Clinical characteristics and risk factors of Talaromyces marneffei infection in human immunodeficiency virus-negative patients: A retrospective observational study

doi:10.5847/wjem.j.1920-8642.2021.04.005

Abstract

Abstract:

BACKGROUND: To investigate the clinical characteristics and risk factors of human immunodeficiency virus (HIV)-negative patients with Talaromyces marneffei (T. marneffei) infection.
METHODS: We retrospectively collected the clinical information of HIV-negative patients with T. marneffei infection from January 1, 2010 to June 30, 2019, and analyzed the related risk factors of poor prognosis.
RESULTS: Twenty-five cases aging 22 to 79 years were included. Manifestations of T. marneffei infection included fever, cough, dyspnea, chest pain or distress, lymphadenopathy, ear, nose, and throat (ENT) and/or skin lesions, bone or joint pain, edema and pain in the lower extremities, digestive symptoms, icterus, malaise, and hoarseness. Two cases had no comorbidity, while 23 cases suffered from autoimmune disease, pulmonary disease, cancer, and other chronic diseases. Sixteen cases had a medication history of glucocorticoids, chemotherapy or immunosuppressors. Pulmonary lesions included interstitial infiltration, nodules, atelectasis, cavitary lesions, pleural effusion or hydropneumothorax, bronchiectasis, pulmonary fibrosis, pulmonary edema, and consolidation. The incidence of osteolytic lesions was 20%. Eight patients received antifungal monotherapy, and 11 patients received combined antifungal agents. Fifteen patients survived and ten patients were dead. The Cox regression analysis showed that reduced eosinophil counts, higher levels of blood urea nitrogen (BUN), alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactic dehydrogenase (LDH), myoglobin (Mb), procalcitonin (PCT), and galactomannan were related to poor prognosis (hazard ratio [HR]>1, P<0.05).
CONCLUSIONS: Bone destruction is common in HIV-negative patients with T. marneffei infection. Defective cell-mediated immunity, active infection, multiple system, and organ damage can be the risk factors of poor prognosis.

Key words: Talaromyces marneffei, Human immunodeficiency virus, Bone destruction, Risk factors

Hong-yan Wei, Wen-jie Liang, Bin Li, Ling-yu Wei, An-qi Jiang, Wei-dong Chen, Peng-hao Guo, Jia Xu. Clinical characteristics and risk factors of Talaromyces marneffei infection in human immunodeficiency virus-negative patients: A retrospective observational study[J]. World Journal of Emergency Medicine, 2021, 12(4): 281-286.

Figures/Tables 1

Table 1

Clinical characteristics of T. marneffei-infected patients, n (%)

Variables	Total (n=25)	Survival (n=15)	Death (n=10)	P-values
Male Female	15 (60.0) 10 (40.0)	10 (66.7) 5 (33.3)	5 (50.0) 5 (50.0)	0.405 0.405
Median age, years, median (interquartile range)	51.3 (22.0-79.0)	50.6 (24.0-76.0)	52.4 (22.0-79.0)	0.801
Mean diagnostic days from admission, days, median (interquartile range)	9.2 (1.0-24.0)	7.5 (1.0-24.0)	11.9 (2.0-24.0)	0.147
Symptoms Fever Cough Dyspnea Chest pain or distress ENT/skin lesions Lymphadenopathy Bone or joint pain Edema and pain in lower extremities Digestive symptoms Urinary frequency & urgency Icterus Malaise	13 (52.0) 13 (52.0) 9 (36.0) 4 (16.0) 2 (8.0) 2 (8.0) 2 (8.0) 2 (8.0) 2 (8.0) 2 (8.0) 1 (4.0) 1 (4.0)	8 (53.3) 8 (53.3) 5 (33.3) 3 (20.0) 2 (13.3) 1 (6.7) 2 (13.3) 0 (0) 1 (6.7) 2 (13.3) 1 (6.7) 1 (6.7)	5 (50.0) 5 (33.3) 4 (20.0) 1 (10.0) 0 (0) 1 (10.0) 0 (0) 2 (20.0) 1 (10.0) 0 (0) 0 (0) 0 (0)
Comorbidities SLE COPD Renal transplantation Diabetes Pulmonary tuberculosis Cancer Nephrotic syndrome Pemphigus Ulcerative colitis Asthma Silicosis Rheumatoid arthritis Epilepsy Congenital heart disease Hypertension None Contact history of poultry	2 (8.0) 6 (24.0) 6 (24.0) 6 (24.0) 3 (12.0) 4 (16.0) 1 (4.0) 1 (4.0) 1 (4.0) 1 (4.0) 1 (4.0) 1 (4.0) 1 (4.0) 1 (4.0) 2 (8.0) 2 (8.0) 1 (4.0)	0 (0) 3 (20.0) 4 (26.7) 3 (20.0) 3 (20.0) 3 (20.0) 0 (0) 0 (0) 0 (0) 1 (6.7) 0 (0) 0 (0) 1 (6.7) 0 (0) 1 (6.7) 2 (13.3) 1 (6.7)	2 (20.0) 3 (30.0) 2 (20.0) 3 (30.0) 0 (0) 1 (10.0) 1 (10.0) 1 (10.0) 1 (10.0) 0 (0) 1 (10.0) 1 (10.0) 0 (0) 1 (10.0) 1 (10.0) 0 (0) 0 (0)
Antifungal therapies Monotherapy Combined therapy Azoles Echinocandins Amphotericin B 5-Flucytosine	19 (76.0) 8 (32.0) 11 (44.0) 14 (52.0) 12 (44.0) 6 (24.0) 1 (4.0)	11 (73.3) 3 (20.0) 8 (53.3) 8 (53.3) 5 (33.3) 4 (26.7) 1 (6.7)	8 (80.0) 5 (50.0) 3 (30.0) 6 (60.0) 7 (70.0) 2 (20.0) 0 (0)
Chemotherapy	1 (4.0)	1 (6.7)	0 (0)
Immunosuppressor	10 (40.0)	5 (33.3)	5 (50.0)	0.405
Glucorticoids	16 (64.0)	8 (53.3)	8 (80.0)	0.174
Co-infection	15 (60.0)	6 (40.0)	9 (90.0)	0.012^*
WBC ≥10×10⁹/L	12 (48.0)	7 (46.7)	5 (50.0)	0.870
Neutrophil ≥6.3×10⁹/L	14 (56.0)	8 (53.3)	6 (60.0)	0.742
Eosinophil ≥0.005×10⁹/L	13 (52.0)	12 (80.0)	1 (10.0)	0.001^*
Monocyte counts ≥0.03×10⁹/L	17 (68.0)	13 (86.7)	4 (40.0)	0.014^*
Lymphocyte ≥0.19×10⁹/L	5 (20.0)	4 (26.7)	1 (10.0)	0.307
Hb ≥100 g/dL	15 (60.0)	9 (60.0)	6 (60.0)	1.000
PLT ≥10×10⁹/L	19 (76.0)	12 (80.0)	7 (70.0)	0.566
BUN ≥8.6 mg/L	13 (52.0)	4 (26.7)	9 (90.0)	0.002^*
Cr ≥120 μmol/L	8 (32.0)	4 (26.7)	4 (40.0)	0.484
ALT ≥40 U/L	8 (32.0)	2 (13.3)	6 (60.0)	0.014^*
AST ≥40 U/L	7 (28.0)	1 (6.7)	6 (60.0)	0.004^*
TBIL ≥24 mmol/L	3 (12.0)	1 (6.7)	2 (20.0)	0.119
DBIL ≥6 mmol/L	3 (12.0)	1 (6.7)	2 (20.0)	0.315
IBIL ≥10.2 mmol/L	2 (8.0)	0 (0)	2 (20.0)	0.071
ALP ≥125 U/L	4 (16.0)	2 (13.3)	2 (20.0)	0.656
LDH ≥240 U/L	12 (48.0)	3 (20.0)	9 (90.0)	0.001^*
ALB ≥35 g/L	16 (64.0)	11 (73.3)	5 (50.0)	0.234
APTT ≥40 seconds	16 (64.0)	9 (60.0)	7 (70.0)	0.610
PT ≥14 seconds	18 (72.0)	10 (66.7)	8 (80.0)	0.467
TnT ≥0.014 ng/L	10 (40.0)	2 (13.3)	8 (80.0)	0.001^*
Mb ≥75 ng/mL	8 (32.0)	2 (13.3)	8 (80.0)	0.014^*
CK-MB ≥1.0 ng/mL	12 (48.0)	5 (33.3)	7 (70.0)	0.072
BNP ≥900 pg/mL	10 (40.0)	2 (13.3)	8 (80.0)	0.001^*
PCT ≥0.5 ng/mL	14 (56.0)	5 (33.3)	9 (90.0)	0.005^*
G test ≥50	9 (36.0)	0 (0)	9 (90.0)	0.000^*
GM test ≥1	5 (20.0)	1 (6.7)	4 (40.0)	0.041^*

Table 1

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