Abstract: Objective To systematically analyze the clinical characteristics of patients with AIDS complicated by central nervous system Talaromyces marneffei (TM) infection, to enhance the effectiveness of early diagnosis, and optimize clinical management strategies. Method A retrospective case analysis was conducted, including 9 patients with AIDS complicated by central nervous system TM infection diagnosed by cerebrospinal fluid (CSF) microbiology at Chest Hospital of Guangxi Zhuang Autonomous Region from January 2021 to November 2024. Clinical data were systematically analyzed. Result The clinical manifestations of the nervous system in patients showed significant heterogeneity, mainly including headache, fever, altered mental status, abnormal mental behavior, and epileptic seizures. CSF examination results showed increased white blood cell count, decreased glucose, decreased chloride, and elevated protein levels in the CSF. Brain MRI showed intracranial infectious lesions and lateral ventricle dilation in all 9 patients. Metagenomic next-generation sequencing (mNGS) of CSF showed a 100% positive detection rate. After treatment with amphotericin B combined with itraconazole/voriconazole and timely initiation of antiretroviral therapy, 8 patients had good clinical outcomes, while 1 patient died of multiple organ failure. Conclusion AIDS complicated by central nervous system TM infection is characterized by complex clinical manifestations and poor prognosis. Timely and accurate diagnosis, along with standardized comprehensive treatment, are key to improving clinical outcomes.

Key words: Acquired immunodeficiency syndrome, Marniffei basket bacterial disease, Central nervous system infection, Clinical features, Antifungal therapy