Clinical Characteristics of HIV-Associated Tracheobronchial Talaromyces marneffei Infection in Seven Patients in Guangxi, China

Abstract Objectives: Tracheobronchial Talaromyces marneffei (TM) infections among HIV-infected patients are rare. To improve understanding, we analysed the clinical features, immune mechanisms, treatment, and prognosis. Methods: We collected clinical information from patients with talaromycosis admitted to the Fourth People’s Hospital of Nanning from January 2015 to June 2022 and retrospectively analyzed their clinical characteristics and prognosis. Results: HIV-positive patients (n = 1567) were enrolled. Of seven patients with tracheobronchial T. marneffei infection were all men with a median age of 48 years (range 39–50 years). Cough, sputum, fever, and weight loss were the most common symptoms. The total white blood cell count was normal or decreased, and all lymphocyte counts decreased. All patients had reduced CD4⁺ T-cell counts, below 50 cells/μL. Chest CT imaging signs included patchy signals or large areas of exudation. Endoscopically, the trachea and bronchial mucosa showed congestion, edema, surface attachment, nodules, lumen stenosis, obstruction, etc. T. marneffei spores were found on bronchial mucosal pathology in all 7 cases. Five patients were initially treated with intravenous infusion of amphotericin B for 2 weeks, followed by oral itraconazole capsules (200 mg) twice daily, and two patients were initially treated with itraconazole. Four patients were cured, 2 improved, and 1 died. Conclusions: It is suggested that bronchoscopy should be performed in HIV-positive patients with pulmonary lesions to improve the diagnostic rate of tracheobronchial T. marneffei.