人类免疫缺陷病毒/获得性免疫综合征（HIV/AIDS）感染者及抗干扰素-γ自身抗体患者的足分支菌病临床特征

Clinical features of talaromycosis in people living with HIV/AIDS (PWHA) and patients with anti-interferon-γ autoantibodies.

作者信息

Krasaewes Kawisara, Patanadamrongchai Narootchai, Kaewpoowat Quanhathai, Wipasa Jiraprapa, Yasri Saowaluck, Wongthanee Antika, Chaiwarith Romanee

机构信息

Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand.

Department of Internal Medicine, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand.

出版信息

PLoS Negl Trop Dis. 2025 May 9;19(5):e0012992. doi: 10.1371/journal.pntd.0012992. eCollection 2025 May.

DOI:10.1371/journal.pntd.0012992

PMID:40344159

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12064013/

Abstract

BACKGROUND

Talaromycosis is increasingly reported in HIV-uninfected, immunocompromised individuals in an endemic area. The aim of this study was to compare the characteristics and mortality associated with talaromycosis in adult immunocompromised individuals caused by the anti-interferon-gamma autoantibody (anti-IFN- γ AAb) with those of people living with HIV/AIDS (PWHA).

METHODS

A retrospective cohort study was conducted at Maharaj Nakorn Chiang Mai Hospital, Thailand, in adults with confirmed HIV infection or anti-IFN- γ-AAbs diagnosed with talaromycosis.

RESULTS

Thirty-two patients with anti-IFN- γ-AAbs and 235 PWHA were included. Patients with anti-IFN- γ-AAbs were older and more likely to have comorbidities. PWHA were more likely to have constitutional symptoms, cough, dyspnea, diarrhea, splenomegaly, umbilicated skin lesions, abnormal chest radiographs, and fungemia. Patients with anti-IFN- γ-AAbs were more likely to have skin lesions such as macule/papules/nodules, abscesses and Sweet's syndrome, as well as bone and joint infections and higher white blood cell counts. The time from first symptom to treatment was longer in patients with anti-IFN- γ-AAbs (44.5 days vs. 30.0 days, p-value = 0.049). The 24-week mortality rate was 9.4% (3 patients) in patients with anti-IFN- γ-AAbs and 15.3% (36 patients) in PWHA (p-value = 0.372).

CONCLUSIONS

The clinical features of talaromycosis in patients with anti-IFN- γ-AAbs differed from PWHA. Clinicians in areas where talaromycosis is endemic should be aware of the different features of talaromycosis in patients with anti-IFN- γ AAbs.

摘要

背景

在流行地区，未感染艾滋病毒的免疫功能低下个体中，踝节菌病的报告越来越多。本研究的目的是比较由抗干扰素-γ自身抗体（抗IFN-γ AAb）引起的成人免疫功能低下个体中踝节菌病的特征及死亡率与艾滋病毒/艾滋病患者（PWHA）的情况。

方法

在泰国清迈玛哈叻那空医院对确诊感染艾滋病毒或诊断为踝节菌病的抗IFN-γ-AAbs成人患者进行了一项回顾性队列研究。

结果

纳入了32例抗IFN-γ-AAbs患者和235例PWHA。抗IFN-γ-AAbs患者年龄较大，合并症更多。PWHA更易出现全身症状、咳嗽、呼吸困难、腹泻、脾肿大、脐状皮肤病变、胸部X光片异常和真菌血症。抗IFN-γ-AAbs患者更易出现斑疹/丘疹/结节、脓肿和Sweet综合征等皮肤病变，以及骨和关节感染，白细胞计数更高。抗IFN-γ-AAbs患者从首次出现症状到治疗的时间更长（44.5天对30.0天，p值 = 0.049）。抗IFN-γ-AAbs患者的24周死亡率为9.4%（3例患者），PWHA为15.3%（36例患者）（p值 = 0.372）。