Abstract
Talaromyces marneffei infection is a major cause of death in HIV-infected individuals in South and Southeast Asia. Talaromycosis immune reconstitution inflammatory syndrome has not been well described. Here we report the clinical features, management, and outcomes of three HIV-infected patients with talaromycosis-associated paradoxical immune reconstitution inflammatory syndrome in Ho Chi Minh City, Vietnam.
Highlights
Talaromycosis is a systemic mycosis caused by the dimorphic fungus Talaromyces marneffei and is amongst the most common HIV-associated opportunistic infections in south and southeast Asia, alongside tuberculosis, cryptococcal meningitis and Pneumocystis jiroveci pneumonia [1,2]
The incidence of immune reconstitution inflammatory syndrome (IRIS) ranges from 10% to 40% and varies by pathogen, being most commonly described in patients with infections caused by mycobacteria, fungi, and lymphotropic viruses such as JC virus and human herpes viruses [4,5]
The plethora or presentations of IRIS are in part driven by the underlying pathogen
Summary
Talaromycosis (formerly penicilliosis) is a systemic mycosis caused by the dimorphic fungus Talaromyces (formerly Penicillium) marneffei and is amongst the most common HIV-associated opportunistic infections in south and southeast Asia, alongside tuberculosis, cryptococcal meningitis and Pneumocystis jiroveci pneumonia [1,2]. The development of skin nodules on her face and body prompted her to seek care at our hospital, where she was diagnosed with HIV infection by three different enzyme-linked immunosorbent assay (ELISA), and with talaromycosis by skin and blood culture. She had no history of injection drug use (IDU). Her laboratory tests revealed pancytopenia and elevated aspartate aminotransferase (AST) (Table 1) She was treated with itraconazole 400 mg/ day with complete resolution of fever and skin lesions by D+11; hemoculture performed on D+14 remained positive. (cells/ culture negative day for 12 weeks of symptoms after female hepatosplenomegaly μL)
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