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Talaromyces marneffei endocarditis initially detected by Next Generation Sequencing: A case report
Youqi Ji1, Bingqian Zhuo2, Tao Jiang3
1School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China; Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, China.
Background:
Talaromyces marneffei (T. marneffei) is a thermal dimorphic fungus, which can cause lung or blood stream infection in patients, often life-threatening. However, endocarditis caused by T. marneffei has not been reported. For elderly patients with implanted cardiac devices or artificial valves, the prevention and treatment of infective endocarditis should not be ignored.
Methods:
This is a descriptive study of a T. marneffei endocarditis by joint detection of cardiac ultrasound examination, peripheral blood DNA metagenomics Next Generation Sequencing (mNGS), and in vitro culture.
Results:
We describe an 80-year-old female patient with an unusual infection of T. marneffei endocarditis. After intravenous drip of 0.2 g voriconazole twice a day for antifungal treatment, the patient showed no signs of improvement and their family refused further treatment.
Conclusion:
Infective endocarditis is becoming more and more common in the elderly due to the widely use of invasive surgical procedures and implantation of intracardiac devices. The diagnosis and treatment of T. marneffei endocarditis is challenging because of its rarity. Here, we discussed a case of T. marneffei endocarditis, and emphasized the role of mNGS in early diagnosis, which is of great significance for treatment and survival rate of patients.
Insights
Talaromyces marneffei endocarditis is a rare but serious infection, particularly in elderly patients with cardiac devices. Metagenomic Next-Generation Sequencing (mNGS) aids in early diagnosis, crucial for improving patient outcomes.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Cardiology
Background:
- Talaromyces marneffei (T. marneffei) is a thermally dimorphic fungus causing life-threatening infections like lung and bloodstream infections.
- Endocarditis caused by T. marneffei is exceptionally rare and poses a significant risk to elderly patients with cardiac implants.
- The increasing prevalence of invasive cardiac procedures necessitates attention to infective endocarditis prevention and treatment.
Observation:
- A case study details an 80-year-old female patient diagnosed with Talaromyces marneffei endocarditis.
- The patient received intravenous voriconazole for antifungal treatment without clinical improvement.
- The family opted to forgo further medical intervention.
Findings:
- Metagenomics Next-Generation Sequencing (mNGS) combined with cardiac ultrasound and in vitro culture was employed for diagnosis.
- T. marneffei endocarditis presents diagnostic and therapeutic challenges due to its rarity.
- Early diagnosis through mNGS is critical for effective management.
Implications:
- This case highlights the importance of considering rare fungal pathogens in endocarditis, especially in vulnerable populations.
- Metagenomic Next-Generation Sequencing (mNGS) offers a valuable tool for the early and accurate diagnosis of T. marneffei endocarditis.
- Improved diagnostic strategies can significantly impact treatment decisions and enhance patient survival rates.
