Metagenomic Next-Generation Sequencing Improves Detection Rate of Talaromyces marneffei Infection in Clinically Immunocompetent Patients

Objective : The incidence of Talaromyces marneffei infection has been increasing annually. However, due to its nonspecific clinical manifestations, diagnosis is often delayed, adversely affecting patient prognosis. This study aims to enhance clinicians' awareness of this disease and improve its timely diagnosis. Methods : We retrospectively analyzed the clinical data of 14 patients diagnosed with Talaromyces marneffei infection at Taizhou Hospital in Zhejiang Province from January 1, 2003, to December 31, 2014. Data included clinical features, laboratory findings, pathogen detection methods, detection rates, and prognosis. Results : A total of 14 patients were confirmed with Talaromyces marneffei infection via microbiological diagnosis, including 11 males and 3 females, with a median age of 52 years. Half of the patients (7 cases) were HIV-positive. Clinically, 10 patients presented with infectious fever, 12 had significant cough and sputum production, and 8 exhibited superficial lymphadenopathy upon physical examination. The detection rate of metagenomic next-generation sequencing (mNGS) was 100% regardless of sample type (blood, sputum, or bronchoalveolar lavage fluid [BALF]). In contrast, the positive rates of blood culture, sputum culture, and BALF culture were only 26.67%, 7.14%, and 37.50%, respectively. We divided the 14 patients into two groups: culture-positive and mNGS-positive (culture-negative). Comparative analysis revealed that the culture-positive group had significantly lower CD4 counts than the mNGS-positive group (*p* < 0.05). Conclusion : Talaromyces marneffei infection should be suspected in patients with pulmonary infection presenting with fever, cough, and lymphadenopathy. Conventional culture methods often fail to detect the infection in patients without significant CD4 count reduction, whereas NGS enables timely diagnosis.