Analysis of two fatal cases of AIDS complicated with Talaromyces marneffei infection

^{Zhiwei Liu1, Bingbin He2, Yuncheng Li1, Zhiwen Chu3*}

¹Infectious Diseases Department of The Sixth People's Hospital of Huizhou, Huizhou, Guangdong.

²Respiratory Department of The Sixth People's Hospital of Huizhou, Huizhou, Guangdong.

³General Practice Department, The Sixth People's Hospital of Huizhou, Huizhou, Guangdong.

*Correspondence:

Zhiwen Chu; Email: yxychuzhiwen@163.com

Abstract

Background Talaromyces marneffei infection combined with acquired immunodeficiency syndrome(AIDS) has a high mortality rate. This article presents two cases of sudden death from AIDS complicated by Talaromyces marneffei septicemia.

Case presentation Both patients were diagnosed with AIDS complicated by Talaromyces marneffei infection, with CD4⁺ T-lymphocyte counts of 1 cell/μL (Case A) and 63.72 cells/μL (Case B), respectively. Both cases exhibited varying degrees of elevated liver enzymes, hypoalbuminemia, and increased procalcitonin (PCT) as well as hypersensitive C-reactive protein (hs-CRP) levels.Following admission, both received comprehensive treatment regimens including antiretroviral therapy, anti-bacterial agents, anti-fungal agents, and prophylaxis against Pneumocystis jirovecii pneumonia. The cause of death in Case A may be attributed to Talaromyces marneffei septicemia complicated by meningitis and cerebral hernia. In Case B, the cause of death may be multifactorial, involving adrenal insufficiency, T. marneffei septicemia, electrolyte imbalance, and pulmonary infection.

Conclusion HIV patients with CD4⁺ counts < 100 cells/μL require close monitoring to enable the early identification of warning signs of Talaromyces marneffei infection and prompt intervention, thereby reducing the risk of sudden death. For HIV patients presenting with any combination of "fever + rash/elevated liver enzymes/electrolyte imbalance/altered consciousness" (especially those with CD4⁺ < 100 cells/μL), immediate screening for T. marneffei, empirical antifungal therapy, and comprehensive organ function monitoring are essential. This approach is the key to mitigating the risk of sudden death.

Keywords: AIDS, talaromyces marneffei, septicemia, sudden death