Hemophagocytic syndrome in a patient with acquired immunodeficiency syndrome and acute disseminated penicilliosis.
Pei Sung-Nan,Lee Chen-Hsiang,Liu Jien-Wei
The American journal of tropical medicine and hygiene
Penicilliosis marneffei, which is caused by the opportunistic fungus Penicillium marneffei, is one of the troublesome infections in patients infected with human immunodeficiency virus (HIV) in southeast Asia. We report an HIV-positive patient with acute disseminated penicilliosis marneffei that manifested as hemophagocytic syndrome. Numerous nucleated erythrocytes were also found in peripheral blood of the affected patient. Bone marrow aspirate histopathologically showed hemophagocytosis and abundant P. marneffei. The hemophagocytic syndrome and peripheral nucleated erythrocytes improved after therapy with amphotericin B. Our report underscores the importance of recognition of this peculiar phenomenon in penicilliosis marneffei. This awareness may alert clinicians to potential penicilliosis marneffei in HIV-positive patients, therefore making early diagnosis and timely effective treatment of the infectious disease possible.
Hemophagocytic Lymphohistiocytosis Secondary to Disseminated Talaromyces marneffei and Cytomegalovirus Infections in an HIV-Infected Patient.
Clinical laboratory
BACKGROUND:Hemophagocytic lymphohistiocytosis (HLH) is a rare and potentially life-threatening syndrome led by a highly stimulated but invalid immune response, and Talaromyces marneffei (T. marneffei) is an opportunistic infection with high mortality commonly among acquired immunodeficiency syndrome (AIDS) patients. METHODS:Here is a rare case, in which secondary HLH is caused by dual infections of T. marneffei and cytomega-lovirus (CMV). A 15 year old man with a 20-day history of fatigue and intermittent fever (maximum 41.0℃) was admitted to the department of infectious diseases. Marked hepatosplenomegaly and pulmonary infection were detected by computed tomography. Examination of peripheral blood and bone marrow (BM) smears provided clues pointing toward T. marneffei infection, and indicated prominent hemophagocytosis. RESULTS:Cytomegalovirus (CMV) and T. marneffei infections were confirmed by CMV quantitative nucleic acid testing and culture of blood and bone marrow, respectively. A diagnosis of acquired HLH caused by dual infections of T. marneffei and CMV was established because 5 of the 8 HLH diagnostic criteria were met. CONCLUSIONS:The case highlights the contribution of the morphological examination on peripheral blood and bone marrow smears in the diagnosis, which sometimes are the only locations that HLH and T. marneffei can be diagnosed.
10.7754/Clin.Lab.2022.220901
Secondary hemophagocytic syndrome in an acquired immunodeficiency syndrome and -thalassemia patient infected with : A case report and literature review.
IDCases
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease characterized by a hyperinflammatory syndrome and impairment of multiple organ systems. Talaromycosis marneffei (TSM) is an opportunistic infection mostly found in immunosuppressed populations, such as those with acquired immunodeficiency syndrome (AIDS), and is prevalent in southern China. However, HLH secondary to TSM is extremely rare and has only been reported in isolated cases. A 30-year-old patient with recurrent high fever and progressive cytopenia was diagnosed with HLH secondary to disseminated TSM with AIDS and -thalassemia. The patient remained in sustained remission without recurrence after effective treatment with antifungals and glucocorticoids.
10.1016/j.idcr.2024.e01954
The Presence of Secondary Evans Syndrome in AIDS Patients with Infection.
Wang Mengyan,Zhang Zhongdong,Yan Jun,Shi Jinchuan,Liu Shourong,Wan Hu
Infection and drug resistance
Objective: (T.M) is a common opportunistic fungus in human immunodeficiency virus (HIV) infection individual. Secondary Evans syndrome in AIDS patients with infection has not been reported before. Here, we described cases related to this comorbidity. Methods:AIDS patients diagnosed with infection from 2016 to 2020 at Xixi Hospital of Hangzhou were included in this retrospective study. Results:Total 76 AIDS patients with T.M infection were enrolled. The most common symptoms were fever and cough (70/76; 55/76, respectively). 53/76 (69.74%) patients got positive results of direct antiglobulin test. 14/76 AIDS-T.M patients combined with secondary Hemophagocytic lymphohistiocytosis (HLH). Five patients were diagnosed with AIDS-T.M associated Evans syndrome. There were severe inflammatory reaction, liver dysfunction, coagulation dysfunction and immunodeficiency status in AIDS-T.M patients with secondary Evans syndrome. All patients received antifungal therapy and three patients received corticosteroids for Evans syndrome treatment. One patient died due to sepsis. Conclusion:AIDS-T.M patients with secondary Evans syndrome is extremely rare and we need to be alert to the occurrence of secondary Evans syndrome in AIDS-T.M patients. Clinicians should timely start effective antifungal treatments with suspicious T.M infection in AIDS patients.
10.2147/IDR.S300082
HIV and fungal priority pathogens.
The lancet. HIV
The burden of invasive fungal infections associated with opportunistic fungal pathogens is a persistent challenge, particularly among people with advanced HIV disease. In October, 2022, WHO published the Fungal Priority Pathogens List (FPPL)-the first global effort to systematically prioritise fungal pathogens. Of the 19 pathogens in the WHO FPPL, four opportunistic pathogens in particular cause invasive diseases in people living with HIV: Cryptococcus neoformans, Histoplasma spp, Pneumocystis jirovecii, and Talaromyces marneffei. These four fungal pathogens are major causes of illness and death in people with advanced HIV and overwhelmingly affect those in low-income and middle-income countries. Access to diagnostics, improved surveillance, targeted support for innovation, and an enhanced public health focus on these diseases are needed in the effort to reduce HIV-associated deaths.
10.1016/S2352-3018(23)00174-1
Infections associated with haemophagocytic syndrome.
Rouphael Nadine G,Talati Naasha J,Vaughan Camille,Cunningham Kelly,Moreira Roger,Gould Carolyn
The Lancet. Infectious diseases
Haemophagocytic syndrome or haemophagocytic lymphohistiocytosis is a rare disease that is often fatal despite treatment. Haemophagocytic syndrome is caused by a dysregulation in natural killer T-cell function, resulting in activation and proliferation of lymphocytes or histiocytes with uncontrolled haemophagocytosis and cytokine overproduction. The syndrome is characterised by fever, hepatosplenomegaly, cytopenias, liver dysfunction, and hyperferritinaemia. Haemophagocytic syndrome can be either primary, with a genetic aetiology, or secondary, associated with malignancies, autoimmune diseases, or infections. Infections associated with haemophagocytic syndrome are most frequently caused by viruses, particularly Epstein-Barr virus (EBV). We present a case of EBV-associated haemophagocytic syndrome in a young adult with no known immunosuppression. We briefly review haemophagocytic syndrome and then discuss its associated infections, particularly EBV and other herpes viruses, HIV, influenza, parvovirus, and hepatitis viruses, as well as bacterial, fungal, and parasitic organisms.
10.1016/S1473-3099(07)70290-6
Response to antifungal therapy by human immunodeficiency virus-infected patients with disseminated Penicillium marneffei infections and in vitro susceptibilities of isolates from clinical specimens.
Supparatpinyo K,Nelson K E,Merz W G,Breslin B J,Cooper C R,Kamwan C,Sirisanthana T
Antimicrobial agents and chemotherapy
Eighty-six patients with laboratory evidence of human immunodeficiency virus infection presented to Chiang Mai University Hospital in Chiang Mai, Thailand, between 1 June 1990 and 30 June 1992 with systemic infection caused by the dimorphic fungus Penicillium marneffei. Thirty isolates of P. marneffei from clinical specimens from these patients were tested for their in vitro susceptibilities to amphotericin B, 5-fluorocytosine, miconazole, ketoconazole, itraconazole, and fluconazole. P. marneffei was highly susceptible to miconazole, itraconazole, ketoconazole, and 5-fluorocytosine. Amphotericin B showed intermediate antifungal activity, while fluconazole was the least active; some strains of the fungus were resistant to fluconazole. The clinical and microbiological responses correlated with the overall patterns of in vitro susceptibility to the azoles, whereas results with amphotericin B were more difficult to assess. Antibiotic failures of initial therapy occurred in 8 of 35 (22.8%) patients treated with amphotericin B, 3 of 12 (25%) patients treated with itraconazole, and 7 of 11 (63.6%) patients treated with fluconazole. Itraconazole or ketoconazole should be considered to be the drug of first choice in the treatment of mild to moderately severe P. marneffei infection. Parenteral therapy with amphotericin B may be required for seriously ill patients. Since at least 12 patients who responded to initial therapy relapsed within 6 months regardless of initial antifungal therapy, maintenance oral therapy with itraconazole or ketoconazole may be necessary.
10.1128/AAC.37.11.2407
Mindray BC-6900 Scattergram Analysis Combined with Peripheral Blood Smear in the Diagnosis of T. Marneffei Infection in an HIV-Positive Patient: a Case Report.
Huang Wenjie,Lu Zhenni,Wu Liangyan,Luo Wenting,Liang Siqun,Feng Jin,Liu Xiaoyong,Su Qiang,Chen Jianlin,Liu Chunming,Sun Yifan
Clinical laboratory
BACKGROUND:Rapid and accurate diagnosis of HIV-positive patients with Talaromyces marneffei (T. marneffei) infections remains challenging. A 60-year-old woman came to our inpatient department presenting with hematuria, abdominal pain, and diarrhea for one week. The patient had a past medical history of Acquired Immune Deficiency Syndrome (AIDS). The patient's stool was watery and the color of soy sauce. The patient was without fever, cough, and skin lesions. METHODS:The blood routine was performed with a Mindray BC-6900 hematology analyzer. RESULTS:Blood routine showed leukocytosis with neutrophilia and basophils and the WBC/DIFF scattergram showed a cluster of neutrophils connected with a monocyte and lymphocyte cluster and an additional cluster of immature granulocytes and heterotypic lymphocytes or primitive cells. Surprisingly, the peripheral blood film evaluation revealed small round-to-ovoid yeast cells within the cytoplasm of neutrophils. A T. marneffei infection was suspected and anti-fungal therapy was initiated. The patient's diarrhea improved after treatment with amphotericin B for two days. A second blood routine showed a normal number of leukocytes and basophils and a diminished cluster of immature granulocytes and heterotypic lymphocytes or primitive cells. After one week, blood cultures had grown T. marneffei. CONCLUSIONS:The WBC/DIFF scattergram obtained from a Mindray BC-6900 analyzer provided significant hints to enhance diagnosis of T. marneffei when combined with results of a peripheral blood smear.
10.7754/Clin.Lab.2020.200601
Disseminated talaromycosis complicated by recurrent gastrointestinal bleeding and hemorrhagic shock: a case report.
Cui Xiaoya,Su Feifei,Ye Hui,Jiang Yi,Guo Xiuxiu
BMC infectious diseases
BACKGROUND:Gastrointestinal involvement is not uncommon in patients with disseminated talaromycosis, but successful management of massive gastrointestinal bleeding and hemorrhagic shock secondary to talaromycosis is rarely reported. Clinical management strategies for these patients have not been well documented. CASE PRESENTATION:Here, we reported a case of disseminated talaromycosis with recurrent gastrointestinal bleeding and hemorrhagic shock who was successfully alleviated solely with medical treatment. CONCLUSIONS:Early diagnosis and treatment for Talaromyces marneffei, intravenous fluid resuscitation, hemostatic therapy and blood transfusion are all essential for talaromycosis complicated with gastrointestinal bleeding and hemorrhagic shock. It is also necessary to warn about the possibility of bleeding induced or aggravated by endoscopic biopsy trauma.
10.1186/s12879-022-07230-8