• View in gallery
    Figure 1.

    May-Grünwald-Giemsa–stained peripheral blood smear showing oval, yeast-like organisms within the cytoplasm of a neutrophil. This figure appears in color at www.ajtmh.org.

  • View in gallery
    Figure 2.

    Gram-staining image of positive blood culture showing filamentous fungi. This figure appears in color at www.ajtmh.org.

  • 1.

    Vanittanakom N, Cooper CR Jr , Fisher MC, Sirisanthana T , 2006. Penicillium marneffei infection and recent advances in the epidemiology and molecular biology aspects. Clin Microbiol Rev 19: 95110.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Duong TA , 1996. Infection due to Penicillium marneffei, an emerging pathogen: review of 155 reported cases. Clin Infect Dis 23: 125130.

  • 3.

    Hong GH, Ortega-Villa AM, Hunsberger S, Chetchotisakd P, Anunnatsiri S, Mootsikapun P, Rosen LB, Zerbe CS, Holland SM , 2020. Natural history and evolution of anti-interferon-γ autoantibody-associated immunodeficiency syndrome in Thailand and the United States. Clin Infect Dis 71: 5362.

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    • Search Google Scholar
    • Export Citation
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Talaromyces marneffei Detected in the Peripheral Blood Smear of an Individual Without Known Immunocompromise

Hirokazu KurodaDepartment of Infectious Diseases, Kobe City Medical Center General Hospital, Kobe, Japan

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Hiroaki NishiokaDepartment of Infectious Diseases, Kobe City Medical Center General Hospital, Kobe, Japan

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A 24-year-old Vietnamese man suffering from fever along with bloody sputum for the past week and with a 4-month history of productive cough was admitted to our hospital. He has been studying in Japan for 2 years, but had visited Vietnam for 2 weeks, approximately 7 months ago. On admission, a computed tomography scan of the chest demonstrated bilateral, scattered lung infiltrates. Moreover, his May-Grünwald-Giemsa–stained peripheral blood smear exhibited oval, yeast-like organisms with a clearly defined central septum within the cytoplasm of a neutrophil (Figure 1). The sputum examinations on admission were negative for acid-fast bacilli smear and polymerase chain reaction assay of Mycobacterium tuberculosis and Mycobacterium avium complex. Therefore, we suspected disseminated Talaromyces marneffei infection and started him on liposomal amphotericin B therapy at 5 mg/kg daily. On the following day, we received reports of the blood cultures obtained on the day of admission, which confirmed the presence of filamentous fungi (Figure 2); 3 days later, these were identified as T. marneffei. Post-admission, his condition deteriorated rapidly, and he developed multiple organ failure, which was further complicated by hospital-acquired pneumonia and bacteremia caused by Enterobacter cloacae and Klebsiella pneumoniae. Despite aggressive treatment in the intensive care unit, he died on the eleventh day after hospitalization. Incidentally, there was no evidence of immunodeficiency diseases, including negative HIV serology, normal lymphocyte count, and normal immunoglobulin levels, in the investigations performed during the hospitalization period. Autoantibodies to interferon gamma were not involved in our investigation because they were commercially unavailable in Japan.

Figure 1.
Figure 1.

May-Grünwald-Giemsa–stained peripheral blood smear showing oval, yeast-like organisms within the cytoplasm of a neutrophil. This figure appears in color at www.ajtmh.org.

Citation: The American Journal of Tropical Medicine and Hygiene 106, 6; 10.4269/ajtmh.21-1278

Figure 2.
Figure 2.

Gram-staining image of positive blood culture showing filamentous fungi. This figure appears in color at www.ajtmh.org.

Citation: The American Journal of Tropical Medicine and Hygiene 106, 6; 10.4269/ajtmh.21-1278

Talaromyces marneffei, formerly known as Penicillium marneffei, causes a fatal fungal infection, particularly in immunocompromised patients, such as those with HIV infection, and it is endemic to Southeast Asia and other tropical areas of Asia.1 However, it is extremely rare to find this fungal pathogen causing disseminated infection in immunocompetent patients.2 Anti-interferon-gamma autoantibody-associated immunodeficiency syndrome is a rare but one of the acquired immunodeficiency diseases associated with T. marneffei infection in Southeast Asia.3 Therefore, autoantibodies to interferon gamma as well as HIV serology should be investigated in the infected patients with no history of immunodeficiency diseases, if possible. In conclusion, as observed in this patient, a microscopic examination of peripheral blood smears, accompanied with a history of staying in endemic areas, may be useful for early presumptive diagnosis and subsequent treatment of disseminated T. marneffei infection, even in patients without preexisting immunocompromised conditions.

ACKNOWLEDGMENTS

We would like to thank Editage (www.editage.com) for English language editing.

REFERENCES

  • 1.

    Vanittanakom N, Cooper CR Jr , Fisher MC, Sirisanthana T , 2006. Penicillium marneffei infection and recent advances in the epidemiology and molecular biology aspects. Clin Microbiol Rev 19: 95110.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Duong TA , 1996. Infection due to Penicillium marneffei, an emerging pathogen: review of 155 reported cases. Clin Infect Dis 23: 125130.

  • 3.

    Hong GH, Ortega-Villa AM, Hunsberger S, Chetchotisakd P, Anunnatsiri S, Mootsikapun P, Rosen LB, Zerbe CS, Holland SM , 2020. Natural history and evolution of anti-interferon-γ autoantibody-associated immunodeficiency syndrome in Thailand and the United States. Clin Infect Dis 71: 5362.

    • Crossref
    • Search Google Scholar
    • Export Citation

Author Notes

Address correspondence to Hirokazu Kuroda, Department of Infectious Diseases, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo 650-0047, Japan. E-mail: hrkz1985@gmail.com

Disclosure: Informed consent was obtained from the concerned patient for publication of this case report.

Authors’ addresses: Hirokazu Kuroda and Hiroaki Nishioka, Department of Infectious Diseases, Kobe City Medical Center General Hospital, Kobe, Japan, E-mails: hrkz1985@gmail.com and nishiokahiroaki@hotmail.com.

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