Successful treatment of Talaromyces marneffei infection in a kidney transplant recipient with voriconazole followed by itraconazole for the first time

Li, Yunfei; Tang, Mimi; Sun, Shusen; Hu, Qin; Deng, Sheng

doi:10.1016/j.mycmed.2021.101214

Cited by 4 publications

(7 citation statements)

References 35 publications

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“…A history of acute (2) [ 190 , 215 ] or chronic (1) rejection [ 189 ] was seen in few patients. The majority presented with fever (15 of 24 [62.5%]) [ 4 , 189 , 191–193 , 214–218 , 222 , 225 , 227 , 229 ] and disseminated disease (19 of 25 [76.0%]) [ 4 , 188–190 , 214–220 , 222 , 223 , 225–229 ]. Many patients with disseminated disease (13 of 19 [68.4%]) had fungemia [ 189 , 190 , 214 , 215 , 218–220 , 222 , 223 , 225 , 226 , 229 ].…”

Section: Resultsmentioning

confidence: 99%

“…Sites of dissemination included the gastrointestinal tract (n = 4), skin (n = 3), peritoneum (n = 1), bone (n = 1), lymph node (n = 2), and urinary tract (n = 5). Seven patients (7 of 8) had cytopenia [ 4 , 190 , 191 , 215 , 218 , 220 , 225 ], either with anemia (n = 4), leukopenia (n = 6), or thrombocytopenia (n = 3).…”

Section: Resultsmentioning

confidence: 99%

“…Chest imaging was reported in 6 recipients [ 4 , 191 , 215 , 218 , 220 , 225 ]; all except 1 [ 218 ] showed abnormalities including a solid lesion with a focal infiltrate (n = 1), multiple lymphadenopathies (n = 1) nodules (n = 1), or interstitial or bilateral infiltrates (n = 2). More than half reported coinfection (13 of 24 [54.2%]) [ 4 , 190 , 192 , 216 , 218–220 , 222–225 , 230 ] ( Supplementary Material, Appendix 2 ).…”

Section: Resultsmentioning

confidence: 99%

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Clinical Characteristics and Outcomes of Endemic Mycoses After Solid Organ Transplantation: A Comprehensive Review

Abad,

Razonable

2024

Open Forum Infectious Diseases

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Background Geographically endemic fungi can cause significant disease among solid organ transplant (SOT) recipients. We provide an update on the epidemiology, clinical presentation and outcomes of 5 endemic mycoses in SOT recipients. Methods Multiple databases were reviewed from inception through May 2023 using key words for endemic fungi (e.g. Coccidioidomycosis or Coccidioides, Histoplasmosis or histoplasma, etc.). We included adult SOT recipients and publications in English or with English translation. Results Among 16 cohort studies that reported on blastomycosis (n=3), coccidioidomycosis (n=5), histoplasmosis (n=4), and various endemic mycoses (n=4), the incidence rates varied: coccidioidomycosis (1.2-5.8%); blastomycosis (0.14-0.99%) and histoplasmosis (0.4-1.1%). There were 204 reports that described 268 unique cases of endemic mycoses, including 172 histoplasmosis, 31 blastomycosis, 34 coccidioidomycosis, 6 paracoccidioidomycosis, and 25 talaromycosis. The majority of patients were male (176/261, 67.4%). Transplanted allografts were mostly kidney (191/268, 71.3%), followed by liver (n=39, 14.6%), heart (n=18, 6.7%), lung (n=13, 4.9%), combined kidney-liver, and kidney-pancreas (n=6, 2.7%). In all five endemic mycoses, most patients presented with fever (162/232, 69.8%) and disseminated disease (179/268, 66.8%). Cytopenias were frequently reported for histoplasmosis (71/91, 78.0%), coccidioidomycosis (8/11, 72.7%) and talaromycosis (7/8, 87.5%). Graft loss was reported in 12/136 patients (8.8%). All-cause mortality was reported in 71/267 (26.6%); half (n=34, 50%) of the deaths were related to the underlying mycoses. Conclusions Endemic mycoses commonly present with fever, cytopenias and disseminated disease in SOT recipients. There is a relatively high rate of all-cause mortality, including many that were attributed to endemic mycoses.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Characteristics and Outcomes of Endemic Mycoses After Solid Organ Transplantation: A Comprehensive Review

Abad,

Razonable

2024

Open Forum Infectious Diseases

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“… 54/M Shen zhen, China kidney sore throat and odynophagia Tac dose was adjusted according to its blood concentration Voriconazole (200 mg bid) Cured Pan M, et al [ 33 ], 2023. 47/F Chang sha, China kidney elevated serum creatinine After diagnose of talaromycosis: Tac (1 mg bid to 0.5 mg bid); Tac dose was adjusted according to its blood concentration Voriconazole (200 mg bid); then changed to itraconazole (200 mg/day) N/A Li Y, et al [ 34 ], 2022. 51/M Jiangxi, China kidney coughing, fever After admission: MMF (750 mg qd, 1000 mg qn to 250 mg bid); Tac dose was adjusted according to its blood concentration Voriconazole (200 mg bid) Cured Cai DH, et al [ 35 ], 2022.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Disseminated Talaromyces marneffei infection initially presenting as cutaneous and subcutaneous lesion in an HIV-Negative renal transplant recipient: a case report and literature review

Yang,

Lou,

et al. 2024

BMC Infect Dis

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Background The incidence of Talaromyces marneffei (T. marneffei) infection has increased in recent years with the development of organ transplantation and the widespread use of immunosuppressive agents. However, the lack of clinical suspicion leading to delay or misdiagnosis is an important reason for the high mortality rate in non-human immunodeficiency virus (HIV) and non-endemic population. Herein, we report a case of disseminated T. marneffei infection in a non-HIV and non-endemic recipient after renal transplant, who initially presented with skin rashes and subcutaneous nodules and developed gastrointestinal bleeding. Case presentation We describe a 54-year-old renal transplantation recipient presented with scattered rashes, subcutaneous nodules and ulcerations on the head, face, abdomen, and right upper limb. The HIV antibody test was negative. The patient had no obvious symptoms such as fever, cough, etc. Histopathological result of the skin lesion sites showed chronic suppurative inflammation with a large number of fungal spores. Subsequent fungal culture suggested T. marneffei infection. Amphotericin B deoxycholate was given for antifungal treatment, and there was no deterioration in the parameters of liver and kidney function. Unfortunately, the patient was soon diagnosed with gastrointestinal bleeding, gastrointestinal perforation and acute peritonitis. Then he rapidly developed multiple organ dysfunction syndrome and abandoned treatment. Conclusions The risk of fatal gastrointestinal bleeding can be significantly increased in kidney transplant patients with T. marneffei infection because of the long-term side effects of post-transplant medications. Strengthening clinical awareness and using mNGS or mass spectrometry technologies to improve the detection rate and early diagnosis of T. marneffei are crucial for clinical treatment in non-HIV and non-endemic population.

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“…We searched literatures in the Web of Science and PubMed databases based on “ Talaromyces marneffei ”, “ Penicillium marneffei ”, “kidney transplantation”, and “renal transplantation”, which had been published up to October 2022. A total of 10 officially published papers reporting 11 cases of T. marneffei infection after kidney transplantation were retrieved ( Wang et al., 2003 ; Chan et al., 2004 ; Lin et al., 2010 ; Hart et al., 2012 ; Peng et al., 2017 ; Lang et al., 2020 ; Vergidis et al., 2021 ; Gupta et al., 2022 ; Li et al., 2022 ; Xing et al., 2022 ) ( Table 1 ). The above 11 recipients were summarized in order to enhance the cognition of T. marneffei infection after renal transplantation and improve the prognosis.…”

Section: Discussionmentioning

confidence: 99%

Disseminated Talaromyces marneffei infection after renal transplantation: A case report and literature review

Chen²,

Yang³

et al. 2023

Front. Cell. Infect. Microbiol.

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We reported a 31-year-old man who received renal transplantation for more than 2 years. He was admitted to our hospital on 9 March 2022 due to intermittent diarrhea accompanied by leukopenia for more than 1 month. The patient successively developed high fever, cough, anemia, weight loss, gastrointestinal bleeding, and liver function impairment. Computed tomography (CT) revealed a slight inflammation in the lower lobes of both lungs, enlargement of the lymph nodes in the retroperitoneal and the root of mesenteric areas, and hepatosplenomegaly. Talaromyces marneffei was detected by metagenomics next-generation sequencing (mNGS) in blood and bronchoalveolar lavage fluid, and the pathogen was subsequently verified by blood culture. After endoscopic hemostatic therapy and antifungal therapy with voriconazole and amphotericin B cholesteryl sulfate complex, the patient was successfully discharged. Oral voriconazole was given regularly after discharge. Diarrhea, fever, enlargement of the lymph nodes, and endoscopic evidence of erosion may indicate intestinal T. marneffei infection. Although the mortality of T. marneffei infection after renal transplantation is very high, timely and effective antifungal therapy with amphotericin B cholesteryl sulfate complex is still expected to improve its prognosis.

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Successful treatment of Talaromyces marneffei infection in a kidney transplant recipient with voriconazole followed by itraconazole for the first time

Cited by 4 publications

References 35 publications

Clinical Characteristics and Outcomes of Endemic Mycoses After Solid Organ Transplantation: A Comprehensive Review

Clinical Characteristics and Outcomes of Endemic Mycoses After Solid Organ Transplantation: A Comprehensive Review

Disseminated Talaromyces marneffei infection initially presenting as cutaneous and subcutaneous lesion in an HIV-Negative renal transplant recipient: a case report and literature review

Disseminated Talaromyces marneffei infection after renal transplantation: A case report and literature review

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