BACKGROUND: To investigate the clinical characteristics and risk factors of human immunodeficiency virus(HIV)-negative patients with Talaromyces marneffei(T. marneffei) infection.METHODS: We retrospectively collected ...BACKGROUND: To investigate the clinical characteristics and risk factors of human immunodeficiency virus(HIV)-negative patients with Talaromyces marneffei(T. marneffei) infection.METHODS: We retrospectively collected the clinical information of HIV-negative patients with T. marneffei infection from January 1, 2010 to June 30, 2019, and analyzed the related risk factors of poor prognosis.RESULTS: Twenty-five cases aging 22 to 79 years were included. Manifestations of T. marneffei infection included fever, cough, dyspnea, chest pain or distress, lymphadenopathy, ear, nose, and throat(ENT) and/or skin lesions, bone or joint pain, edema and pain in the lower extremities, digestive symptoms, icterus, malaise, and hoarseness. Two cases had no comorbidity, while 23 cases suff ered from autoimmune disease, pulmonary disease, cancer, and other chronic diseases. Sixteen cases had a medication history of glucocorticoids, chemotherapy or immunosuppressors. Pulmonary lesions included interstitial infiltration, nodules, atelectasis, cavitary lesions, pleural effusion or hydropneumothorax, bronchiectasis, pulmonary fibrosis, pulmonary edema, and consolidation. The incidence of osteolytic lesions was 20%. Eight patients received antifungal monotherapy, and 11 patients received combined antifungal agents. Fifteen patients survived and ten patients were dead. The Cox regression analysis showed that reduced eosinophil counts, higher levels of blood urea nitrogen(BUN), alanine aminotransferase(ALT), aspartate aminotransferase(AST), lactic dehydrogenase(LDH), myoglobin(Mb), procalcitonin(PCT), and galactomannan were related to poor prognosis(hazard ratio [HR]>1, P<0.05).CONCLUSIONS: Bone destruction is common in HIV-negative patients with T. marneffei infection. Defective cell-mediated immunity, active infection, multiple system, and organ damage can be the risk factors of poor prognosis.展开更多
Penicillium marneffei （R marneffei） infection usually occurs with skin, bone marrow, lung or hepatic involve- ment. However, no cases of P. mameffei infection with chylous ascites have been reported thus far. In thi...Penicillium marneffei （R marneffei） infection usually occurs with skin, bone marrow, lung or hepatic involve- ment. However, no cases of P. mameffei infection with chylous ascites have been reported thus far. In this re- port, we describe the first case of acquired immune de- ficiency syndrome （AIDS） which has been complicated by a P. marneffei infection causing chylous ascites. We describe the details of the case, with an emphasis on treatment regimen. This patient was treated with am- photericin B for 3 mo, while receiving concomitant ther- apy with an efavirenz-containing antiretroviral regimen, but cultures in ascitic fluid were persistently positive for P. marneffei. The infection resolved after treatment with high-dose voriconazole （400 mg every 12 h） for 3 too. R marneffei should be considered in the differential di- agnosis of chylous ascites in human immunodeficiency virus patients. High-dose voriconazole is an effective, well-tolerated and convenient option for the treatment of systemic infections with R marneffei in AIDS patients on an efavirenz-containing antiretroviral regimen.展开更多
Objective： To investigate the difference of proteome between yeast form and mould form of Penicillium mameffei, and to investigate the association of specific proteins expressed with biochemical properties, susceptib...Objective： To investigate the difference of proteome between yeast form and mould form of Penicillium mameffei, and to investigate the association of specific proteins expressed with biochemical properties, susceptibility of antifungal agent with dimorphic growth. Methods： Biochemistry identity plates were used to test the assimilation of carbohydrates and E-test strips were used to detect the minimum inhibitory concentration （MIC） of mould form and yeast form 16 P. mameffei. Surface enhanced laser desorption/ionization （SELDI） mass spectrometry with ProteinChip WCX2 was performed to compare the expressed proteins in yeast form and mould form. Protein profiles were read by PBSⅡ proteinchip reader and the proteome database was analyzed by proteincbip software 3.2.0. Results： Mould form assimilated lactose, melibiose significantly stronger （ P 〈0.01）, while yeast form assimilated sorbinose significantly stronger （ P 〈 0.05）. The mean MIC of fluconazole against mould form increased significantly （ P 〈 0.01 ） compared with yeast form. Seventy-five distinct proteins were found in yeast form and mould form of P. mameffei, in which proteins of 2900Da and 3151Da were specifically expressed in yeast form and other two proteins of 13151Da and 13285Da were specifically expressed in mould form （ P 〈 0.01 ）. Conclusion： The assimilation of carbohydrates and drug susceptibility of P. mameffei may change partly due to the morphogenetic conversion and different texture. Specific proteins may he involved in the regulation, the change of biochemical reaction and drug susceptibility during dimorpbic growth.展开更多
Elderly patients with systemic disseminated <em>Penicillium marneffei </em>are generally more seriously ill with high mortality. In addition to clear diagnosis and timely treatment, careful nursing through...Elderly patients with systemic disseminated <em>Penicillium marneffei </em>are generally more seriously ill with high mortality. In addition to clear diagnosis and timely treatment, careful nursing throughout the hospitalization is particularly important for the patient’s recovery. Psychological nursing and family emotional support, the treatment of adverse drug reactions, systemic infection wound care, the prevention of pressure sores in long-term bedridden patients, antithrombotic nursing, disinfection isolation and the standard prevention of nosocomial cross infection all play decisive roles in the patient’s prognosis. After one month treatment and medical care, the patient was cured and was discharged from hospital. After discharge, the patient follow-up was carried out up to one year. This patient had completely recovered. In this paper, we report a successful nursing experience of an elderly patient with systemic disseminated <em>Penicillium marneffei.</em> With the summary of nursing key points, it could play a reference in the treatment and rehabilitation of similar patients.展开更多
Penicillium marneffei(P.marneffei)is a pathogenic fungus that can cause fatal infections in humans,particularly immunocompromised hosts.It is prevalent only in the Southeast Asian region.A 5-year-old boy was presented...Penicillium marneffei(P.marneffei)is a pathogenic fungus that can cause fatal infections in humans,particularly immunocompromised hosts.It is prevalent only in the Southeast Asian region.A 5-year-old boy was presented with diagnosed Acute Lymphoblastic Leukemia undergoing chemotherapy and suffering from high-grade fever for 15 days positively responded to antibiotics on the initial day,but later he became unresponsive.He was found negative for blood cultures of bacterial growth.Ultrasound of the abdomen showed a borderline enlarged liver with multiple small hypoechoic areas of variable sizes seen scattered in both lobes of the liver.Morphological and microscopic analyses of liver tissues showed multiple septate hyphae of P.marneffei.Amphotericin B was found to be effective in treating the child.Appropriate identification is essential to treat the pathogen-causing disease,especially in immuno-compromised conditions like a leukemic patient,and determine underlying mechanisms behind the pathogenesis.展开更多
Background: Mycobacterium avium complex (MAC) infection case which involves bones and joints are rare scenarios. Here, we report a rare case of Penicillium marneffei (PM), lung infection and systemic multi joint damag...Background: Mycobacterium avium complex (MAC) infection case which involves bones and joints are rare scenarios. Here, we report a rare case of Penicillium marneffei (PM), lung infection and systemic multi joint damage reported with positive anti-interferon-gamma at the same time. Case Presentation: A 55-year-old woman with fever for 10 days due to repeated multiple joint pain for more than one month was admitted to our hospital on September 19th 2020. During hospitalization, the patient was confirmed with mycobacterium avium combined with Penicillium marneffei (PM) infection involving multiple bone joints. Antifungal therapy and immunity regulatory agent were given during hospitalization. Following pharmocol-therapy, symptoms gradually improved, and the patient was discharged. Conclusions: The patient was considered disseminated and refractory non-tubercular mycobacterium (NTM) combined with Penicillium marneffei infection. In addition, we found that anti IFN-γ autoantibodies are closely related. Although the current incidence of this patient is related to anti IFN-γ, there is a strong correlation between autoantibody-mediated immunodeficiency in adults.展开更多
目的探讨(1-3)-β-D葡聚糖联合降钙素原(procalcitonin,PCT)、CD4^(+)T淋巴细胞多指标在艾滋病患者马尔尼菲篮状菌感染早期诊断临床研究。方法回顾性选取我院2020年1月—2022年6月住院的120例艾滋病患者为研究对象。依据实验室结果,将...目的探讨(1-3)-β-D葡聚糖联合降钙素原(procalcitonin,PCT)、CD4^(+)T淋巴细胞多指标在艾滋病患者马尔尼菲篮状菌感染早期诊断临床研究。方法回顾性选取我院2020年1月—2022年6月住院的120例艾滋病患者为研究对象。依据实验室结果,将其分为马尔尼菲篮状菌感染确诊组(血或组织液培育养出马尔尼菲篮状菌),简称A组(62例),及马尔尼菲篮状菌感染临床诊断组[根据临床症状、体征、血常规及(1-3)-β-D葡聚糖、PCT、CD4^(+)T淋巴细胞多指标诊断],简称B组(58例)。检测患者(1-3)-β-D葡聚糖、PCT、CD4^(+)T淋巴细胞的表达水平,采用受试者工作特征(receiver-operating characteristic,ROC)曲线下面积(area under the curve,AUC)评估上述指标联合检测对艾滋病患者感染马尔尼菲篮状菌的诊断效能。结果A组的(1-3)-β-D葡聚糖和PCT水平均高于B组,CD4^(+)T淋巴细胞个数低于B组(P<0.05);(1-3)-β-D葡聚糖、PCT、CD4^(+)T淋巴细胞联合检测的AUC为0.933,(1-3)-β-D葡聚糖单独检测的AUC是0.812,PCT单独检测的AUC为0.883,CD4^(+)T淋巴细胞单独检测的AUC是0.810,(1-3)-β-D葡聚糖、PCT和CD4^(+)T淋巴细胞联合检测的AUC皆优于三项单独检测,表明(1-3)-β-D葡聚糖、PCT和CD4^(+)T淋巴细胞联合检测的诊断价值皆优于单一指标诊断,且联合检测的特异度、约登指数分别为92.43%和0.580,均高于三项单独检测。结论(1-3)-β-D葡聚糖联合PCT和CD4^(+)T淋巴细胞多指标对艾滋病马尔尼菲篮状菌感染具有非常高的临床诊断价值,能够帮助医生分析出高危风险患者,及时制定治疗方案,同时也承担预后效果的判断依据,对治疗艾滋病马尔尼菲篮状菌感染具有非常重要的研究价值。展开更多
Background： Talaromyces （Penicillium） marneffei （TIM） is an emerging dimorphic human pathogenic fungus that is endemic to Southeast Asia. TM mostly occurs as an opportunistic infection in patients with human immu...Background： Talaromyces （Penicillium） marneffei （TIM） is an emerging dimorphic human pathogenic fungus that is endemic to Southeast Asia. TM mostly occurs as an opportunistic infection in patients with human immunodeficiency virus （HIV）. The objective of this study was to compare the clinical and laboratory parameters of patients with TM infections who were HIV-positive and HIV-negative and to assess therapies and outcomes. Methods： This was a retrospective analysis of 26 patients diagnosed with disseminated TM infection from September 2005 to April 2014 at Fujian Provincial Hospital, China. Results： Patients with TM infection tend to present with fever, weight loss, and anemia. The time from symptom onset to confirmed diagnosis was greater for HlV-negative patients （n 7; median： 60 days, range： 14-365 days） than for HIV-positive patients （n = 19; median： 30 days, range： 3-90 days, Mann-Whitney U= 31.50, P = 0.041）. HIV-negative patients were more likely to have dyspnea （57.1% vs. 5.3%, Z： = 8.86, P = 0.010）, low neutrophil count （Mann-Whitney U = 27.00, P = 0.029）, high CD4 count （Mann-Whitney U= 0.00, P 0.009）, and high lymphocyte count （Mann-Whitney U = 21.00, P = 0.009）. There were no significant differences in other demographic, clinical, or biochemical characteristics. Among all the patients, 12 HIV-positive patient and 1 HlV-negative patient received amphotericin and fluconazole treatment, 9 of whom improved, l died, 2 had kidney damage, 1 had hypokalemia due to exceeded doses. Conclusions： HIV-negative patients with TM infections tend to have a longer diagnostic interval, a higher percentage of dyspnea, higher levels of CD4 and lymphocytes, and lower neutrophil counts than TM infection in HIV-positive patients. Treatment programs with amphotericin and fluconazole are mostly effective.展开更多
X连锁高IgM综合征(X-linked hyper-immunoglobulin M syndrome,XHIGM)是罕见的原发性免疫缺陷病,该病以反复感染为特征,易感染机会致病微生物。临床上以马尔尼菲篮状菌肺炎起病的XHIGM更为罕见。该文回顾性分析1例以马尔尼菲篮状菌肺炎...X连锁高IgM综合征(X-linked hyper-immunoglobulin M syndrome,XHIGM)是罕见的原发性免疫缺陷病,该病以反复感染为特征,易感染机会致病微生物。临床上以马尔尼菲篮状菌肺炎起病的XHIGM更为罕见。该文回顾性分析1例以马尔尼菲篮状菌肺炎起病的X连锁高IgM综合征婴儿的临床资料,实验室、影像学检查结果和诊疗经过并探讨其基因型,结合最新文献复习,以提高对该疾病的认识。展开更多
Background: Little study has investigated the differences between Talatomyces marneffei (T. marneffei) respiratory infection and tuberculosis and the prognostic factors of such infection. This study investigated the c...Background: Little study has investigated the differences between Talatomyces marneffei (T. marneffei) respiratory infection and tuberculosis and the prognostic factors of such infection. This study investigated the characteristics and prognostic factors of T. marneffei infections with respiratory lesions and the causes of misdiagnosis. Methods: Clinical characteristics and prognoses of patients with T. marneffei infections with respiratory system lesion were investigated. T. marneffei diagnosis followed isolation from clinical specimens using standard culture, cytology, and histopathology. Survival curves were estimated by using Kaplan-Meier analysis, with log-rank test to compare differences in survival rates between groups. Univariate and multivariate Cox regression analyses were also performed to assess significant differences in clinical characteristics of overall survival. Results: Of 126 patients diagnosed with T. marneffei infections, 63 (50.0%) had T. marneffei respiratory system infections;38.1%(24/63) were misdiagnosed as having tuberculosis. Human immunodeficiency virus (HIV) infection, CD4/CD8 < 0.5, percentage of CD4+ T cells <42.8%, and length of time from onset to confirmation of diagnosis >105 days were potential risk factors for poor prognoses. Length of time from onset to confirmation of diagnosis persisted as an independent predictor of all-cause mortality in multivariate analysis (odds ratio: 0.083, 95.0% confidence interval: 0.021–0.326, P < 0.001). However, the size of the lung lesions, dyspnea, thoracalgia, mediastinal lymphadenopathy, and pleural effusion did not significantly predict overall survival. There was no significant difference in prognosis according to the type of treatment. Conclusions: T. marneffei infections involving the respiratory system are common. The critical determinants of prognosis are HIV infection, CD4/CD8, percentage of CD4+ T cells, type of treatment, and the time range from onset to confirmation of diagnosis. Rapid and accurate diagnosis is crucial for improving prognosis.展开更多
Background Penicillium mameffei （P. marneffe~） is an emerging pathogenic fungus that can cause invasive mycosis in patients with AIDS. The epidemiological features of P. marneffeiinfection in AIDS patients in Guangd...Background Penicillium mameffei （P. marneffe~） is an emerging pathogenic fungus that can cause invasive mycosis in patients with AIDS. The epidemiological features of P. marneffeiinfection in AIDS patients in Guangdong province remain unclear so far. This study aimed to investigate the genetic diversity within a population of 163 P. mameffei isolates obtained from AIDS patients and search for the dominant clinical strains in Guanqdong province.展开更多
P enicillium marneffei ( P. marneffei ) is a facultative intracellular pathogen and the only thermally dimorphic fungus. This fungal infection is commonly found in Southeast Asian, Hong Kong, south China, and especi...P enicillium marneffei ( P. marneffei ) is a facultative intracellular pathogen and the only thermally dimorphic fungus. This fungal infection is commonly found in Southeast Asian, Hong Kong, south China, and especially in acquired immunodeficiency syndrome (AIDS) patients. 1-4 We reported a patient with AIDS in whom infection due to P. marneffei was demonstrated. CASE REPORT A 34-year-old man with human immunodeficiency virus (HIV) infection (diagnosed before 6 months), living in Guangzhou of south China, was admitted to the hospital because of prolonged fever, cough, and weight loss. Initial examination revealed permanent high-grade fever (39-40℃) with chill and cough. Laboratory findings revealed haemoglobin concentration at 80 g/L, CD 4 lymphocyte count at 7×10 6/L, and viral load at 1.3×10 5 copies/ml. Blood and urine culture revealed no bacterial growth. Sputum culture was negative for mycobacterium. Chest X-ray film revealed left upper lobe ill-defined parenchymal opacities and widening of the superior mediastinum with left lung hilum prominence (Fig. 1). Abdominal B ultrasound showed hepatoplenomegaly and coeliac enlarged lymph nodes. On physical examination, the patient was found to have facial papula, cervical and superclavicular multiple lymph nodes.展开更多
基金supported by the National Natural Science Foundation of China (81801948)。
文摘BACKGROUND: To investigate the clinical characteristics and risk factors of human immunodeficiency virus(HIV)-negative patients with Talaromyces marneffei(T. marneffei) infection.METHODS: We retrospectively collected the clinical information of HIV-negative patients with T. marneffei infection from January 1, 2010 to June 30, 2019, and analyzed the related risk factors of poor prognosis.RESULTS: Twenty-five cases aging 22 to 79 years were included. Manifestations of T. marneffei infection included fever, cough, dyspnea, chest pain or distress, lymphadenopathy, ear, nose, and throat(ENT) and/or skin lesions, bone or joint pain, edema and pain in the lower extremities, digestive symptoms, icterus, malaise, and hoarseness. Two cases had no comorbidity, while 23 cases suff ered from autoimmune disease, pulmonary disease, cancer, and other chronic diseases. Sixteen cases had a medication history of glucocorticoids, chemotherapy or immunosuppressors. Pulmonary lesions included interstitial infiltration, nodules, atelectasis, cavitary lesions, pleural effusion or hydropneumothorax, bronchiectasis, pulmonary fibrosis, pulmonary edema, and consolidation. The incidence of osteolytic lesions was 20%. Eight patients received antifungal monotherapy, and 11 patients received combined antifungal agents. Fifteen patients survived and ten patients were dead. The Cox regression analysis showed that reduced eosinophil counts, higher levels of blood urea nitrogen(BUN), alanine aminotransferase(ALT), aspartate aminotransferase(AST), lactic dehydrogenase(LDH), myoglobin(Mb), procalcitonin(PCT), and galactomannan were related to poor prognosis(hazard ratio [HR]>1, P<0.05).CONCLUSIONS: Bone destruction is common in HIV-negative patients with T. marneffei infection. Defective cell-mediated immunity, active infection, multiple system, and organ damage can be the risk factors of poor prognosis.
文摘Penicillium marneffei （R marneffei） infection usually occurs with skin, bone marrow, lung or hepatic involve- ment. However, no cases of P. mameffei infection with chylous ascites have been reported thus far. In this re- port, we describe the first case of acquired immune de- ficiency syndrome （AIDS） which has been complicated by a P. marneffei infection causing chylous ascites. We describe the details of the case, with an emphasis on treatment regimen. This patient was treated with am- photericin B for 3 mo, while receiving concomitant ther- apy with an efavirenz-containing antiretroviral regimen, but cultures in ascitic fluid were persistently positive for P. marneffei. The infection resolved after treatment with high-dose voriconazole （400 mg every 12 h） for 3 too. R marneffei should be considered in the differential di- agnosis of chylous ascites in human immunodeficiency virus patients. High-dose voriconazole is an effective, well-tolerated and convenient option for the treatment of systemic infections with R marneffei in AIDS patients on an efavirenz-containing antiretroviral regimen.
文摘Objective： To investigate the difference of proteome between yeast form and mould form of Penicillium mameffei, and to investigate the association of specific proteins expressed with biochemical properties, susceptibility of antifungal agent with dimorphic growth. Methods： Biochemistry identity plates were used to test the assimilation of carbohydrates and E-test strips were used to detect the minimum inhibitory concentration （MIC） of mould form and yeast form 16 P. mameffei. Surface enhanced laser desorption/ionization （SELDI） mass spectrometry with ProteinChip WCX2 was performed to compare the expressed proteins in yeast form and mould form. Protein profiles were read by PBSⅡ proteinchip reader and the proteome database was analyzed by proteincbip software 3.2.0. Results： Mould form assimilated lactose, melibiose significantly stronger （ P 〈0.01）, while yeast form assimilated sorbinose significantly stronger （ P 〈 0.05）. The mean MIC of fluconazole against mould form increased significantly （ P 〈 0.01 ） compared with yeast form. Seventy-five distinct proteins were found in yeast form and mould form of P. mameffei, in which proteins of 2900Da and 3151Da were specifically expressed in yeast form and other two proteins of 13151Da and 13285Da were specifically expressed in mould form （ P 〈 0.01 ）. Conclusion： The assimilation of carbohydrates and drug susceptibility of P. mameffei may change partly due to the morphogenetic conversion and different texture. Specific proteins may he involved in the regulation, the change of biochemical reaction and drug susceptibility during dimorpbic growth.
文摘Elderly patients with systemic disseminated <em>Penicillium marneffei </em>are generally more seriously ill with high mortality. In addition to clear diagnosis and timely treatment, careful nursing throughout the hospitalization is particularly important for the patient’s recovery. Psychological nursing and family emotional support, the treatment of adverse drug reactions, systemic infection wound care, the prevention of pressure sores in long-term bedridden patients, antithrombotic nursing, disinfection isolation and the standard prevention of nosocomial cross infection all play decisive roles in the patient’s prognosis. After one month treatment and medical care, the patient was cured and was discharged from hospital. After discharge, the patient follow-up was carried out up to one year. This patient had completely recovered. In this paper, we report a successful nursing experience of an elderly patient with systemic disseminated <em>Penicillium marneffei.</em> With the summary of nursing key points, it could play a reference in the treatment and rehabilitation of similar patients.
文摘Penicillium marneffei(P.marneffei)is a pathogenic fungus that can cause fatal infections in humans,particularly immunocompromised hosts.It is prevalent only in the Southeast Asian region.A 5-year-old boy was presented with diagnosed Acute Lymphoblastic Leukemia undergoing chemotherapy and suffering from high-grade fever for 15 days positively responded to antibiotics on the initial day,but later he became unresponsive.He was found negative for blood cultures of bacterial growth.Ultrasound of the abdomen showed a borderline enlarged liver with multiple small hypoechoic areas of variable sizes seen scattered in both lobes of the liver.Morphological and microscopic analyses of liver tissues showed multiple septate hyphae of P.marneffei.Amphotericin B was found to be effective in treating the child.Appropriate identification is essential to treat the pathogen-causing disease,especially in immuno-compromised conditions like a leukemic patient,and determine underlying mechanisms behind the pathogenesis.
文摘Background: Mycobacterium avium complex (MAC) infection case which involves bones and joints are rare scenarios. Here, we report a rare case of Penicillium marneffei (PM), lung infection and systemic multi joint damage reported with positive anti-interferon-gamma at the same time. Case Presentation: A 55-year-old woman with fever for 10 days due to repeated multiple joint pain for more than one month was admitted to our hospital on September 19th 2020. During hospitalization, the patient was confirmed with mycobacterium avium combined with Penicillium marneffei (PM) infection involving multiple bone joints. Antifungal therapy and immunity regulatory agent were given during hospitalization. Following pharmocol-therapy, symptoms gradually improved, and the patient was discharged. Conclusions: The patient was considered disseminated and refractory non-tubercular mycobacterium (NTM) combined with Penicillium marneffei infection. In addition, we found that anti IFN-γ autoantibodies are closely related. Although the current incidence of this patient is related to anti IFN-γ, there is a strong correlation between autoantibody-mediated immunodeficiency in adults.
文摘目的探讨(1-3)-β-D葡聚糖联合降钙素原(procalcitonin,PCT)、CD4^(+)T淋巴细胞多指标在艾滋病患者马尔尼菲篮状菌感染早期诊断临床研究。方法回顾性选取我院2020年1月—2022年6月住院的120例艾滋病患者为研究对象。依据实验室结果,将其分为马尔尼菲篮状菌感染确诊组(血或组织液培育养出马尔尼菲篮状菌),简称A组(62例),及马尔尼菲篮状菌感染临床诊断组[根据临床症状、体征、血常规及(1-3)-β-D葡聚糖、PCT、CD4^(+)T淋巴细胞多指标诊断],简称B组(58例)。检测患者(1-3)-β-D葡聚糖、PCT、CD4^(+)T淋巴细胞的表达水平,采用受试者工作特征(receiver-operating characteristic,ROC)曲线下面积(area under the curve,AUC)评估上述指标联合检测对艾滋病患者感染马尔尼菲篮状菌的诊断效能。结果A组的(1-3)-β-D葡聚糖和PCT水平均高于B组,CD4^(+)T淋巴细胞个数低于B组(P<0.05);(1-3)-β-D葡聚糖、PCT、CD4^(+)T淋巴细胞联合检测的AUC为0.933,(1-3)-β-D葡聚糖单独检测的AUC是0.812,PCT单独检测的AUC为0.883,CD4^(+)T淋巴细胞单独检测的AUC是0.810,(1-3)-β-D葡聚糖、PCT和CD4^(+)T淋巴细胞联合检测的AUC皆优于三项单独检测,表明(1-3)-β-D葡聚糖、PCT和CD4^(+)T淋巴细胞联合检测的诊断价值皆优于单一指标诊断,且联合检测的特异度、约登指数分别为92.43%和0.580,均高于三项单独检测。结论(1-3)-β-D葡聚糖联合PCT和CD4^(+)T淋巴细胞多指标对艾滋病马尔尼菲篮状菌感染具有非常高的临床诊断价值,能够帮助医生分析出高危风险患者,及时制定治疗方案,同时也承担预后效果的判断依据,对治疗艾滋病马尔尼菲篮状菌感染具有非常重要的研究价值。
文摘Background： Talaromyces （Penicillium） marneffei （TIM） is an emerging dimorphic human pathogenic fungus that is endemic to Southeast Asia. TM mostly occurs as an opportunistic infection in patients with human immunodeficiency virus （HIV）. The objective of this study was to compare the clinical and laboratory parameters of patients with TM infections who were HIV-positive and HIV-negative and to assess therapies and outcomes. Methods： This was a retrospective analysis of 26 patients diagnosed with disseminated TM infection from September 2005 to April 2014 at Fujian Provincial Hospital, China. Results： Patients with TM infection tend to present with fever, weight loss, and anemia. The time from symptom onset to confirmed diagnosis was greater for HlV-negative patients （n 7; median： 60 days, range： 14-365 days） than for HIV-positive patients （n = 19; median： 30 days, range： 3-90 days, Mann-Whitney U= 31.50, P = 0.041）. HIV-negative patients were more likely to have dyspnea （57.1% vs. 5.3%, Z： = 8.86, P = 0.010）, low neutrophil count （Mann-Whitney U = 27.00, P = 0.029）, high CD4 count （Mann-Whitney U= 0.00, P 0.009）, and high lymphocyte count （Mann-Whitney U = 21.00, P = 0.009）. There were no significant differences in other demographic, clinical, or biochemical characteristics. Among all the patients, 12 HIV-positive patient and 1 HlV-negative patient received amphotericin and fluconazole treatment, 9 of whom improved, l died, 2 had kidney damage, 1 had hypokalemia due to exceeded doses. Conclusions： HIV-negative patients with TM infections tend to have a longer diagnostic interval, a higher percentage of dyspnea, higher levels of CD4 and lymphocytes, and lower neutrophil counts than TM infection in HIV-positive patients. Treatment programs with amphotericin and fluconazole are mostly effective.
文摘X连锁高IgM综合征(X-linked hyper-immunoglobulin M syndrome,XHIGM)是罕见的原发性免疫缺陷病,该病以反复感染为特征,易感染机会致病微生物。临床上以马尔尼菲篮状菌肺炎起病的XHIGM更为罕见。该文回顾性分析1例以马尔尼菲篮状菌肺炎起病的X连锁高IgM综合征婴儿的临床资料,实验室、影像学检查结果和诊疗经过并探讨其基因型,结合最新文献复习,以提高对该疾病的认识。
基金the grants from the Natural Science Foundation of China (No.NSFC81760010)the Guangxi Medical University Young Science Foundation (No.GXMUYSF201632).
文摘Background: Little study has investigated the differences between Talatomyces marneffei (T. marneffei) respiratory infection and tuberculosis and the prognostic factors of such infection. This study investigated the characteristics and prognostic factors of T. marneffei infections with respiratory lesions and the causes of misdiagnosis. Methods: Clinical characteristics and prognoses of patients with T. marneffei infections with respiratory system lesion were investigated. T. marneffei diagnosis followed isolation from clinical specimens using standard culture, cytology, and histopathology. Survival curves were estimated by using Kaplan-Meier analysis, with log-rank test to compare differences in survival rates between groups. Univariate and multivariate Cox regression analyses were also performed to assess significant differences in clinical characteristics of overall survival. Results: Of 126 patients diagnosed with T. marneffei infections, 63 (50.0%) had T. marneffei respiratory system infections;38.1%(24/63) were misdiagnosed as having tuberculosis. Human immunodeficiency virus (HIV) infection, CD4/CD8 < 0.5, percentage of CD4+ T cells <42.8%, and length of time from onset to confirmation of diagnosis >105 days were potential risk factors for poor prognoses. Length of time from onset to confirmation of diagnosis persisted as an independent predictor of all-cause mortality in multivariate analysis (odds ratio: 0.083, 95.0% confidence interval: 0.021–0.326, P < 0.001). However, the size of the lung lesions, dyspnea, thoracalgia, mediastinal lymphadenopathy, and pleural effusion did not significantly predict overall survival. There was no significant difference in prognosis according to the type of treatment. Conclusions: T. marneffei infections involving the respiratory system are common. The critical determinants of prognosis are HIV infection, CD4/CD8, percentage of CD4+ T cells, type of treatment, and the time range from onset to confirmation of diagnosis. Rapid and accurate diagnosis is crucial for improving prognosis.
基金This work was supported by the grants from the Key Subject Programs of Guangzhou Municipal Health Bureau （No. 2009-Zdi-16） the Natural Science Foundation of Guangdong Province （No. 10151006002000000） and Chinese National llth Five-year Plan on Key Infectious diseases （No. 2008ZX10001-006）.
文摘Background Penicillium mameffei （P. marneffe~） is an emerging pathogenic fungus that can cause invasive mycosis in patients with AIDS. The epidemiological features of P. marneffeiinfection in AIDS patients in Guangdong province remain unclear so far. This study aimed to investigate the genetic diversity within a population of 163 P. mameffei isolates obtained from AIDS patients and search for the dominant clinical strains in Guanqdong province.
文摘P enicillium marneffei ( P. marneffei ) is a facultative intracellular pathogen and the only thermally dimorphic fungus. This fungal infection is commonly found in Southeast Asian, Hong Kong, south China, and especially in acquired immunodeficiency syndrome (AIDS) patients. 1-4 We reported a patient with AIDS in whom infection due to P. marneffei was demonstrated. CASE REPORT A 34-year-old man with human immunodeficiency virus (HIV) infection (diagnosed before 6 months), living in Guangzhou of south China, was admitted to the hospital because of prolonged fever, cough, and weight loss. Initial examination revealed permanent high-grade fever (39-40℃) with chill and cough. Laboratory findings revealed haemoglobin concentration at 80 g/L, CD 4 lymphocyte count at 7×10 6/L, and viral load at 1.3×10 5 copies/ml. Blood and urine culture revealed no bacterial growth. Sputum culture was negative for mycobacterium. Chest X-ray film revealed left upper lobe ill-defined parenchymal opacities and widening of the superior mediastinum with left lung hilum prominence (Fig. 1). Abdominal B ultrasound showed hepatoplenomegaly and coeliac enlarged lymph nodes. On physical examination, the patient was found to have facial papula, cervical and superclavicular multiple lymph nodes.
