Clinical features of talaromycosis in people living with HIV/AIDS (PWHA) and patients with anti-interferon-γ autoantibodies.

IF 3.4 2区医学 Q1 PARASITOLOGY

PLoS Neglected Tropical Diseases Pub Date : 2025-05-09 eCollection Date: 2025-05-01 DOI:10.1371/journal.pntd.0012992

Kawisara Krasaewes, Narootchai Patanadamrongchai, Quanhathai Kaewpoowat, Jiraprapa Wipasa, Saowaluck Yasri, Antika Wongthanee, Romanee Chaiwarith

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Abstract

Background: Talaromycosis is increasingly reported in HIV-uninfected, immunocompromised individuals in an endemic area. The aim of this study was to compare the characteristics and mortality associated with talaromycosis in adult immunocompromised individuals caused by the anti-interferon-gamma autoantibody (anti-IFN- γ AAb) with those of people living with HIV/AIDS (PWHA).

Methods: A retrospective cohort study was conducted at Maharaj Nakorn Chiang Mai Hospital, Thailand, in adults with confirmed HIV infection or anti-IFN- γ-AAbs diagnosed with talaromycosis.

Results: Thirty-two patients with anti-IFN- γ-AAbs and 235 PWHA were included. Patients with anti-IFN- γ-AAbs were older and more likely to have comorbidities. PWHA were more likely to have constitutional symptoms, cough, dyspnea, diarrhea, splenomegaly, umbilicated skin lesions, abnormal chest radiographs, and fungemia. Patients with anti-IFN- γ-AAbs were more likely to have skin lesions such as macule/papules/nodules, abscesses and Sweet's syndrome, as well as bone and joint infections and higher white blood cell counts. The time from first symptom to treatment was longer in patients with anti-IFN- γ-AAbs (44.5 days vs. 30.0 days, p-value = 0.049). The 24-week mortality rate was 9.4% (3 patients) in patients with anti-IFN- γ-AAbs and 15.3% (36 patients) in PWHA (p-value = 0.372).

Conclusions: The clinical features of talaromycosis in patients with anti-IFN- γ-AAbs differed from PWHA. Clinicians in areas where talaromycosis is endemic should be aware of the different features of talaromycosis in patients with anti-IFN- γ AAbs.

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HIV/AIDS （PWHA）患者和抗干扰素-γ自身抗体患者talaromyosis的临床特征

背景：在流行地区，越来越多的hiv未感染、免疫功能低下的个体报告了塔拉香菌病。本研究的目的是比较由抗干扰素- γ自身抗体（抗ifn - γ AAb）引起的成人免疫功能低下个体与艾滋病毒/艾滋病（PWHA）感染者的特征和死亡率。方法：在泰国清迈Maharaj Nakorn医院进行了一项回顾性队列研究，研究对象是确诊为HIV感染或抗ifn - γ-抗体诊断为talaromysis的成年人。结果：共纳入32例抗ifn - γ-抗体患者和235例PWHA患者。抗ifn - γ-自身抗体的患者年龄更大，更容易出现合并症。PWHA患者更有可能出现体质症状、咳嗽、呼吸困难、腹泻、脾肿大、脐部皮肤病变、胸片异常和真菌血症。抗干扰素- γ-自身抗体的患者更有可能出现皮肤病变，如斑疹/丘疹/结节、脓肿和斯威特综合征，以及骨骼和关节感染和更高的白细胞计数。抗ifn - γ-抗体组患者从首次出现症状到治疗所需时间较长（44.5天比30.0天，p值= 0.049）。抗ifn - γ-自身抗体组24周死亡率为9.4%（3例），PWHA组为15.3%（36例）（p值= 0.372）。结论：抗ifn - γ-抗体患者的临床特征与PWHA患者不同。在塔拉香菌病流行地区的临床医生应该意识到抗ifn - γ自身抗体患者的塔拉香菌病的不同特征。

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PLoS Neglected Tropical Diseases PARASITOLOGY-TROPICAL MEDICINE

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10.50%

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723

期刊介绍： PLOS Neglected Tropical Diseases publishes research devoted to the pathology, epidemiology, prevention, treatment and control of the neglected tropical diseases (NTDs), as well as relevant public policy. The NTDs are defined as a group of poverty-promoting chronic infectious diseases, which primarily occur in rural areas and poor urban areas of low-income and middle-income countries. Their impact on child health and development, pregnancy, and worker productivity, as well as their stigmatizing features limit economic stability. All aspects of these diseases are considered, including: Pathogenesis Clinical features Pharmacology and treatment Diagnosis Epidemiology Vector biology Vaccinology and prevention Demographic, ecological and social determinants Public health and policy aspects (including cost-effectiveness analyses).