Clinical Characteristics, Management, and Outcomes of Patients Living with HIV and Coinfected with Talaromyces marneffei and Cryptococcus: A Retrospective Case Series

Background: Talaromycosis and Cryptococcosis are life-threatening opportunistic infections that occur in severely immunocompromised individuals. However, data on the clinical characteristics, management, and outcomes of patients with concurrent Talaromyces marneffei and Cryptococcus infections are limited. Methods: We performed a retrospective review of the electronic medical records of patients living with human immunodeficiency virus (PLHIV) who were diagnosed with concurrent Talaromyces marneffei and Cryptococcus infection between January 2013 and December 2023. Risk factors for poor outcomes were determined through univariate and multivariate analyses. Results: Most patients were male (72.3%) with advanced immunosuppression (median CD4 count: 15 cells/μL). Constitutional symptoms (91.5%) were most common, followed by gastrointestinal (55.3%) and respiratory symptoms (53.2%). Blood cryptococcal antigen testing was the most frequent method for detecting Cryptococcus in co-infected patients. The overall mortality rate was 29.8%. Cerebrospinal fluid (CSF) lactate dehydrogenase (LDH) > 21.15 U/L was identified as an independent predictor of mortality (OR = 13.1, 95% CI: 1.27– 135.76, p = 0.031). Conclusion: Co-infection with T. marneffei and Cryptococcus in HIV patients is associated with nonspecific clinical presentations and high mortality. Elevated CSF LDH levels, particularly CSF LDH levels > 21.15 U/L, are a significant risk factor for death. Early cryptococcal antigen screening and prompt antifungal therapy are crucial for improving outcomes in this population. Keywords: Talaromyces marneffei , Cryptococcus , coinfection, fungal infection, HIV