Indian Journal of Critical Care Case Report

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VOLUME 3 , ISSUE 3 ( May-June, 2024 ) > List of Articles


A First Case Report of Talaromyces marneffei Infection in a Person with Immunocompromised Rheumatoid Arthritis and Non-HIV Diabetes in South India

Faris Hussain, Namitha Raveendranath, Shihabudheen Pichen, Ashique Eradiparambath, Nidhi Raghuram, Joshua John, Muneer Thari

Keywords : Acquired immunodeficiency syndrome, Diabetes mellitus, Itraconazole, Rheumatoid arthritis, Talaromycosis, Talaromyces marneffei

Citation Information : Hussain F, Raveendranath N, Pichen S, Eradiparambath A, Raghuram N, John J, Thari M. A First Case Report of Talaromyces marneffei Infection in a Person with Immunocompromised Rheumatoid Arthritis and Non-HIV Diabetes in South India. 2024; 3 (3):64-67.

DOI: 10.5005/jp-journals-11006-0111

License: CC BY-NC 4.0

Published Online: 03-05-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Talaromycosis is a fungal infection caused by Talaromyces marneffei. The infection was formerly known as penicilliosis. It is the only penicillin species with a dimorphic character and causes systemic mycosis infections in humans. This infection commonly happens in immunocompromised individuals, especially those who are infected with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) or any other immunodeficiency state. The symptoms associated with T. marneffei include fever, weight loss, cough, breathing difficulty, abdominal pain, diarrhea, swollen lymph nodes, and general discomfort. The clinical manifestations impacted by T. marneffei can vary from mild skin lesions to circulatory collapse or respiratory failure. The lungs, liver, and mouth are frequently impacted by talaromycosis in persons who do not have HIV, while it can occasionally spread through the blood and affect the entire body. Here is a case of 70-year-old female patient who had a history of rheumatoid arthritis on steroids, diabetes and hypertension with a recent past history of community-acquired pneumonia treated with intravenous antibiotics from a local hospital. Despite being on appropriate broad-spectrum antibiotics, her condition deteriorated, and she was referred here. On admission, she was in sepsis, and she remained sick in spite of being on carbapenems and azithromycin. As she was an immunocompromised host, partial response to initial empiric therapy was considered early transbronchial lung biopsy, which revealed T. marneffei species. She was started on itraconazole oral therapy, to which she responded well and was later discharged. Unfortunately, she got re-admitted on the 25th day with type 1 respiratory failure and shock. The possibility of hospital-acquired infection was considered, and all higher antibiotics, including polymyxin and vancomycin, were initiated in addition to itraconazole therapy and plain amphotericin B as an add-on antifungal therapy; could not revive the patient, and she passed away. This case demonstrates the possibility of T. marneffei infection in any immunocompromised host rather than the fact of its occurrence only in HIV patients and the high mortality associated with it even with reasonable good critical care support.

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