Clinical Characteristics, Laboratory Findings, and Prognosis in Patients With Talaromyces marneffei Infection Across Various Immune Statuses

Dianwu Li; Huaying Liang; Yiqun Zhu; Qinyu Chang; Pinhua Pan; Yan Zhang

doi:10.3389/fmed.2022.841674

Clinical Characteristics, Laboratory Findings, and Prognosis in Patients With Talaromyces marneffei Infection Across Various Immune Statuses

Front Med (Lausanne). 2022 Apr 15:9:841674. doi: 10.3389/fmed.2022.841674. eCollection 2022.

Authors

Dianwu Li^{1

2

3

4

5}, Huaying Liang^{1

2

3

4

5}, Yiqun Zhu^{1

2

3

4

5}, Qinyu Chang^{1

2

3

4

5}, Pinhua Pan^{1

2

3

4

5}, Yan Zhang^{1

2

3

4

5}

Affiliations

¹ Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China.
² Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.
³ Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China.
⁴ Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China.
⁵ National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.

Abstract

Objective: Talaromyces marneffei (TM) is an opportunistic fungus that is predominantly prevalent among patients who are HIV-positive in South-East Asia. However, few studies focused on the clinical features, laboratory findings, and prognosis across varying immune states.

Methods: A total of 54 patients with TM infection in Xiangya Hospital of Central South University from January 1, 2006 to October 31, 2021 were retrospectively analyzed. Clinical profiles were compared across the different immune statuses by HIV-positive (HIV group, n = 18), HIV negative but with immunocompromised conditions (Non-HIV with IC Group, n = 11), and immunocompetent patients (n = 25).

Results: All the patients were diagnosed by pathogen culture or by metagenomic next-generation sequencing (mNGS). The median age was 50, and patients with HIV were much younger compared to the other two groups. The most common symptom at presentation was fever (79.6%), followed by cough (70.4%), weight loss (61.1%), and expectoration (53.7%). The patients with HIV were more likely to develop into a subtype of disseminated TM affecting multiple organs including lymph node, liver, skin, and spleen, thus, resulting in higher hospital mortality compared to the other two groups. Patients without HIV but with immunocompromised conditions presented similar hospital mortality rates compared to immunocompetent patients, while experiencing longer days of hospitalization to recover from the diseases. Additionally, in this study, the pathogen culture easily confirmed the patients with HIV. However, mNGS presented as a promising tool to confirm TM infection in those suspicious patients without HIV.

Conclusions: In summary, patients with HIV were more likely to develop into disseminated TM, resulting in higher mortality compared to those patients without HIV. Additionally, mNGS presented as an important supplementary tool to confirm TM infection in patients without HIV, particularly in those with immunocompromised diseases.

Keywords: Talaromyces marneffei; clinical characteristics; immune status; next-generation sequencing; prognosis.