Disseminated Infections with Talaromyces marneffei in Non-AIDS Patients Given Monoclonal Antibodies against CD20 and Kinase Inhibitors - Volume 21, Number 7—July 2015 - Emerging Infectious Disease journal - CDC

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Disseminated Infections with Talaromyces marneffei in Non-AIDS Patients Given Monoclonal Antibodies against CD20 and Kinase Inhibitors - Volume 21, Number 7—July 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 7—July 2015

CME ACTIVITY - Synopsis

Disseminated Infections with Talaromyces marneffei in Non-AIDS Patients Given Monoclonal Antibodies against CD20 and Kinase Inhibitors

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• Medscape CME Activity
• Case-Patient 1
• Case-Patient 2
• Case-Patient 3
• Case-Patient 4
• Discussion
• Suggested Citation

Figures

• Figure 1
• Figure 2

Tables

• Table 1
• Table 2

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Jasper F.W. Chan, Thomas S.Y. Chan, Harinder Gill, Frank Y.F. Lam, Nigel J. Trendell-Smith, Siddharth Sridhar, Herman Tse, Susanna K.P. Lau, Ivan F.N. Hung, Kwok-Yung Yuen, and Patrick C.Y. Woo 

Author affiliations: The University of Hong Kong, Hong Kong, China

Suggested citation for this article

Abstract

Infections with the fungus Talaromyces (formerly Penicillium) marneffei are rare in patients who do not have AIDS. We report disseminated T. marneffei infection in 4 hematology patients without AIDS who received targeted therapy with monoclonal antibodies against CD20 or kinase inhibitors during the past 2 years. Clinicians should be aware of this emerging complication, especially in patients from disease-endemic regions.

Talaromyces (formerly Penicillium) marneffei is a pathogenic, thermal dimorphic fungus that causes systemic mycosis in Southeast Asia. T. marneffei infection is characterized by fungal invasion of multiple organ systems, especially blood, bone marrow, skin, lungs, and reticuloendothelial tissues, and is highly fatal, especially when diagnosis and treatment are delayed (1,2). This disease is found predominantly in AIDS patients and occasionally those with cell-mediated immunodeficiencies involving the interleukin-12/interferon-γ (IFN-γ) signaling pathway, such as congenital STAT1 mutations or acquired autoantibodies against IFN-γ (1,3–6). The infection has rarely been reported among hematology patients, including those from disease-endemic regions (7,8).

At Queen Mary Hospital in Hong Kong, a 1,600-bed university teaching hospital that has a hematopoietic stem cell transplantation service, where a wide range of invasive fungal infections have been observed (9,10), only 3 cases of T. marneffei infection were encountered in >2,000 hematology patients in the past 20 years, despite the long-standing availability of mycologic culture and serologic testing (7,8,11,12). In contrast, the infection was commonly reported among AIDS patients (13).

In the past 2 years, we have been alerted by 4 unprecedented cases of disseminated T. marneffei infection among non-AIDS hematology patients given targeted therapies, including monoclonal antibodies (mAbs) against CD20 and kinase inhibitors, which are being increasingly used in recent years. We report details for these 4 hematology case-patients. The study was approved by the institutional review board of The University of Hong Kong/Hospital Authority Hong Kong West Cluster in Hong Kong.

Dr. Jasper F.W. Chan is a clinical assistant professor in the Department of Microbiology, The University of Hong Kong, Hong Kong, China. His research interests include emerging infectious diseases and opportunistic infections in immunocompromised hosts.

Acknowledgment

This study was partly supported by donations from the Hui Hoy and Chow Sin Lan Charity Fund Limited; the Health and Medical Research Fund (ref. no. 13121342) and HKM-15-M07 (commissioned study) of the Food and Health Bureau of Hong Kong Special Administrative Region Government; the Strategic Research Theme Fund, The University of Hong Kong; and a Croucher Senior Medical Research Fellowship.

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Figures

• Figure 1. Multiple, shallow, oozing ulcers at the terminal ileum (arrows) detected by colonoscopy on day 4 of hospitalization for case-patient 1, who had a disseminated infection with Talaromyces marneffei.
• Figure 2. Nasopharyngeal biopsy specimen from case-patient 1, who had a disseminated infection with Talaromyces marneffei. A) Grocott silver staining showing abundant yeast cells (arrows) with central septa 4–5 µm in...

Tables

• Table 1. Characteristics of 4 case-patients with disseminated Talaromyces marneffei infection after targeted therapies
• Table 2. Laboratory results for 4 case-patients with disseminated Talaromyces marneffei infection after targeted therapies

Suggested citation for this article: Chan JFW, Chan TSY, Gill H, Lam FYF, Trendell-Smith NJ, Sridhar S, et al. Disseminated Infections with Talaromycesmarneffei in non-AIDS patients given monoclonal antibodies against CD20 and kinase inhibitors. Emerg Infect Dis. 2015 Jul [date cited].http://dx.doi.org/10.3201/eid2107.150138

DOI: 10.3201/eid2107.150138