Pharmaceutical care for the HIV-negative patient with disseminated Talaromyces marneffei osteomyelitis complicated by pulmonary tuberculosis
- VernacularTitle:HIV阴性播散型马尔尼菲篮状菌骨髓炎合并肺结核患者的药学监护
- Author:
Qinghua ZHANG
1
;
Liting HE
1
Author Information
1. Dept. of Pharmacy，Jiangmen Central Hospital，Guangdong Jiangmen 529000，China
- Publication Type:Journal Article
- Keywords:
Talaromyces marneffei;
amphotericin B cholesteryl sulfate complex;
suppurative osteomyelitis;
pulmonary
- From:
China Pharmacy
2025;36(16):2062-2066
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To provide references for pharmaceutical care in the anti-infective treatment of disseminated Talaromyces marneffei （TM）osteomyelitis complicated with pulmonary tuberculosis in a human immunodeficiency virus （HIV）-negative patient. METHODS Clinical pharmacists participated in the entire treatment process of a HIV-negative patient with disseminated TM osteomyelitis complicated by pulmonary tuberculosis. The pharmacist assisted the clinician in formulating an individualized treatment plan and improving the diagnosis based on the patient’s clinical symptoms， signs， laboratory tests， and imaging findings. Recommendations included the use of amphotericin B cholesteryl sulfate complex for antifungal therapy， the completion of a tuberculin skin test and sputum acid-fast bacilli test. The pharmacist monitored the patient’s clinical manifestations and laboratory results in real time. Upon timely detection of hypokalemia in the patient， after analyzing the causes， oral and then intravenous potassium supplementation was sequentially recommended， along with adjustments to the treatment plan （switching to itraconazole and combining it with a four-drug antituberculosis regimen of isoniazid+rifampicin+pyrazinamide+ethambutol）. Meanwhile， monitoring of itraconazole blood concentration was also advised. Additionally， the clinical pharmacist closely monitored the patient’s medication adherence and provided medication education. RESULTS The clinicians accepted the clinical pharmacist’s recommendations. The patient improved after treatment and was discharged. One-year follow-up showed that the patient was cured without adverse reactions. CONCLUSIONS Amphotericin B cholesteryl sulfate complex is an effective therapeutic agent for disseminated TM osteomyelitis in HIV-negative patients. Prolonging the course of treatment can prevent recurrence. During therapy， clinical pharmacists should strengthen pharmaceutical care as well as provide medication and health education to ensure patient safety.
