Clinical features of Talaromyces marneffei infection in HIV-positive and HIV-negative individuals: a retrospective study in southern China.

Talaromyces marneffei (TSM) is a temperature-dependent dimorphic fungus endemic to Southeast Asia and southern China. As the number of people at risk of TSM infection continues to increase, the clinical manifestations are becoming increasingly complex, posing challenges for clinical management. In this study, we analyzed the medical records of 99 patients (71 HIV-positive and 28 HIV-negative) diagnosed with TSM infection from January 1, 2017 to December 31, 2022 in southern China and compared the clinical manifestations in HIV-positive and HIV-negative patients. Most patients (83/99, 84%) were male. The incidence of skin and soft tissue involvement (48% vs. 21%, P = 0.016); disseminated infection with blood circulation, hematopoietic, lymphatic, alimentary, or central nervous system involvement (69% vs. 36%, P = 0.002); and gastrointestinal bleeding (33% vs. 9%, P = 0.023) was higher in the HIV-positive group than the HIV-negative group. The HIV-positive group also had significantly higher alanine aminotransferase levels (31 [26-42] vs. 14 [11-16]) U/L, P < 0.001) and alanine aminotransferase/aspartate transaminase ratio (1.9 [1.5-2.2] vs. 1.3 [1.1-1.6], P = 0.006) than the HIV-negative group. The time to diagnosis (5.5 ± 1.1 vs. 5.1 ± 1.4 days, P = 0.103), antifungal regimen (P = 0.278), case fatality rate (20% vs. 21%, P = 0.849), and relapse/reinfection rate (11% vs. 19%, P = 0.576) did not differ significantly between the HIV-positive and HIV-negative groups. Poor antiretroviral therapy adherence (OR=26.19, 95%CI 3.26-210.70, P = 0.002), advanced age (OR=1.13, 95%CI 1.03-1.23, P = 0.010), and Epstein-Barr virus co-infection (OR=37.13, 95%CI 3.03-455.64, P = 0.005) were independent risk factors for all-cause mortality from TSM infection in HIV-positive patients. Overall, the predominant infection sites, clinical manifestations, and complications of TSM infection differed by HIV status. However, with prompt diagnosis and appropriate treatment, HIV-positive patients with TSM infection can have similar outcomes to HIV-negative patients.