The research on the value of quantitative real-time PCR in the diagnosis and treatment monitoring of Talaromycosis marneffei infection

doi:10.19871/j.cnki.xfcrbzz.2026.03.005

Abstract

Abstract: Objective To evaluate the application value of real-time quantitative PCR (qPCR) in the diagnosis of Talaromyces marneffei (T. marneffei) infection and in the monitoring of antifungal therapy, and to provide laboratory evidence for optimizing antifungal treatment strategies. Method Patients with confirmed T. marneffei infection at the Fourth People's Hospital of Nanning from January to June 2022 were enrolled. Using fungal culture as the diagnostic gold standard, baseline paired specimens were collected. The sensitivity of qPCR for diagnosing fungal infection was evaluated by comparing the positive rates of qPCR and fungal culture. Spearman correlation analysis was used to assess the correlation between baseline fungal load and the time to positivity in culture. A linear mixed-effects model was constructed to analyze the changes in fungal load during antifungal therapy. Result A total of 64 culture-confirmed T. marneffei infected patients were included. At baseline, plasma qPCR demonstrated a sensitivity of 95.3% (61/64), exceeding the positivity rates of concurrent blood culture (90.7%) and bone marrow culture (91.7%). Baseline plasma fungal load was significantly and negatively correlated with the time to culture positivity (r=-0.495, P<0.001). During treatment, fungal load demonstrated a significant declining trend over time (β=-0.3216, P<0.001), whereas no statistically significant difference in the rate of fungal load decline was observed between treatment regimens with and without amphotericin B (P=0.532); substantial inter-individual heterogeneity was noted in both baseline fungal load and treatment response. On the day of blood culture conversion to negative (days 4-13 after treatment initiation), qPCR results simultaneously converted to negative in 50 patients (78.1%), while 14 patients (21.9%) remained qPCR-positive in blood. Conclusion The qPCR method demonstrates high sensitivity for diagnosing T. marneffei infection and can be used for early auxiliary diagnosis. In treatment monitoring, qPCR can dynamically reflect changes in fungal load and can identify patients with persistent infection even after blood cultures have become negative, thereby facilitating efficacy assessment and adjustment of individualized therapy.

Key words: Tuberculous cervical lymph nodes, Metastatic lymph nodes, Ultrasound radiomics, Differentiation, Diagnosis

CLC Number:

R519.9

Liu Xia, Zou Jun, Lu Yibo, Qin Xiaoying, Xu Qiuna, Liang Cuijin, Zhao Rui, Lan Jian, Xiao Qiuye, Huang Tian, Wei Yinduo, Qin Jinmei, Yang Shixiong. The research on the value of quantitative real-time PCR in the diagnosis and treatment monitoring of Talaromycosis marneffei infection[J]. Electronic Journal of Emerging Infectious Diseases, 2026, 11(3): 24-29.

References

[1] WANG F, HAN R, CHEN S.An Overlooked and Underrated Endemic Mycosis-Talaromycosis and the Pathogenic Fungus Talaromyces marneffei[J]. Clin Microbiol Rev, 2023, 36(1): e0005122.
[2] NONG L, MA J, ZHENG Y, et al.Cardiovascular system characteristics in HIV/AIDS patients with talaromycosis[J]. Braz J Med Biol Res, 2026, 59: e14655.
[3] 中华医学会感染病学分会艾滋病学组,中国疾病预防控制中心. 中国艾滋病诊疗指南(2024版)[J/CD].新发传染病电子杂志,2024,9(4):68-94.
[4] NIU X, YU Q, CAO L, et al.Challenges in Diagnosis and Treatment of HIV-Negative Host Pulmonary Talaromyces marneffei in Non-Endemic Areas: A Case Report with a History of Pulmonary Tuberculosis[J]. Infect Drug Resist, 2026, 19: 582375.
[5] JIANG J, MENG S, HUANG S, et al.Effects of Talaromyces marneffei infection on mortality of HIV/AIDS patients in southern China: a retrospective cohort study[J]. Clin Microbiol Infect, 2019, 25(2): 233-241.
[6] BROWN L, HOA NT, LY VT, et al.Recent Advances in the Diagnosis of Talaromycosis[J]. Clin Infect Dis, 2026, 81(6): e533-e543.
[7] LI X, ZHENG Y, WU F, et al.Evaluation of quantitative real-time PCR and Platelia galactomannan assays for the diagnosis of disseminated Talaromyces marneffei infection[J]. Med Mycol, 2020, 58(2): 181-186.
[8] SULAIMAN AS, NUGROHO P, BAHRI DR, RACHMANI D.Diagnostic concordance of GeneXpert HCV VL fingerstick and GeneXpert HCV viral load with RT-PCR in POCT settings among hemodialysis patients[J]. PLoS One, 2026, 21(2): e0324671.
[9] 中华医学会感染病学分会艾滋病丙型肝炎学组, 中国疾病预防控制中心. 中国艾滋病诊疗指南(2021年版)[J]. 协和医学杂志, 2022, 13(2): 203-226.
[10] 郑艳青, 史娜娜, 曹存巍. 实时荧光定量PCR检测马尔尼菲篮状菌病组织样本中菌载量的研究[J]. 中国真菌学杂志, 2018, 13(2): 71-74.
[11] CAO C, LI R, WAN Z, et al.The effects of temperature, pH, and salinity on the growth and dimorphism of Penicillium marneffei[J]. Med Mycol, 2007, 45(5): 401-407.
[12] SUPPARATPINYO K, KHAMWAN C, BAOSOUNG V, et al.Disseminated Penicillium marneffei infection in southeast Asia[J]. Lancet, 1994, 344(8915): 110-113.
[13] MD ALI H, PENG L, YUAN Y, et al.[Diagnostic Value of Serological Markers and Quantitative Real-Time PCR in Patients With Invasive Candidiasis] [J]. Sichuan Da Xue Xue Bao Yi Xue Ban, 2026, 57(1): 170-176.
[14] 周游, 何希, 黄丽花,等. 多指标单独或联合检测在艾滋病合并马尔尼菲篮状菌感染的诊断价值[J]. 中国真菌学杂志, 2024, 19(5): 480-486.
[15] 廖柳维, 潘开素, 李炳坤, 等. 实时荧光定量PCR检测肺泡灌洗液在HIV阴性马尔尼菲篮状菌病诊断中的价值[J]. 中国真菌学杂志, 2023, 18(3): 205-210.
[16] JANDRIC M, MOMCICEVIC D, DRAGIC S, et al.Continuous Renal Replacement Therapy for Patients With Sepsis in a Low-Resource Medical Intensive Care Unit (MICU): Incidence, Risk Factors, and Outcomes[J]. Cureus, 2026, 18(2): e103319.
[17] BOWMAN JC, ABRUZZO GK, ANDERSON JW, et al.Quantitative PCR assay to measure Aspergillus fumigatus burden in a murine model of disseminated aspergillosis: demonstration of efficacy of caspofungin acetate[J]. Antimicrob Agents Chemother, 2001, 45(12): 3474-3481.
[18] LASS-FLöRL C, GUNSILIUS E, GASTL G, et al. Diagnosing invasive aspergillosis during antifungal therapy by PCR analysis of blood samples[J]. J Clin Microbiol, 2004, 42(9): 4154-4157.
[19] MILLON L, ROUSSELOT J, SCHERER E, BELLANGER AP.Blood mucorales quantitative PCR ready for prime time[J]. Curr Opin Infect Dis, 2025, 38(6): 530-534.