Talaromycosis is an invasive mycosis caused by the thermally dimorphic saprophytic fungus Talaromyces marneffei (Tm) endemic in Asia. Like other endemic mycoses, talaromycosis occurs predominantly in immunocompromised and, to a lesser extent, immunocompetent hosts. The lungs are the primary portal of entry, and pulmonary manifestations provide a window into the immunopathogenesis of talaromycosis. Failure of alveolar macrophages to destroy Tm results in reticuloendothelial system dissemination and multi-organ disease. Primary or secondary immune defects that reduce CD4⁺ T cells, INF-γ, IL-12, and IL-17 functions, such as HIV infection, anti-interferon-γ autoantibodies, STAT-1 and STAT-3 mutations, and CD40 ligand deficiency, highlight the central roles of Th1 and Th17 effector cells in the control of Tm infection. Both upper and lower respiratory infections can manifest as localised or disseminated disease. Upper respiratory disease appears unique to talaromycosis, presenting with oropharyngeal lesions and obstructive tracheobronchial masses. Lower respiratory disease is protean, including alveolar consolidation, solitary or multiple nodules, mediastinal lymphadenopathy, cavitary disease, and pleural effusion. Structural lung disease such as chronic obstructive pulmonary disease is an emerging risk factor in immunocompetent hosts. Mortality, up to 55%, is driven by delayed or missed diagnosis. Rapid, non-culture-based diagnostics including antigen and PCR assays are shown to be superior to blood culture for diagnosis, but still require rigorous clinical validation and commercialisation. Our current understanding of acute pulmonary infections is limited by the lack of an antibody test. Such a tool is expected to unveil a larger disease burden and wider clinical spectrum of talaromycosis.

踝节菌病是一种侵袭性真菌病，由亚洲流行的热二形性腐生真菌马尔尼菲踝节菌(Tm) 引起。与其他地方性真菌病一样，踝部真菌病主要发生在免疫功能低下的宿主中，在较小程度上发生在免疫功能正常的宿主中。肺部是主要的侵入门户，肺部表现为了解踝部真菌病的免疫发病机制提供了一个窗口。肺泡巨噬细胞无法破坏 Tm 会导致网状内皮系统传播和多器官疾病。降低 CD4 ⁺ T 细胞、INF-γ、IL-12 和 IL-17 功能的原发性或继发性免疫缺陷，例如 HIV 感染、抗干扰素-γ 自身抗体、STAT-1 和 STAT-3 突变以及 CD40 配体缺陷，强调 Th1 和 Th17 效应细胞在控制 Tm 感染中的核心作用。上呼吸道和下呼吸道感染均可表现为局部或播散性疾病。上呼吸道疾病似乎是踝部真菌病所特有的，表现为口咽部病变和阻塞性气管支气管肿块。下呼吸道疾病多种多样，包括肺泡实变、单发或多发结节、纵隔淋巴结肿大、空洞性疾病和胸腔积液。结构性肺病（例如慢性阻塞性肺病）是免疫功能正常宿主中新出现的危险因素。延迟或漏诊导致死亡率高达 55%。快速、非培养的诊断（包括抗原和 PCR 检测）已被证明优于血培养诊断，但仍需要严格的临床验证和商业化。由于缺乏抗体测试，我们目前对急性肺部感染的了解有限。 这样的工具预计将揭示踝部真菌病更大的疾病负担和更广泛的临床谱。