Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Med Mycol. 2023 Aug 2;61(8). doi: 10.1093/mmy/myad083.
Talaromyces marneffei (TSM) is a temperature-dependent dimorphic fungus endemic to Southeast Asia and southern China. As the number of people at risk of TSM infection continues to increase, the clinical manifestations are becoming increasingly complex, posing challenges for clinical management. In this study, we analyzed the medical records of 99 patients (71 human immunodeficiency virus [HIV]-positive and 28 HIV-negative) diagnosed with TSM infection from January 1, 2017, to December 31, 2022, in southern China and compared the clinical manifestations in HIV-positive and HIV-negative patients. Most patients (83/99, 84%) were male. The incidence of skin and soft tissue involvement (48% vs. 21%, P = .016); disseminated infection with blood circulation, hematopoietic, lymphatic, alimentary, or central nervous system involvement (69% vs. 36%, P = .002); and gastrointestinal bleeding (33% vs. 9%, P = .023) was higher in the HIV-positive group than the HIV-negative group. The HIV-positive group also had significantly higher alanine aminotransferase (ALT) levels (31 [26-42] vs. 14 [11-16] U/l, P < .001) and ALT/aspartate transaminase ratio (1.9 [1.5-2.2] vs. 1.3 [1.1-1.6], P = .006) than the HIV-negative group. The time to diagnosis (5.5 ± 1.1 vs. 5.1 ± 1.4 days, P = .103), antifungal regimen (P = .278), case fatality rate (20% vs. 21%, P = .849), and relapse/reinfection rate (11% vs. 19%, P = .576) did not differ significantly between the HIV-positive and HIV-negative groups. Poor antiretroviral therapy adherence (OR = 26.19, 95%CI 3.26-210.70, P = .002), advanced age (OR = 1.13, 95%CI 1.03-1.23, P = .010), and Epstein-Barr virus co-infection (OR = 37.13, 95%CI 3.03-455.64, P = .005) were independent risk factors for all-cause mortality from TSM infection in HIV-positive patients. Overall, the predominant infection sites, clinical manifestations, and complications of TSM infection differed by HIV status. However, with prompt diagnosis and appropriate treatment, HIV-positive patients with TSM infection can have similar outcomes to HIV-negative patients.
马尔尼菲青霉（TSM）是一种温度依赖性的二态真菌，流行于东南亚和中国南方。随着感染 TSM 的高危人群数量不断增加，其临床表现变得越来越复杂，给临床管理带来了挑战。本研究分析了 2017 年 1 月 1 日至 2022 年 12 月 31 日期间在中国南方确诊为 TSM 感染的 99 例患者（71 例 HIV 阳性和 28 例 HIV 阴性）的病历，并比较了 HIV 阳性和 HIV 阴性患者的临床表现。大多数患者（83/99，84%）为男性。皮肤和软组织受累（48% vs. 21%，P =.016）；血液传播、造血、淋巴、消化或中枢神经系统受累的播散性感染（69% vs. 36%，P =.002）；以及胃肠道出血（33% vs. 9%，P =.023）在 HIV 阳性组中更为常见。HIV 阳性组的丙氨酸氨基转移酶（ALT）水平（31[26-42]比 14[11-16]U/L，P<.001）和 ALT/天门冬氨酸转氨酶比值（1.9[1.5-2.2]比 1.3[1.1-1.6]，P=.006）也明显高于 HIV 阴性组。HIV 阳性组和 HIV 阴性组在诊断时间（5.5±1.1 比 5.1±1.4 天，P=.103）、抗真菌方案（P=.278）、病死率（20% vs. 21%，P=.849）和复发/再感染率（11% vs. 19%，P=.576）方面无显著差异。抗逆转录病毒治疗依从性差（OR=26.19，95%CI 3.26-210.70，P=.002）、年龄较大（OR=1.13，95%CI 1.03-1.23，P=.010）和 EBV 合并感染（OR=37.13，95%CI 3.03-455.64，P=.005）是 HIV 阳性患者 TSM 感染全因死亡的独立危险因素。总体而言，HIV 状态不同，TSM 感染的主要感染部位、临床表现和并发症也不同。然而，通过及时诊断和适当治疗，HIV 阳性 TSM 感染患者的结局可与 HIV 阴性患者相似。
