Clinical Characteristics, Course, and Long-Term Outcomes in Patients with Talaromyces marneffei Infection: A 10-Year Retrospective Cohort Study

Abstract

Introduction Talaromyces marneffei ( T . marneffei ), a dimorphic fungus, causes local or disseminated infection in humans. We aimed to analyze the clinical characteristics, prognostic factors, and survival outcomes of patients with T . marneffei infection and compare the differences between human immunodeficiency virus (HIV)-positive and HIV-negative subgroups. Methods We retrospectively analyzed 241 patients with T . marneffei infection at the First Affiliated Hospital of Guangxi Medical University between January 2012 and January 2022. The overall population was stratified into HIV-positive ( n = 98) and HIV-negative ( n = 143) groups according to HIV status. Kaplan–Meier analysis and multivariate Cox regression models were used to determine the prognostic factors for overall survival (OS) and progression-free survival (PFS). Results With a median follow-up time of 58.9 months, 120 patients (49.8%) experienced disease progression and 85 patients (70.8%) died. The 5-year rates of OS and PFS were 61.4% (95% CI 55.0–68.6%) and 47.8% (95% CI 41.5–55.1%), respectively. As an independent factor, patients who were HIV positive had better PFS (HR 0.50, 95% CI 0.31–0.82; p < 0.01) than patients who were HIV negative. Compared with patients who were HIV positive, patients who were HIV negative were older and had more probabilities of underlying diseases, chest involvement, bone destruction, and higher count of neutrophils (all p < 0.05). Hemoglobin (PFS: HR 0.62; 95% CI 0.39–1.00; p < 0.05; OS: HR 0.45; 95% CI 0.22–0.89; p = 0.02) and lymphocyte count (PFS: HR 0.06; 95% CI 0.01–0.26; p < 0.01; OS: HR 0.08; 95% CI 0.01–0.40; p < 0.01) were independent prognostic factors for PFS and OS in patients who were HIV negative. Conclusions Patients with T . marneffei infection have a poor prognosis. Patients who are HIV positive and HIV negative have relatively independent clinical characteristics. Multiple organ involvement and disease progression are more common in patients who are HIV negative. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-023-00801-5.

HIV-Negative Case of Talaromyces marneffei Pulmonary Infection with Liver Cirrhosis in China: A Case Report and Literature Review

“…A 10-year retrospective cohort study showed that HIV-negative patients with TM infection have greater neutrophil counts, more organ damage and greater mortality than HIV-positive patients. 7 This patient had only one lung lesion that did not spread to other organs. The infection is more prevalent in Guangxi Province and Guangdong Province in mainland China, and respiratory signs, fever, lymphadenopathy, skin lesions, anemia, and hepatosplenomegaly are the primary clinical manifestations of TM infections in HIV-negative adults.…”

Secondary hemophagocytic syndrome in an acquired immunodeficiency syndrome and Alpha-thalassemia patient infected with Talaromyces marneffei: A case report and literature review

“…The 3-year progression-free survival (PFS) rate and overall survival (OS) rates were 69.1% and 71.2% in patients co-infected with HIV and T. marneffei ，respectively. Prognosis may be associated with prothrombin time and combination anti-fungal therapy with AMB and triazoles [16] . Among HIV patients with bloodstream infection caused by T. marneffei , those with CD8 count < 200/μl had a 12.6-fold increased risk of poor prognosis, while those with whole blood BDG < 100 pg/mL had a 34.9-fold increased risk [17] .…”