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Volume 21, Number 7—July 2015

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

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, Patrick C.Y. Woo, and Kwok-Yung YuenComments to Author 
Author affiliations: The University of Hong Kong, Hong Kong, China

Main Article

Table 2

Laboratory results for 4 case-patients with disseminated Talaromyces marneffei infection after targeted therapies*

Laboratory parameter Case-patient 1 Case-patient 2 Case-patient 3 Case-patient 4
Leukocytes, x 109 cells/L 12.08 0.91 4.93 33.79
Neutrophils, x 109 cells/L 11.01 0.45 3.11 8.45 (with blasts)
Lymphocytes, x 109 cells/L 0.83 (CD4+: 315/µL)‡ 0.45 1.05 9.12 (with blasts)
Hemoglobin, g/dL 12.3 10.3 8.0 9.2
Platelets, x 109/L 250 5 539 15
Sodium, mmol/L 136 135 139 138
Potassium, mmol/L 3.5 4.1 3.7 4.4
Creatinine, µmol/L 101 111 78 92
Albumin, g/L 40 32 39 37
Globulin, g/L 34 36 36 39
Total bilirubin, µmol/L 8 9 13 19
ALP, U/L 234 163 112 96
ALT, U/L 79 20 32 61
AST, U/L 38 9 28 123
LDH, U/L 209 97 352 2,069
Combined HIV antibody/antigen Negative Negative Negative Negative
Autoantibody against IFN-γ Negative Negative Negative Negative
Blood culture No bacteria and fungi T. marneffei; Mycobacterium chelonae, Enterococcus faecium, MRCNS, and Candida glabrata§ Klebsiella pneumoniae§ T. marneffei
Bone marrow aspirate ND T. marrneffei ND ND
Sputum culture Negative for pathogenic bacteria, AFB, and fungi Negative for pathogenic bacteria, AFB, and fungi Negative for pathogenic bacteria, AFB, and fungi Negative for pathogenic bacteria, AFB, and fungi
Urine culture No bacteria and fungi No bacteria and fungi No bacteria and fungi No bacteria and fungi
Stool culture T. marneffei; negative for pathogenic bacteria, including Clostridium difficile and AFB ND ND ND
Serum CMV pp65 antigen Negative Negative Negative Negative
Other Stool for C. difficile toxin (negative); serum for Entamoeba histolytica antibody (negative); multiple blood smears for Plasmodium sp. (negative) BAL: Pneumocystis jiroveci (smear-positive) Cervical lymph node: T. marneffei (culture-positive)

*ALP, alkaline phosphatase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; LDH, lactate dehydrogenase; IFN-γ, interferon-γ; MRCNS, methicillin-resistant coagulase-negative Staphylococcus; ND, not done; AFB, acid-fast bacilli; CMV, cytomegalovirus; BAL, bronchoalveolar lavage. Reference ranges: leukocytes; 3.89–9.93 × 109 cells/L; neutrophils, 2.01–7.42 × 109 cells/L; lymphocytes, 1.06–3.61 × 109 cells/L; hemoglobin, 13.3–17.7g/dL; platelets, 162–341 × 109/L; sodium, 136–148 mmol/L; potassium, 3.6–5.0 mmol/L; creatinine, 67–109 µmol/L; albumin, 39–50 g/L; globulin, 24–37 g/L; total bilirubin, 4–23 µmol/L; ALP, 42–110 U/L; ALT, 8–58 U/L; AST, 5–38 U/L; LDH, 118–221 U/L.
†Results at presentation.
‡Reference range of CD4+ lymphocyte count: 415–1,418 cells/µL.
§Bacteremia caused by M. chelonae, E. faecium, MRCNS, and candidemia in case-patient 2, and bacteremia caused by K. pneumoniae in case-patient 3 occurred after recovery from T. marneffei infection and prolonged hospitalization.

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Page created: July 14, 2015
Page updated: July 14, 2015
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