Talaromycosis in HIV Positive Patient

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Talaromycosis in HIV positive patient
Image Source: The New England Journal of Medicine

A 31-year-old man presents with skin lesions and fever. Gets a diagnosis of HIV and Talaromycosis!

A 31-year-old man presented to the emergency department with complaints of fever and papular skin lesions for 1 month. Moreover, he reported a 10 kg weight loss in the past month. On examination, he was cachectic and febrile, with a body temperature of 38°C. Skin examination revealed umbilicated papules on his face, body, and extremities. Serological investigations showed a haemoglobin level of 8.3 g/dL, a white-cell count of 9200/mm3 with 88% neutrophils, and 4% lymphocytes. His platelet count was 80,000/mm3. Testing for human immunodeficiency virus (HIV) was positive. CD4 T-cell count was 10 cells/mm3.

A peripheral blood smear revealed several intracellular and extracellular yeast-like organisms. These organisms measured 2 to 4 μm in diameter. Gram’s staining showed septate hyphae fungus. The investigations confirmed the diagnosis of Talaromycosis (formerly called Penicillosis), caused by Talaromyces marneffei (formerly Penicillium marneffei).

Talaromycosis is seen mostly in patients with HIV infection. However, non-HIV patients may acquire the infection when they have an immunocompromised state and/or in endemic areas.

T. marneffei, the culprit fungus, is a dimorphic fungus that can lead to rapidly progressive, life-threatening infection. Patients may have a fever, weight loss, fatigue, bone-marrow involvement ) anaemia, thrombocytopenia), respiratory symptoms, gastrointestinal symptoms, lymphadenopathy, altered mental state/confusion, agitation, etc.

The diagnosis in non-HIV patients is often delayed. Culture is the gold standard but slow, as it takes 2–4 weeks. Yeasts may be visible on microscopy of a peripheral blood smear or skin or lymph node biopsy.

The treating physicians diagnosed the patient and started him on amphotericin B. However, the patient, unfortunately, died 4 days after the initial presentation.

Reference:

Thamonwan Norasethasopon, M. a. (2021, April 01). Talaromycosis. Retrieved from The New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMicm2032478

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Dr. Arsia Parekh
Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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