Clinical Characteristics of Transplant Recipients Infected with Talaromyces Marneffei: 2 Case Reports and a Literature Review

Figures & data

Figure 1 (A) (2019–10-18) Multiple nodules, patchy high-density shadows and glass high-density shadows were seen in both lungs. (B) (2019–10-23) Multiple nodules and patchy high-density shadows were present in both lungs. (C) (2019–10-30) Nodules and patchy shadows were seen in both lungs, and bilateral pleural effusion.

Figure 2 (A) (2019–06-27) Patchy, flocculent and ground glass-like shadows were seen in both lungs, a nodule was seen in right lung. (B) (2019–07-22) Patchy, nodular and banding shadows had significantly increased, and bilateral pleural effusion.

Table 1 The Clinical Characteristics, Diagnostic Methods and Other Coinfections of the 21 Patients

No.	Age (Years) /Sex	Endemic Area	Graft Type	Clinical Manifestations	Involved Systems	Diagnosis Methods	Coinfection
P3^Citation3	43/M	Taiwan, China	Renal transplant	Stomach ache	Digestive system, hematopoietic system	Ascitic Fluid culture, Blood culture	Salmonella
P4^Citation4	33/M	Taiwan, China	Renal transplant	Melena, shortness of breath	Digestive system, hematopoietic system	Duodenal biopsies, Blood culture	Candida, Acid-fast bacillus
P5^Citation5	47/M	Taiwan, China	Renal transplant	Cough, fever, emaciation, skin nodular, skin turgor	Skin, hematopoietic system	Blood Culture, Skin secretion culture	N
P6^Citation6	38/M	Hong Kong, China	Renal transplant	Fever, stomach ache, cough	Hematopoietic system, bone, lymph nodes, respiratory system	Blood culture, bone marrow culture, lymph node biopsy	Herpesvirus
P7^Citation7	42/F	Taiwan	Renal transplant	Left Buttock pain	Bone	Bone biopsy	N
P8^Citation8	67/M	Vietnam	Renal transplant	Stomach ache, diarrhoea	Hematopoietic system, digestive system	Ascitic Fluid culture, blood culture	CMV, Candida
P9^Citation9	41/M	China	Renal transplant	Cough, acratia, muscular soreness	Respiratory system	Lung biopsy	Hepatitis C virus (HCV)
P10^Citation10	46/M	Indonesia	Renal transplant	Fever, Face nodular	Skin	Skin biopsy	Candida, Enterobacter faecalis
P11^Citation11	45/F	Guangdong, China	Renal transplant	Oliguria, abdominal distension, cough, fever, emaciation	Respiratory system, digestive system, hematopoietic system	Ascitic Fluid culture, hydrothorax culture, Blood culture	Acinetobacter baumannii, E coli bacteraemia
P12^Citation12	51/M	China	Renal transplant	Fever, stomach ache	Lymph nodes, hematopoietic system	Blood Culture, lymph node biopsy	CMV
P13^Citation13	56/M	India	Renal transplant	Skin turgor	Respiratory system	Lung biopsy	Dematiaceous septate hyphae, Alternaria alternata
P14^Citation14	57/M	China	Bone marrow transplant	Shortness of breath	Hematopoietic system, respiratory system	Blood culture	Candida, Staphylococcus aureus
P15^Citation15	41/F	Taiwan, China	Lung transplant	Shortness of breath, headache	Respiratory system, hematopoietic system, lymph nodes	Blood culture, BALF culture, lymph node culture, lung biopsy	Pseudomonas aeruginosa, Staphylococcus aureus, Aspergillus
P16^Citation16	61/M	Myanmar*	Lung transplant	Fever, stomach-ache	Lymph nodes, hematopoietic system	Blood Culture, lymph node biopsy	CMV
P17^Citation17	52/M	China	Liver transplant	Shortness of breath	Urinary system, hematopoietic system, respiratory system	Blood culture, BALF culture, urinary culture, urinary NGS	E coli bacteraemia, CMV
P18^Citation18	52/M	China	Liver transplant	Fever, cough, expectoration	Hematopoietic system, respiratory system	Blood culture	N
P19^Citation19	50/M	China	Renal transplant	Discomfort on micturition	Urinary system, respiratory system	Urinary NGS, BALF NGS	N
P20^Citation20	53/F	China	Renal transplant	Cough, expectoration, activity intolerance	Respiratory system, lymph nodes	Lymph node biopsy, lung biopsy	N
P21^Citation21	0.58/M	China	Liver transplant	Fever	Respiratory system, hematopoietic system, digestive system	Sputum NGS, blood culture, liver biopsy	N
P22^Citation22	34/M	China	Renal transplant	Fever, cough, diarrhoea	Respiratory system, urinary system	Sputum culture, urinary culture	N
P23^Citation23	58/M	China	Liver transplant	Skin vesicles, skin pruritus	Respiratory system, skin	Skin biopsy, lung biopsy	N

Notes: N is unknown. * means the donor has been to Myanmar.

Table 2 The Treatment Regimens and Outcomes of the 21 Patients

No.	Immunosuppressive Agents	The Time Interval from Postoperative Immunosuppressive Therapy to the Onset of Symptoms or Disease Changes (Months)	The Time Interval from Invasion to Antifungal Therapy (Days)	The Use of Immunosuppressive Agents During Invasion	Antifungal Drugs	Outcome
P3	Azathioprine	N	N	N	Amphotericin B 2 days	Died
P4	Azathioprine+CsA/Tac+PED	48	N	N	None	Died
P5	Tac+PED5mg qd	31	60	Reduced Tac dosage	Liposomal amphotericin B 100mg qd, followed by Itraconazole 1 year	Improved
P6	Tac+MMF+PED	9	17	Reduced Tac dosage, withheld MMF	Amphotericin B 0.5mg/kg/day 30 days, followed by Itraconazole 200mg qd	Improved
P7	Tac3mg bid+ PED5mg qd	7	60	N	Liposomal amphotericin B 2mg/kg/day 21 days, followed by Itraconazole 200mg qd	Improved
P8	Tac1mg bid+MMF1000 mg bid + PED10mg qd	48	21	Reduced Tac dosage	Liposomal amphotericin B 3mg/kg/day 21 days, followed by Itraconazole 300mg 3 months	Improved
P9	Tac2-3mg bid+MMF750mg bid	60	30	N	Voriconazole 200mg qd, followed by Itraconazole 200mg bid 2 weeks	Improved
P10	Tac	11	N	N	#	Died
P11	Tac+MMF+PED	6	120	Withheld Tac	Itraconazole 250mg qd 4 days	Worsened
P12	Tac/CsA+MMF+Methylprednisolone(MP)	10	99	Withheld Tac and MP, change to CsA, continued MMF	Liposomal amphotericin B 0.4mg/kg/day 14 days, followed by Itraconazole 200mg bid	Improved
P13	Tac 3.5mg twice daily+MMF 360mg bid+ PED 10 mg qd	24	180	N	Liposomal amphotericin B 3mg/kg/day 1 week, followed by Itraconazole 200mg bid 6 months	Improved
P14	Fludarabine	48	57	N	Amphotericin B 1mg/kg/day 10 days	Died
P15	Tac4mg bid+MMF 750 mg bid+ PED7.5mg qd	28	N	Reduced Tac dosage, Withheld MMF	Voriconazole 200mg bid 12 months	Improved
P16	Tac+MMF+ MP	4	21	N	Liposomal amphotericin B 5mg/kg/day 6 months	Improved
P17	Tac+MMF+ PED	36	21	N	Amphotericin B 5mg qd	Died
P18	Tac+MMF	12	N	Reduced dosage and Withheld	Voriconazole 47 days change to Amphotericin B 2 weeks, followed by voriconazole 3 months	Improved
P19	*	36	10	N	Voriconazole 0.2g bid 2 months	Improved
P20	Tac+MMF	140	N	Reduced Tac dosage, Withheld MMF	Amphotericin B 2 weeks, followed by Itraconazole 12 months	Improved
P21	*	0.5	N	Used MP	#	Died
P22	Tac+MMF+ PED	12	16	N	Voriconazole 0.2g qd	Improved
P23	MP+Tac+MMF	3	30	Reduced dosage	Voriconazole 11 days	Died

Notes: * indicates that immunosuppressants were used in both P19 and P21, but the types are unknown. bid: twice daily, qd: once daily. N means unknown. # means without antifungal therapy.

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