Differences in clinical characteristics and prognosis of Penicilliosis among HIV-negative patients with or without underlying disease in Southern China: a retrospective study

Abstract

BackgroundThe incidence of Penicillium marneffei infection has recently increased. This fungus can cause fatal systemic mycosis in both immunocompetent and immunocompromised patients without HIV infection.MethodsWe retrospectively analysed Penicilliosis patients between January 1, 2003 and August 1, 2014 at the First Affiliated Hospital of Guangxi Medical University. HIV-negative patients with Penicilliosis were divided into two groups: patients with underlying disease (Group D) and patients without underlying disease (Group ND). HIV-positive patients were excluded. The relationships between overall survival and the study variables were assessed using univariate and multivariate analyses.ResultsDuring 11 years, Penicillium marneffei infection was diagnosed in 109 patients. Sixty-six (60.55 %) patients were HIV-positive and excluded from these cases. Forty-three patients were HIV-negative were enrolled. Among these patients, 18 (41.86 %) patients were in Group D, and 25 (58.14 %) were in Group ND. The most common underlying disease was diabetes. There were no statistically significant differences between the two groups in clinical characteristics, except for immune state and prognosis. Group ND had higher lymphocyte cell counts, CD4 cell counts, and CD4 T-cell percentages than Group D (P < 0.05). Patients in Group D had higher recurrence and mortality rates than Group ND (P < 0.05). In the univariate analysis, only underlying disease, CD4 cell percentage, and T lymphocyte cell percentage were significantly associated with overall survival.ConclusionsPenicillium marneffei can infect HIV-negative patients and can cause fatal systemic mycosis. There were no clear differences in clinical manifestations among HIV-negative patients with and without underlying disease. However, Penicillium marneffei in HIV-negative patients in with underlying diseases may cause immune function decline and a deficiency in T-cell-mediated immunity. Underlying disease, CD4 cell percentage, and T lymphocyte cell percentage may be potential risk factors affecting prognosis. Timely, effective, and longer courses of antifungal treatments are important in improving prognoses.

Clinical Characteristics and Prognosis of Penicilliosis Among Human Immunodeficiency Virus–Infected Patients in Eastern China

“…The mortality of the patients is 16.7%, which is similar to that in the previous studies. 19,23,[27][28][29][30] Besides low CD4 T-cell count, the well-known predictor of bad outcome, low hemoglobin level is also associated with increased mortality risk in this study. This is different from the previous studies.…”

Recovery from Talaromyces marneffei involving the kidney in a renal transplant recipient: A case report and literature review

“…T. marneffei has gradually spread from HIV‐infected persons to the general population. It is also seen increasingly in immunocompetent hosts in China and death has been reported in immunocompetent children . T. marneffei in immunocompetent hosts can be manifested as disseminated infection, focal abscesses, osteolytic destruction, or purulent pneumonia.…”

Two Unusual Cases of Human Immunodeficiency Virus–Negative Patients with Talaromyces marneffei Infection

“…[2][3][4][5]7 However, T. marneffei complicated by LCH has not been reported. LCH is a proliferation of Langerhans cells mixed with inflammatory cells, particularly eosinophils, characterized by the expression of CD1a and S100 protein, and the presence of Birbeck granules on ultrastructural examination.…”

“…Systemic intravenous amphotericin B and itraconazole are the main effective treatment options. [1][2][3][4][5] However, in case 1, after 10 months of regular and adequate antifungal treatments, but without treatment of LCH, the patient ultimately died. This outcome suggested that it is essential to treat not only the secondary infection, but also the underlying disease such as connective tissue diseases, etc.…”

“…However, it is increasingly observed in HIV-negative subjects without any obvious risk factors or immunocompromised condition. [1][2][3][4][5] The infection can disseminate hematogenously to the bone, bone marrow, joints, lymph nodes, pericardium, liver, trachea, spleen, etc. [6][7][8] Herein, we report the first case of T. marneffei complicated by Langerhans cell histiocytosis (LCH) and a case of pleural nodules and pleural effusion caused by T. marneffei using thoracoscopic pleural biopsy for differential diagnosis.…”