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

## TL;DR

This study compares how talaromycosis affects HIV patients and those with anti-interferon-gamma autoantibodies, highlighting differences in symptoms and outcomes.

## Contribution

The study identifies distinct clinical features of talaromycosis in patients with anti-IFN-γ autoantibodies compared to HIV/AIDS patients.

## Key findings

- Patients with anti-IFN-γ autoantibodies had more skin and subcutaneous lesions and bone/joint infections.
- PWHA showed more constitutional symptoms and umbilicated skin lesions.
- Mortality rates were not significantly different between the two groups.

## Abstract

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).

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.

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).

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.

Talaromycosis, caused by Talaromyces marneffei, is an opportunistic fungal infection in people with a weakened immune system. The number of cases increased immediately after the HIV epidemic. HIV infection weakens the immune system by destroying CD4 + T cells, which are among the most important components of the immune system to protect against T. marneffei. However, with the introduction of antiretroviral therapy, the number of cases in people with HIV/AIDS (PWHA) has declined. Recently, we have found a group of patients whose immune system is weakened by autoantibodies against interferon-gamma. In these patients, CD4 + T cells are normal, but the cytokine cascade cannot fight the fungus due to antibodies against interferon-gamma (anti-IFN- γ AAbs), a major cytokine in the proinflammatory cytokine cascade. In this study, the clinical features of talaromycosis were compared between PWHA and patients with anti-IFN- γ AAbs. We found that patients with anti-IFN- γ AAbs had more diverse types of skin and subcutaneous lesions including macule, papules, nodules, abscesses, and Sweet’s syndrome, as well as bone and joint infections, while PWHA were more likely to have constitutional symptoms, cough, dyspnea, diarrhea, splenomegaly, and umbilicated skin papules. Our paper highlights the different clinical characteristics of talaromycosis in these two populations.