01 March 2020
Objective To analyze the clinical characteristics of gerontal patients with HIV and infection caused by Talaromyces marneffei, and we try to provide evidence for the treatment of opportunistic infection in special population groups.
Methods A retrospective analysis of clinical features and outcome of 203 cases of HIV-infected gerontal patients with Talaromyces marneffei infection confirmed by the hospital from January 2013 to December 2018.
Results At the time of diagnosis of Talaromyces marneffei infection, the mean CD4+ lymphocyte count was 15(9-26)/μL in 203 cases of HIV-infected gerontal patients. The prevalence rates of Talaromyces marneffei in rainy season (April to September) and dry season (October to March) showed not significant differences ( P=0.851). Common clinical features were fevers, weak, weight loss, and skin lesions, accounting for 96.55%, 73.39%, 75.36%, and 26.46%, respectively. Concurrent opportunistic infections were present in 168 cases (82.75%), of which were pulmonary tuberculosis accounted for the highest proportion in 45.81%. The abnormal findings of chest computed tomography were 94.89%, including patchy lesions, ground glass opacity lesions, nodular lesions, cavity lesions, miliary lesions, and pleural effusions, accounting for 91.39%, 38.17%, 10.21%, 5.37%, 3.22%, and 58.60%, respectively. After treatment, 57.14% of the patients were cured, 31.03% were treatment withdrawing, and 11.82% died.
Conclusion Talaromyces marneffei is a common opportunity infection in HIV-infected gerontal patients. There is no typical clinical features. It is often complicated with multiple infections such as pulmonary tuberculosis, and the mortality rate is high. It is necessary to study the diagnosis, treatment and management strategy of Talaromyces marneffei infection among HIV-infected gerontal patient.
摘要： 目的 总结老年HIV/AIDS患者合并马尔尼菲篮状菌感染的临床特点，为特殊人群机会性感染的诊疗提供依据。 方法回顾性分析2013年1月至2018年12月住院的203例老年艾滋病合并马尔尼菲篮状菌感染患者的临床特征及治疗转归。 结果203例患者在确诊马尔尼菲篮状菌感染时CD4+T淋巴细胞中位数为15(9∼26)个/μL。马尔尼菲篮状菌在雨季(4月至9月)和旱季（10月至次年3月)的感染率比较差异无统计学意义( P=0.851)。临床主要表现发热为96.55%，全身乏力为73.39%，体重下降为75.36%，脐凹样皮疹为26.46%。168例（82.75%)患者合并其他机会性感染，以肺结核所占比例最高（45.81%)。胸部CT表现异常征象为94.89%，其中斑片状病变占91.39%，磨玻璃样病变占38.17%，结节性病变占10.21%，空洞病变占5.37%，粟粒性病变占3.22%，胸腔积液占58.60%。好转占57.14%，放弃治疗占31.03%，死亡占11.82%。 结论马尔尼菲篮状菌是老年HIV/AIDS患者常见的机会性感染，临床表现无典型的特征，常合并肺结核等多重感染，死亡率高。临床上需要对老年HIV/AIDS患者合并马尔尼菲篮状菌感染的诊疗和管理策略进行研究。