Challenges in Diagnosing and Managing Disseminated Mycobacterium avium and Talaromyces marneffei Co-infection: A Case Report

Abstract

Background Mycobacterium avium (M. avium) is emerging as an opportunistic pathogen and has been grouped with the nontuberculosis mycobacteria (NTM). Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), primarily affects elderly individuals with chronic lung disease and remains one of the leading causes of death in many regions worldwide. Distinguishing between NTM infection and drug-resistant TB is challenging due to similar manifestations and resistance to conventional anti-tuberculosis therapies (ATT). Talaromyces marneffei (T. marneffei) is a pathogenic fungus causing devastating infection, primarily in immunocompromised individuals. Few reports describe disseminated co-infection of M. avium and T. marneffei in HIV-uninfected persons. Case presentation: Herein, we present a case study of an HIV-negative Chinese woman who initially presented with chronic cough, sputum production, and recurrent low-grade fever, which was initially diagnosed as TB. After three years of anti-TB treatment, her situation progressed, and she developed multiple subcutaneous abscesses throughout the body, including the brain. Subsequent bacterial culture and genetic analysis confirmed the presence of NTM specifically identified as M. avium. However, despite receiving anti-NTM treatment, it remained ineffective until co-infection with T. marneffei was eventually diagnosed. Conclusions Early utilization of genetic diagnostic methods is necessary to detect the possibility of NTM infections, especially when patients do not respond adequately to ATT. It is also crucial to remain vigilant for co-infections when the disease progresses despite ongoing anti-NTM treatment.