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

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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Rapid and precise diagnosis of T. marneffei pulmonary infection in a HIV-negative patient with autosomal-dominant STAT3 mutation: a case report

Therapeutic Advances in Respiratory Disease ◽

10.1177/1753466620929225 ◽

2020 ◽

Vol 14 ◽

pp. 175346662092922

Author(s):

Wei Zhang ◽

Jian Ye ◽

Chenhui Qiu ◽

Limin Wang ◽

Weizhong Jin ◽

...

Keyword(s):

Pulmonary Infection ◽

Opportunistic Pathogen ◽

Lavage Fluid ◽

Human Beings ◽

Immunodeficiency Virus ◽

Precise Diagnosis ◽

Stat3 Mutation ◽

Next Generation Sequencing Ngs ◽

Transcription 3 ◽

Hiv Negative

Background: Talaromyces marneffei, also named Penicillium marneffei, is an opportunistic pathogen that can cause systemic or limited infection in human beings. This infection is especially common in human immunodeficiency virus (HIV)-infected hosts; however, it has also been recently reported in HIV-negative hosts. Here, we report a very rarely seen case of T. marneffei pulmonary infection in a non-HIV-infected patient with signal transducer and activator of transcription 3 ( STAT3) mutation. Case presentation: A 34-year-old woman was admitted to our hospital for uncontrollable nonproductive cough and dyspnea with exercise. She had been immunocompromised since infancy. Computerized tomography scan showed multiple ground glass opacities with multiple bullae in both lungs. Next generation sequencing (NGS) of the bronchoalveolar lavage fluid identified T. marneffei nucleotide sequences. Culture of bronchoscopy specimens further verified the results. The patient was HIV negative, and blood gene detection indicated STAT3 mutation. To date, following the application of itraconazole, the patient has recovered satisfactorily. Conclusion: In clinical practice, T. marneffei infection among HIV-negative individuals is relatively rare, and we found that patients who are congenitally immunocompromised due to STAT3 mutation may be potential hosts. Early diagnosis and timely treatment are expected to improve the prognosis of T. marneffei infection. NGS is a powerful technique that may play an important role in this progress. The reviews of this paper are available via the supplemental material section.

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A Talaromyces marneffei infection with osteolytic lesions in an HIV-negative patient at non-endemic areas: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x20938242 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2093824

Author(s):

Youfei Chen

Keyword(s):

Severe Nausea ◽

Ventilator Support ◽

Osteolytic Lesions ◽

Negative Patient ◽

Talaromyces Marneffei ◽

Subcutaneous Mass ◽

Endemic Areas ◽

Osteolytic Destruction ◽

Hiv Negative

Talaromyces marneffei infection is an endemic opportunistic infection for immunodepression patients, especially HIV-positive patients. Our case describes an unendemic and HIV-negative patient who presented with fever, subcutaneous mass, osteolytic destruction of the skull and subcutaneous abscess penetrating the diseased skull. The growth of Talaromyces marneffei was identified by the culture of the frontal pus, sputum, blood and bone marrow. Due to severe nausea and vomiting during the use of amphotericin B, voriconazole was finally selected for treatment. Two weeks after intravenous infusion of voriconazole injection, the patient was given oral voriconazole tablets for 5 months. After the initial intravenous treatment of voriconazole, the patient developed increased dyspnea and required ventilator support with endotracheal intubation, and methylprednisolone was given intravenously for 5 days. All lesions absorbed and no obvious discomfort was found during the follow-up at the third month after discharge. At present, the patient has been followed up for more than 3 years without recurrence. The case aims to raise doctors’ awareness of this rare disease in non-endemic areas and HIV-negative patients.

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Characterization of Anti–Interferon-γ Antibodies in HIV-Negative Patients Infected With Disseminated Talaromyces marneffei and Cryptococcosis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz208 ◽

2019 ◽

Vol 6 (10) ◽

Cited By ~ 2

Author(s):

Wen Zeng ◽

Ye Qiu ◽

Shudan Tang ◽

Jianquan Zhang ◽

Mianluan Pan ◽

...

Keyword(s):

Clinical Laboratory ◽

Critical Role ◽

Clinical Manifestations ◽

Interferon Γ ◽

White Cell ◽

Talaromyces Marneffei ◽

Group 4 ◽

Group 2 ◽

Routine Clinical Laboratory ◽

Hiv Negative

Abstract Background Few reports of Talaromyces marneffei (TM) or cryptococcosis infections among HIV-negative patients with high-titeranti–IFN-γautoantibodies (nAIGAs) have been published. We investigated the clinical manifestations of patients with nAIGAs and TM infections. Methods HIV-negative adults (≥18 years) were enrolled if they haddisseminated TM infection (group 1; further divided into nAIGAs positive [group 1P] and negative [group 1N]); cryptococcosis(pulmonary cryptococcosis and/or cryptococcosis of the brain)(group 2); pulmonary tuberculosis (group 3); and healthy controls (group 4) with nAIGAs detected. Complete histories, physical examinations, and routine clinical laboratory tests were obtained at baseline. Results Overall, 88 participants were in the four groups (20,13,23, and 32 in groups 1 to 4, respectively). Significant differences occurred between groups with higher nAIGAs titers (P < 0.001), and higher total white-cell and absolute neutrophil counts (P < 0.001) in group1. Lungs (90.0%), lymph nodes (60.0%), skin (55.0%), and bones (50.0%) were most common sites of involvement. Significant differences in total white-cell and absolute neutrophil counts occurred between groups IP and 1N.Patients with recurrent TM infections, particularly group 1P, had higher initial nAIGA titer. Conclusions Patients with persistent infection who died tended to have positive initial nAIGA titer. It suggests that nAIGAs may play a critical role in the pathogenesis of TM infections, and may be associated with more severe, refractory infection.

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