Absence of cutaneous involvement in disseminated Talaromyces marneffei infection in an AIDS patient: a case report and literature review.

BACKGROUND: Talaromyces marneffei (T. marneffei) is an important opportunistic pathogen found in human immunodeficiency virus-positive individuals in Southeast Asia, Southern China, and Northeastern India. Patients with disseminated talaromycosis commonly develop multi-organ involvement including the skin. In this report, we describe the clinical presentation, investigation, management, and clinical outcome of an acquired immune deficiency syndrome (AIDS) patient with newly diagnosed disseminated talaromycosis without skin involvement. CASE PRESENTATION: A 27-year-old male with AIDS presented with acute onset of abdominal pain for 4 days and fever for 2 days. He had been diagnosed with AIDS, pneumocystis pneumonia, and presumptive smear-negative pulmonary tuberculosis 2 months previously. His initial CD4 count was 91 cells/mm3. After a 3-week course of trimethoprim/sulfamethoxazole and anti-tuberculosis treatment, anti-retroviral therapy was initiated. Physical examination revealed left upper quadrant tenderness but no abnormal skin lesions. On this visit, his CD4 count rose to 272 cells/mm3 (19%). Computed tomography of the abdomen showed evidence of a small hypodense lesion with a thin enhancing rim at the spleen and extensive intra-abdominal lymphadenopathy. Empirical amphotericin B deoxycholate was administered in response to positive serum galactomannan, although this was switched to intravenous liposomal amphotericin B 1 week later because of acute kidney injury. Blood and bone marrow cultures for fungus grew T. marneffei on days 9 and 12, respectively. After 21 days of treatment, oral itraconazole replaced intravenous therapy. The patient was discharged home after 29 days in the hospital and continued to improve clinically at a follow-up visit as an outpatient. CONCLUSION: Talaromycosis is a fairly common opportunistic infection among AIDS patients in Thailand, despite a rise in CD4 count which may reflect a change in immune status. To a lesser extent, a systemic disease without skin involvement can be expected in real clinical practice.

Prediction Model of Pre-treatment HIV RNA Levels in Naïve Thai HIV-infected Patients: Application for Resource-limited Settings.

A prediction model for pretreatment HIV RNA level ≤100,000 copies/ml would provide a useful tool for selection of abacavir (ABC) or rilpivirine (RPV) in the first-line regimen in a resource-limited setting. Factors associated with pre-treatment HIV RNA ≤100,000 copies/ml were determined from a cohort of 1,223 patients divided into a derivation (n = 873) and the remaining in a validation group. Their median [interquartile range (IQR)] age was 36.3 (30.5-42.9) years, CD4 count 122 (39-216) cells/mm3 and pre-treatment HIV RNA level 100,000 (32,449-229,777) copies/ml. Factors associated with pretreatment HIV RNA ≤100,000 copies/ml were non-anemia [odds ratio (OR)= 2.05; 95% confidence interval (CI): 1.28-3.27, p= 0.003], CD4 count ≥200 cells/mm3 (OR= 3.00; 95% CI: 2.08-4.33, p<0.001) and non-heterosexual HIV exposure (OR= 1.61; 95% CI: 1.07-2.43, p= 0.021). The area under a receiver operating characteristic curve was 0.66 (95% CI: 0.62-0.69), but specificity was 97.3%. The prediction model identified a set of readily available clinical data but lacked the requisite predictive performance to fulfill its purpose.