Disseminated Talaromyces marneffei in newly diagnosed HIV patient.

Abstract

A 31-year-old Chinese man referred to the haematology clinic, was presented with recurrent fever for 19 days and two enlarged lymph nodes on the left neck. Past medical history was unremarkable. Laboratory data revealed white blood cell (WBC) count 9.81 × 109/L (neutrophilic band granulocyte 67%, neutrophilic myelocyte 11%, neutrophilic metamyelocyte 7%, polymorphonuclear neutrophil 6%, lymphocyte 5%, eosinophil 1%, monocyte 2%, basophil 1% and nucleated red blood cell 18/100 WBC), haemoglobin 77 g/L and platelet count 41 × 109/L. The peripheral blood and bone marrow aspirate smear revealed small round-to-ovoid yeast cells located predominantly within or surrounding the neutrophil (top left, middle and right, 1000×, Wright-Giemsa staining). The blood culture showed the fungus grown in a mould form arranged in a mulberry-like pattern and produced a soluble red pigment that diffuses into the sabouraud medium (bottom left). Lactophenol cotton blue staining confirmed numerous yeast-like organisms by the microscopic morphology (bottom middle, 400×). Fungus staining also showed numerous blue yeast-like organisms by fluorescence microscope (bottom right, 400×). The patient was subsequently diagnosed with AIDS having HIV antibody, and the blood cultures showed the growth of Talaromyces marneffei, a dimorphic fungus that is an important opportunistic pathogen. After treatment with anti-fungus and anti-HIV drug, this patient had significantly improved and discharged. The authors would like to thank the encouragement and support of the members who take advanced study in the unit of cytology of the Department of Clinical Laboratory, Zhejiang Provincial People's Hospital. Yanxia Chen was supported by the Zhejiang Provincial Natural Science Fund (No. LY20H100008). Financing entity had no role in the study design, data collection or analysis, decision to publish or preparation of the manuscript. The authors declared that they have no conflict of interest. Zhejiang Provincial Natural Science Fund, Grant Number: LY20H100008. Yingcai Huang provided the haematology picture and wrote the manuscript. Haiyan Cui provided the microbiology picture. Yanxia Chen analysed the data. Jinlin Liu wrote the manuscript. All authors reviewed this manuscript and agreed to submit it. This study was approved by the ethical committee of Longgang District People's Hospital of Shenzhen & The Second Affiliated Hospital of the Chinese University of Hong Kong (No. 2022007). This study did not involve any personal information, but only reports the laboratory data. Therefore, the patient consent was waived, and this waive was approved by the ethical committee of Longgang District People's Hospital of Shenzhen & The Second Affiliated Hospital of the Chinese University of Hong Kong.