Prognosis of Patients Infected With Talaromyces marneffei Across Various Risk Factors.

BACKGROUND: Talaromyces marneffei (TM) is an opportunistic infectious fungus, and more patients in HIV-negative populations are infected with TM. METHODS: We reviewed the adult patients with TM infections (TMIs) between November 1, 2020 and April 30, 2025. This single-center retrospective study was conducted at a tertiary care hospital located in an urban area, eastern China. Patients with TMI were divided into the following four groups: the HIV group, the non-HIV with solid organ transplant (SOT) group, the non-HIV with stem cell transplantation (SCT) group, and the non-HIV with other factors group. RESULTS: There were a total of 218 cases of talaromycosis: 165 in the HIV group, 16 in the non-HIV with SOT group, 4 in the non-HIV with SCT group, and 33 in the non-HIV with other factors group. The number (proportion) of patients diagnosed through metagenomic next-generation sequencing (mNGS) in the four groups was as follows: 51 (30.9%), 11 (68.8%), 2 (50.0%), and 25 (75.8%), respectively. The number (proportion) of patients who tested positive in both culture and mNGS was as follows: 19 (11.5%), 1 (6.3%), 0 (0.0%), and 1 (3.0%), respectively. Kaplan-Meier estimates indicated that the patients in the non-HIV with SCT group had the worst prognosis and those in the non-HIV with other factors group had poorer prognosis than the patients in the HIV group. CONCLUSIONS: TMI in patients who are HIV-negative without SOT may have poorer prognosis. If talaromycosis is suspected, mNGS can be an important supplementary tool for confirming TMI.