Talaromyces amestolkiae Infection in an AIDS Patient with Cryptococcal Meningitis
Abstract
:1. Introduction
2. Case Report
3. Results and Discussion
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Species | Country | Underlying Conditions | Treatment | Outcome |
---|---|---|---|---|
T. amestolkiae | New Caledonia [4] Taiwan | AML case AIDS patients Cystic fibrosis case ALL case | Not mentioned in article | Not mentioned in article |
T. marneffei | East Asian countries including China, Taiwan, Thailand, and Vietnam | AIDS | Amphotericin B then Itraconazole | Mortality rate: ~75% in untreated patient ~25% in received treatment patient |
T. indigoticus | Nepal, Japan, Thailand, and Western Panama [12] | Diabetes mellitus | Not mentioned in article | Not mentioned in article |
T. piceus | Argentina [13] | X-linked chronic granulomatous disease (X-CGD) patient | Amphotericin B then voriconazole due to renal impairment Surgical resection of affected ribs | Recovered and free from fungal infections |
Germany [14] | Alcohol-abused and cholangiocarcinoma | Deceased before treatment | ||
T. stollii | France, Hamburg, and Netherlands [4] | lung transplantation, France AIDS patient; the Netherlands | Not mentioned in article | Not mentioned in article |
Talaromyces amestolkiae | Talaromyces marneffei | |
---|---|---|
Risk factors | Immunocompromised patient. Case reported in an acute lymphoblastic leukemia patient [15] and we found this pathogen in an AIDS patient. | AIDS (majority of cases having a CD4 count <100 cells/mm3) [16,17,18], autoimmune disorders, cancer, diabetes mellitus [19,20,21]. |
Clinical manifestations | Respiratory symptoms Productive cough, mild dyspnea, and occasional low grade fever [15] Other symptoms Lymphadenopathy | Respiratory symptoms Nonproductive cough, fever, dyspnea, and chest pain Gastrointestinal symptoms Diarrhea and abdominal pain Skin lesions Papules on the face, chest, and extremities. Subsequently, the center of the papule becomes necrotic, giving the appearance of an umbilicated papule, which can resemble molluscum contagiosum [22]. Mucosal lesions Mucosal lesions appear similar to skin lesions. Distributed in the oral cavity, oropharynx, hypopharynx, stomach, colon, and genitalia had been reported [9,23,24,25]. Other symptoms Weight loss, hepatomegaly, splenomegaly, and/or generalized lymphadenopathy [22]. |
Definitive diagnosis | ||
Culture | 7 days in CYA at 25 °C [2] | May need 4~7 days to grow |
|
| |
7 days in MEA at 25 °C | At 25 °C to 30 °C, yellow-green colonies with sulcate folds and a red diffusible pigment in the medium are produced. At 32 to 37 °C (yeast phase) | |
| Morphological transition from a mold to a yeast, producing colonies without a red diffusible pigment [22] | |
Molecular diagnostics | PCR amplification Sequence identification of specific regions | PCR amplification Sequence identification of specific regions |
Treatment | ||
Pulmonary infection [15] Oral Voriconazole 200 mg every 12 h for 2 months Our patient (co-infected with cryptococcus neoformans meningitis) Amphotericin B for 6 weeks then oral Voriconazole | Recommended induction therapy [22] Amphotericin B, preferably liposomal amphotericin B 3 to 5 mg/kg body weight/day or Deoxycholate amphotericin B 0.7 mg/kg body weight/day, IV for 2 weeks | |
Consolidation therapy oral itraconazole, 200 mg every 12 h for a subsequent duration of 10 weeks [26] | ||
Maintenance therapy (or secondary prophylaxis) oral Itraconazole 200 mg/day | ||
| ||
Special consideration | For patients who cannot tolerate any form of amphotericin induction therapy with IV Voriconazole 6 mg/kg every 12 h on day 1 (loading dose), then 4 mg/kg every 12 h or with oral Voriconazole 600 mg every 12 h on day 1 (loading dose), then 400 mg every 12 h for 2 weeks is recommended [28,29] |
Pathogens | Underlying Disease | Specimen of Co-Infectants | Specimens of Cryptococcus | Treatment Strategy | Treatment for Cryptococcus | Treatment for Co-Infectants | Outcome |
---|---|---|---|---|---|---|---|
Pneumocystis jiroveci [30] | AIDS | * BAL 1 | BAL 2 and Blood 2 | Pneumocystis jiroveci, then ART, then asymptomatic cryptococcus | Voriconazole | Cotrimoxazol | Complete resolution of the cavitation |
Non-tuberculous Mycobacteria [31] | AIDS, syphilis | Sputum/BAL 1 (CMV, EBV, Candida albicans also detected) | Blood 2 | Treat NTM only because the culture results are later than the patient’s discharge | No treatment | Trimethoprim-sulfamethoxazole and steroids | Not mentioned |
Mycobacterium avium complex [32] | AIDS | Lymph node biopsy 2 | Blood 1 and * CSF 1 | Treat Cryptococcus first, then ART, then MAC | Amphotericin B and flucytosine then fluconazole | Azithromycin, ethambutol and rifabutin | Good clinical evolution |
Histoplasmosis [33] | AIDS | Lymph node biopsy | Blood and Sputum | HARRT then treat Cryptococcus infection | Amphotericin B and flucytosine then fluconazole | Continue * ART and Fluconazole | |
T. marneffei | AIDS [34] | Skin papules culture | * CSF | HARRT and treat Cryptococcus infection | Amphotericin B then itraconazole | Not mentioned | Skin papule disappeared and Continue * HAART therapy |
Hemolytic anemia with 8-year steroid history [35] | Blood 1 and lymph node aspiration | Blood culture 2 | Voriconazole for T. marneffei and Cryptoccocus | Voriconazole | Voriconazole | Discharged with oral voriconazole | |
Aspergillus [36] | Multiple myeloma | * BAL 2 | Pulmonary infection 1, not mentioned about the specimen | Treat Cryptococcus first then Aspergillus | Amphotericin B and flucytosine, then fluconazole | Fluconazole was shifted to voriconazole for additional coverage | Discharged with oral voriconazole |
Mycobacterium tuberculosis [37] | No remarkable history | Transbronchial biopsy specimen from RUL lung and Sputum 1 | * BAL 1 & CSF 2 | combination of anti-TB and antifungal therapy | Amphotericin B and flucytosine then fluconazole | Isoniazid+ rifampin+pyrazinamide+ ethambutol | Hold fluconaconazole for nephrotoxicity; Discharged |
Mycobacterium abscessus [38] | Lupus nephritis and 10-year corticosteroid history | Sputum | Sputum | Patient refused inpatient care | Itraconazole | Clarithromycin and faropenem | No recurrence was observed |
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Wang, L.-A.; Chuang, Y.-C.; Yeh, T.-K.; Lin, K.-P.; Lin, C.-J.; Liu, P.-Y. Talaromyces amestolkiae Infection in an AIDS Patient with Cryptococcal Meningitis. J. Fungi 2023, 9, 932. https://doi.org/10.3390/jof9090932
Wang L-A, Chuang Y-C, Yeh T-K, Lin K-P, Lin C-J, Liu P-Y. Talaromyces amestolkiae Infection in an AIDS Patient with Cryptococcal Meningitis. Journal of Fungi. 2023; 9(9):932. https://doi.org/10.3390/jof9090932
Chicago/Turabian StyleWang, Li-An, Yu-Chuan Chuang, Ting-Kuang Yeh, Kuan-Pei Lin, Chi-Jan Lin, and Po-Yu Liu. 2023. "Talaromyces amestolkiae Infection in an AIDS Patient with Cryptococcal Meningitis" Journal of Fungi 9, no. 9: 932. https://doi.org/10.3390/jof9090932