Talaromyces marneffei Mp1p Antigen Detection may Play an Important Role in the Early Diagnosis of Talaromycosis in Patients with Acquired Immunodeficiency Syndrome.

Xiaoman Chen,Weiping Cai,Liya Li,Xu Ou,Xiejie Chen,Pengle Guo,Xiaoping Tang,Haodi Wang,Linghua Li

doi:10.1007/s11046-022-00618-9

Abstract

Talaromycosis is a life-threatening fungal disease commonly seen in patients with acquired immunodeficiency syndrome (AIDS), which is endemic in Southern China and Southeast countries. The diagnostic methods available for talaromycosis are relatively time-consuming and yield a high mortality. Therefore, early diagnosis of talaromycosis is extremely important. We aimed to determine a potential method for assisting in its early diagnosis. A total of 283 patients with AIDS admitted to our hospital were prospectively included in this cross-sectional study and divided into those with Talaromyces marneffei (TSM group, n = 93) and those without Talaromyces marneffei (non-TSM group, n = 190). The diagnostic accuracy of the Mp1p enzyme immunoassay (EIA), galactomannan (GM) assay, and blood culture performed within 3 days of hospitalisation were evaluated, using talaromycosis confirmed by culture and/or pathology as the gold standard. The positivity rates in the Mp1p EIA, GM assay, and blood culture were 72%, 64.5%, and 81.7%, respectively, in the TSM group. The sensitivity, specificity, and positive and negative predictive values of the Mp1p EIA were 72.0% (67/93), 96.8% (184/190), 91.8% (67/73), and 87.6% (184/210), respectively. The Mp1p EIA showed a substantial agreement with the gold standard (kappa: 0.729) and superiority to the GM assay (kappa: 0.603); it also showed a superior diagnostic accuracy in the patients with CD4+ counts of < 50 cells/µL compared to those with CD4+ counts ranged from 50–100 cells/µL. The Mp1p EIA has the advantage of assisting in the early diagnosis of talaromycosis in patients with AIDS, especially those with low CD4+ counts.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11046-022-00618-9.

Highlights

Talaromycosis is an invasive fungal disease caused by Talaromyces marneffei (T. marneffei), which is common in immunocompromised individuals, especially in patients with acquired immunodeficiency syndrome (AIDS)
In the non-Talaromyces marneffei (TSM) group, 6 patients had positive results on the Mp1p assay, none of whom were diagnosed with a fungal infection (Table S4)
We found that Mp1p antigen detection possesses a superior advantage in assisting in talaromycosis diagnosis in patients with AIDS within 3 days of admission, especially those with low CD4? counts (\ 50 cells/lL)

Summary

Introduction

Talaromycosis is an invasive fungal disease caused by Talaromyces marneffei (T. marneffei), which is common in immunocompromised individuals, especially in patients with acquired immunodeficiency syndrome (AIDS). Count is a risk factor for talaromycosis, especially if the CD4? It is mainly prevalent in Southern China and Southeast countries, including Thailand, Vietnam, India, and Malaysia [3–7]. In Southern China, the prevalence of talaromycosis in hospitalized patients with AIDS has increased by 65% within 5 years [8]. Talaromycosis is a life-threatening disease with a high mortality rate of up to 50.6% without timely antifungal treatment [6, 9, 10]. Delayed diagnosis of talaromycosis is an important reason for its high mortality rate [10, 11]. For every day of delay in the diagnosis of talaromycosis, the risk of death increases by 2% [11].

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