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Case Reports
. 2024 Oct 10;189(6):91.
doi: 10.1007/s11046-024-00898-3.

Emergence and Rapid Diagnosis of Talaromyces marneffei Infections in Renal Transplant Recipients by Next-Generation Sequencing

Fanfan Xing  1 , Chaowen Deng  1 , Shan Zou  2 , Chi-Ching Tsang  3 , Simon K F Lo  1 , Susanna K P Lau  4 , Patrick C Y Woo  5   6   7
Affiliations
Case Reports

Emergence and Rapid Diagnosis of Talaromyces marneffei Infections in Renal Transplant Recipients by Next-Generation Sequencing

Fanfan Xing et al. Mycopathologia. .

Abstract

In the last few years, next-generation sequencing (NGS) has emerged as a technology for laboratory diagnosis of many culture-negative infections and slow-growing microorganisms. In this study, we describe the use of metagenomic NGS (mNGS) for rapid diagnosis of T. marneffei infection in a 37-year-old renal transplant recipient who presented with chronic pneumonia syndrome. Bronchoalveolar lavage for mNGS was positive for T. marneffei sequence reads. Prolonged incubation of the bronchoalveolar lavage revealed T. marneffei colonies after 6 days of incubation. Analysis of 23 cases of T. marneffei infections in renal transplant recipients from the literature revealed that the number of cases ranged from 1 to 4 cases per five years from 1990 to 2020; but increased rapidly to 9 cases from 2021 to 2023, with 7 of them diagnosed by NGS. Twenty of the 23 cases were from T. marneffei-endemic areas [southern part of mainland China (n = 9); Hong Kong (n = 4); northeastern India (n = 2); Indonesia (n = 1) and Taiwan (n = 4)]. For the 3 patients from non-T. marneffei-endemic areas [United Kingdom (n = 2) and Australia (n = 1)], they had travel histories to China and Vietnam respectively. The time taken for diagnosis by mNGS [median 1 (range 1 to 2) day] was significantly shorter than that for fungal culture [median 6 (range 3 to 15) days] (P = 0.002). mNGS is useful for picking up more cases of T. marneffei infections in renal transplant recipients as well as providing a rapid diagnosis. Talaromycosis is an emerging fungal infection in renal transplant recipients.

Keywords: Talaromyces marneffei; Next-generation sequencing; Rapid diagnosis; Renal transplant.

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Conflict of interest statement

Patrick C. Y. Woo has provided scientific advisory/laboratory services for Gilead Sciences, Incorporated; International Health Management Associates, Incorporated; Merck & Corporation, Incorporated; Micología Molecular S.L. and Pfizer, Incorporated. The funding sources had no role in study design, data collection, analysis, interpretation, or writing of the report. The authors alone are responsible for the content and the writing of the manuscript. The other authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
Clinical and radiological assessment of the index patient. Panel A: Clinical photo on admission, showing subcutaneous nodules on left chest wall and crusting due to healing herpes zoster. Panel B: Thoracic computerized tomography (CT) on admission, showing multiple patchy infiltrates and consolidation with air bronchograms in both lungs and bilateral pleural effusion. Panel C: Mediastinum window of thoracic CT on admission, showing multiple subcutaneous nodules of low density in the left chest wall (arrow). Panel D: Thoracic CT two weeks after commencement of antifungal therapy, showing resolving lung infiltrates and consolidation, and residual pleural effusion. Panel E: Mediastinum window of thoracic CT two weeks after commencement of antifungal therapy, showing shrinking of the subcutaneous nodules in left chest wall (arrow)
Fig. 2
Fig. 2
Temporal and geographical distribution of T. marneffei infections in renal transplant recipients. Panel A: Number of reported cases of T. marneffei infections in renal transplant recipients from 1990 to 2023. Panel B: Global distribution of reported cases of T. marneffei infections in renal transplant recipients. The number of patients is depicted in different grades of purple color
Fig. 3
Fig. 3
Comparison of time taken for diagnosis of T. marneffei infection by mNGS and culture. Panel A: The 4 cases diagnosed by both mNGS and culture. Panel B: The 6 cases diagnosed by mNGS and the 7 cases diagnosed only by culture
See this image and copyright information in PMC

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