Talaromyces marneffei Infection May Be More Severe in HIV-Negative Patients

The clinical presentation of Talaromyces marneffei infection differs significantly on the basis of HIV status, according to results of a study published in International Journal of Infectious Diseases.

The opportunistic fungal pathogen T marneffei more commonly infects immunocompromised hosts. As the use of immunosuppressive drugs becomes more common, more HIV-negative patients may be at risk for T marneffei infection.

This retrospective study was designed to evaluate differences in the clinical presentation of T marneffei infection among HIV-positive and HIV-negative patients. Patients (N=848) included in the analysis were diagnosed with T marneffei infection at 4 sites in China between 2018 and 2021. Characteristics and outcomes of the infection were evaluated on the basis of HIV status.

Among patients with (n=744) and without (n=104) HIV infection, the median ages were 42 (IQR, 33.0-52.0) and 51 (IQR, 39.5-59.3) years (P <.001), and 82% and 64.4% were men (P <.001), respectively.

The time between T marneffei diagnosis and symptom onset was significantly increased among patients with vs without HIV infection (median, 36.0 vs 137.5 days; P <.001).

The clinical presentation of T marneffei infection differed significantly between the groups, with lower rates of cough (66.9% vs 85.1%; P <.001), expectoration (53.6% vs 71.3%; P <.001), angina (5.4% vs 21.8%; P <.001), gasping (16.3% vs 41.0%; P <.001), lymphadenopathy (2.0% vs 51.0%; P <.001), and bone pain (0.7% vs 20.5%; P <.001) observed among HIV-negative patients. Of note, fever was more commonly observed among HIV-positive patients (89.4% vs 76.4%; P <.001).

Results of laboratory studies also differed significantly on the basis of HIV status. Patients without HIV infection were more likely to have higher leukocyte counts and higher neutrophil, lymphocyte, platelet, hemoglobin, eosinophil, albumin, erythrocyte sedimentation rate, C-reactive protein, CD4, and CD8 levels (all P £.002).

For HIV-positive patients, the most common coinfections included Candida pathogens (14.0%), tuberculosis (TB; 7.8%), cytomegalovirus (6.6%), Pneumocystis jirovecii (4.7%), and nontuberculous mycobacteria (3.6%). For HIV-negative patients, the most common coinfections included TB (26.9%), Epstein‒Barr virus (3.84%), and nontuberculous mycobacteria (2.9%).

A total of 105 patients died, of whom the majority were in the HIV-positive group (89.5%). Persistent T marneffei infection was more common among HIV-negative (n=3) vs HIV-positive (n=2) patients. Of 703 patients who achieved complete or partial symptom improvement following antimicrobial treatment, the majority were in the HIV-positive group (88.7%).

Study limitations include the retrospective design and insufficient data.

“As a potentially life-threatening pathogen, TM [T marneffei] deserves more investigation, not only in HIV-positive patients but also in HIV-negative patients,” the researchers concluded.