Clinical characteristics and risk factors for poor prognosis among HIV patients with Talaromyces marneffei bloodstream infection

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Abstract

Background

Talaromyces marneffei (TM) bloodstream infection is common in Acquired Immunodeficiency Syndrome (AIDS) patients with extreme immunodeficiency in Southeast Asia and South China, however, clinical case study on TM bloodstream infection is scarce. We retrospectively analyzed the clinical characteristics of TM bloodstream infection in hospitalized AIDS patients and determined the outcomes of hospitalization after diagnosis in our hospital over the past 5 years.

Methods

From January 2015 to July 2020, 87 cases of TM detected by blood culture in patients admitted to our center were collected. The admission complaints, blood cells, biochemistry, CD4 and CD8 cell counts and 1,3-β-D-glucan (BDG), procalcitonin (PCT), CRP level on the day of blood culture test, and outcomes during hospitalization were analyzed. Logistic regression analysis was performed for the risk factors for poor prognosis (60 cases). Spearman correlation analysis was used to analyze the correlation between peripheral blood cells, albumin and the time required for TM turnaround in blood culture. The difference was statistically significant when the P value was < 0.05.

Results

A total of 87 patients were collected, with a median age of 34 years, a median hemoglobin of 94 g/L and CD4 count of 7/μl. The rate of TM bloodstream infection among all in-hospital patients increased from 0.99% in 2015 to 2.09% in 2020(half year). Patients with TM bloodstream infection with CD8 count < 200/μl had a 12.6-fold higher risk of poor prognosis than those with CD8 count > 200/μl ( p = 0.04), and those with BDG < 100 pg/mL had a 34.9-fold higher risk of poor prognosis than those with BDG > 100 pg/mL ( p = 0.01).

Conclusions

TM bloodstream infection is becoming more common in advanced AIDS patients in endemic areas. For those patients with extremely low CD4 and CD8 cell counts below 200/μl is with an increased risk of poor prognosis.

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Most cited references 35

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Disseminated Penicillium marneffei infection in southeast Asia.

K Supparatpinyo, C Khamwan, V Baosoung … (1994)

Disseminated infection with the fungal pathogen Penicillium marneffei is, after extrapulmonary tuberculosis and cryptococcal meningitis, the third most common opportunistic infection in HIV disease in northern Thailand. We report the clinical, microbiological, and therapeutic features of a large series of HIV-infected adults with disseminated P marneffei infection. From August, 1987, to June, 1992, 92 patients with P marneffei infection confirmed by culture were seen at Chiang Mai University Hospital, of whom 86 were also infected with HIV. Clinical information was available for 80 of these patients. The most common presenting symptoms and signs were fever (92%), anaemia (77%), weight loss (76%), and skin lesions (71%). 87% of patients presenting with skin lesions had generalised papules with central umbilication. Presumptive diagnosis was made in 50 patients by microscopic examination of Wright's-stained bone-marrow aspirate and/or touch smears of skin biopsy or lymph-node biopsy specimens. Most patients who were diagnosed responded initially to amphotericin or itraconazole, whereas most who were not diagnosed and treated died. 12 patients relapsed within 6 months of cessation of treatment. P marneffei has become an important pathogen of HIV-associated opportunistic infection in Thailand.

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Penicillium marneffei infection: an emerging disease in mainland China.

Liyan Xi, J.-J. Ma, Y. Hu … (2013)

Penicillium marneffei is an emerging pathogenic fungus that can cause a life-threatening systemic mycosis in immunocompromised hosts, especially in patients with AIDS. This infection is endemic in Southeast Asia. With the prevalence of AIDS in this area, the number of patients with systemic penicilliosis marneffei is found to be increasing rapidly in mainland China in recent years. We recently reviewed 668 cases of penicilliosis marneffei in mainland China from January 1984 to December 2009 in cnki, cqvip, CBMdisc and PubMed. We analyzed epidemiological and clinical features, laboratory findings, reaction to therapy and prognosis of the disease. We found that 99.4% of the cases were reported in the southern part of China; among these cases, 42.8% were from Guangxi (286 cases) and 40.6% were from Guangdong province (271 cases). Five hundred and eighty-six cases (87.7%) of penicilliosis marneffei were reported with infection by the human immunodeficiency virus, 25 cases (3.8%) with other immunocompromised diseases, and 57 cases (8.5%) without any documented underlying diseases. Fever, weight loss, anemia, lymphadenopathy, hepatosplenomegaly, respiratory signs and skin lesions were the common clinical manifestations of P. marneffei infections. The 569 cases received antifungal therapy with a mortality of 24.3% (138 cases), 99 cases who had not received antifungal therapy had a mortality of 50.6%. P. marneffei was an emerging pathogenic fungus and become a medical and public health importance in mainland China. The immunocompromised patients should pay more attention to P. marneffei infection in the endemic areas.

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Clinical and laboratory characteristics of penicilliosis marneffei among patients with and without HIV infection in Northern Thailand: a retrospective study

Rathakarn Kawila, Romanee Chaiwarith, Khuanchai Supparatpinyo (2013)

Background Penicilliosis marneffei is increasingly observed in individuals without HIV infection. This study aimed to compare the clinical and laboratory features among HIV infected and uninfected individuals with penicilliosis marneffei. Methods A retrospective cohort study was conducted between January 1, 2007 and December 31, 2011 at Chiang Mai University Hospital. We included individuals who were ≥15 years of age and presented with culture-proven P. marneffei infection. Results 116 HIV-infected and 34 HIV-uninfected patients were enrolled. Comparing to HIV-infected patients, HIV-uninfected patients were older; less likely to have fever, splenomegaly, and umbilicated skin lesions; more likely to have Sweet’s syndrome and bone and joint infections; had higher white blood cell count, platelet count, and CD4 cell count; had lower alanine transaminase (ALT); and less likely to have positive fungal blood cultures. The mortality rates were 20.7% and 29.4% among HIV infected and uninfected patients, respectively. Conclusions Clinical manifestations of penicilliosis marneffei are different between patients with and without HIV infection. Physician’s awareness of this disease in HIV-uninfected patients may prompt the diagnosis and timely treatment, and can lead to a better outcome.

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Author and article information

Contributors

Hongzhou Lu: luhongzhou@fudan.edu.cn

Journal

Journal ID (nlm-ta): BMC Infect Dis

Journal ID (iso-abbrev): BMC Infect Dis

Title: BMC Infectious Diseases

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2334

Publication date (Electronic): 1 June 2021

Publication date PMC-release: 1 June 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 514

Affiliations

[1 ]GRID grid.470110.3, ISNI 0000 0004 1770 0943, Department of Infection and Immunity, , Shanghai Public Health Clinical Center, ; Shanghai, China

[2 ]GRID grid.470110.3, ISNI 0000 0004 1770 0943, Department of Obstetrics and Gynecology, , Shanghai Public Health Clinical Center, ; Shanghai, China

[3 ]GRID grid.411405.5, ISNI 0000 0004 1757 8861, Department of Infectious Disease, , Huashan Hospital Affiliated to Fudan University, ; Shanghai, China

[4 ]GRID grid.8547.e, ISNI 0000 0001 0125 2443, Department of Internal Medicine, Shanghai Medical College, , Fudan University, ; Shanghai, China

Article

Publisher ID: 6232

DOI: 10.1186/s12879-021-06232-2

PMC ID: 8170804

PubMed ID: 34074256

SO-VID: ee4c2d7c-9bef-4fbd-b119-7d3a7059b794

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Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 5 January 2021

Date accepted : 24 May 2021

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: hiv infection,aids,talaromyces marneffei,bloodstream infection,prevalence,clinical characteristics,poor prognosis,risk factors

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: hiv infection, aids, talaromyces marneffei, bloodstream infection, prevalence, clinical characteristics, poor prognosis, risk factors

Clinical characteristics and risk factors for poor prognosis among HIV patients with Talaromyces marneffei bloodstream infection

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Most cited references 35

Disseminated Penicillium marneffei infection in southeast Asia.

Penicillium marneffei infection: an emerging disease in mainland China.

Clinical and laboratory characteristics of penicilliosis marneffei among patients with and without HIV infection in Northern Thailand: a retrospective study

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