Clinical characteristics of central nervous system talaromycosis: A comparative analysis with cryptococcal meningitis and tuberculous meningitis in patients with AIDS.

BACKGROUND

The incidence of central nervous system (CNS) talaromycosis, an emerging complication in patients with acquired immunodeficiency syndrome (AIDS), is increasing, accompanied by a high mortality rate. Limited understanding of whether its clinical manifestations differ from those of common AIDS-associated CNS infections, such as cryptococcal meningitis (CM) and tuberculous meningitis (TBM), makes diagnosis challenging. Therefore, we aimed to systematically elucidate the key differences in clinical manifestations, diagnostic approaches, and treatment strategies among CNS talaromycosis, CM, and TBM.

METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional analysis was conducted on monomicrobial-pathogen CNS talaromycosis, CM, and TBM in patients with human immunodeficiency virus/AIDS, comparing demographics, clinical features, and cerebrospinal fluid (CSF). Patients with CNS talaromycosis (n = 16) were predominantly male (87.5 %) with advanced immunosuppression (median CD4+ T-cell count 107.00 cells/μL). Compared to CM (n = 50), CNS talaromycosis had higher antiretroviral treatment coverage (62.50 % vs. 18.00 %) and CD4+ counts (107.00 vs. 23.50 cells/μL), a lower incidence of fever (25 % vs. 74 %) and headache (31 % vs. 84 %), and similar CSF findings. Compared to those with TBM (n = 14), patients with CNS talaromycosis had a lower incidence of fever (25 % vs. 86 %), and distinct CSF profiles (lower lactate dehydrogenase [LDH]: 26.00 vs. 79.50 U/L; and lower adenosine deaminase [ADA]: 0.98 vs. 5.50 U/L).

CONCLUSIONS

CNS talaromycosis patients primarily present with a mild meningeal inflammatory response, less pronounced than in CM and TBM. Due to the similarities in clinical symptoms and CSF findings, microbiological tests are crucial for differentiating CNS talaromycosis from CM. When differentiating CNS talaromycosis from TBM, the levels of LDH and ADA in CSF can serve as valuable reference indicators.