Clinical characteristics and outcome of Penicillium marneffei infection among HIV-infected patients in northern Vietnam

Abstract

ObjectiveThis study reports the clinical characteristics and outcome of HIV-associated Penicilliummarneffei infection in northern Vietnam.MethodsWe conducted a retrospective chart review of all patients with laboratory confirmed Penicilliummarneffei infection admitted to the National Hospital for Tropical Diseases in Hanoi, Vietnam, between July 2006 and September 2009.Results127 patients with P. marneffei infection were identified. All were HIV-infected; median CD4+ T-cell count was 24 cells/μl (IQR:12-48); 76% were men. Common clinical features were fever (92.9%), skin lesions (82.6%), hepatomegaly (61.4%), lymphadenopathy (40.2%), weight loss (59.1%) and cough (49.6%). Concurrent opportunistic infections were present in 22.0%; half of those had tuberculosis. Initial treatment regimens were: itraconazole or ketoconazole capsule (77.2%), amphotericin B (20.5%), and fluconazole (1.6%). In-hospital mortality was 12.6% and showed no significant difference in patients treated with itraconazole (or ketoconazole) and amphotericin B (p = 0.43). Dyspnea, ascites, and increased LDH level were independent predictors of mortality. No seasonality was observed.ConclusionThe clinical features, treatments and outcomes of HIV-associated P. marneffei infection in northern Vietnam are similar to those reported in other endemic regions. Dyspnea was an important predictor of mortality. More patients were treated with itraconazole than amphotericin B and no significant difference in treatment outcome was observed. It would be of clinical value to compare the efficacy of oral itraconazole and amphotericin B in a clinical trial.

Conducting Record Review Studies in Clinical Practice

“…Studying the course and outcome of diseases over a follow up period -Information about the course of the disease can be obtained from the follow up and progress notes of the patient over a period of time [25]. Data from such records data may not cover detailed examination or symptom evaluation.…”

Case of Penicillium marneffei infection in a non‐AIDS patient

“…1,2 We did not initially consider P. marneffei infection in this case, although we have previously reported P. marneffei infections in AIDS patients. 3,4 The manifestations of the infection on the skin were different in this patient than those observed in AIDS patients. 5 It is now widely recognized that P. marneffei infection is not limited to immunocompromised patients, as seen in this case.…”

Skin and subcutaneous infections in south-east Asia

“…Other associated symptoms and signs such as fever, malaise, weight loss, anaemia, lymphadenopathy and hepatosplenomegaly are present in disseminated penicilliosis [37]. In more than 70% of HIV patients, the presence of cutaneous penicilliosis suggests disseminated infection [38,39] and this warrants further investigation to determine the involvement of other organs. HIV-negative children with penicilliosis need to be screened for primary immunodeficiency diseases, which may predispose them to the infection [40].…”