pleural nodules and pleural effusion caused by T. marneffei using thoracoscopic pleural biopsy for differential diagnosis. We describe the clinical, radiographical, histopathological, and immunohistochemical features of these rare cases.…”