R S Ying1, T Le2,3, W P Cai1, Y R Li4, C B Luo1, Y Cao1, C Y Wen1, S G Wang1, X Ou1, W S Chen1, S Z Chen1, P L Guo1, M Chen5, Y Guo4, X P Tang1, L H Li1. 1. Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China. 2. Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA. 3. Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam. 4. Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China. 5. Hospital-Acquired Infection Control Department, Bijie Third People's Hospital, Bijie, China.
Abstract
OBJECTIVES: Talaromycosis is an invasive mycosis endemic to Southeast Asia. This study aimed to investigate the epidemiology, clinical features and prognostic factors of HIV-associated talaromycosis in Guangdong, China. METHODS: We retrospectively evaluated HIV patients hospitalized with histopathology- or culture-confirmed talaromycosis between 2011 and 2017. Factors associated with poor prognosis were identified using logistic regression. RESULTS: Overall, 1079 patients with HIV-associated talaromycosis were evaluated. Both the number and prevalence of talaromycosis among HIV admissions increased from 125 and 15.7% in 2011 to 253 and 18.8% in 2017, respectively, reflecting the increase in HIV admissions. Annual admissions peaked during the rainy season between March and August. Common clinical manifestations included fever (85.6%), peripheral lymphadenopathy (72.3%), respiratory symptoms (60.8%), weight loss (49.8%), skin lesions (44.5%) and gastrointestinal symptoms (44.3%). Common laboratory abnormalities were hypoalbuminaemia (98.6%), anaemia (95.6%), elevated aspartate aminotransferase level (AST) (76.9%), elevated alkaline phosphatase level (55.8%) and thrombocytopenia (53.7%). The median CD4 count was 9 cells/μL. Talaromyces marneffei was isolated from blood and bone marrow cultures of 66.6% and 74.5% of patients, respectively. The rate increased to 86.6% when both cultures were performed concurrently. At discharge, 14% of patients showed worsening conditions or died. Leucocytosis, thrombocytopenia, elevated AST, total bilirubin, creatinine and azole monotherapy independently predicted poor prognosis. CONCLUSIONS: The incidence of HIV-associated talaromycosis has increased in Guangdong with the high HIV burden in China. Skin lesions were seen in less than half of patients. Induction therapy with azole alone is associated with higher mortality. Findings from this study should help to improve treatment of the disease.
OBJECTIVES:Talaromycosis is an invasive mycosis endemic to Southeast Asia. This study aimed to investigate the epidemiology, clinical features and prognostic factors of HIV-associated talaromycosis in Guangdong, China. METHODS: We retrospectively evaluated HIV patients hospitalized with histopathology- or culture-confirmed talaromycosis between 2011 and 2017. Factors associated with poor prognosis were identified using logistic regression. RESULTS: Overall, 1079 patients with HIV-associated talaromycosis were evaluated. Both the number and prevalence of talaromycosis among HIV admissions increased from 125 and 15.7% in 2011 to 253 and 18.8% in 2017, respectively, reflecting the increase in HIV admissions. Annual admissions peaked during the rainy season between March and August. Common clinical manifestations included fever (85.6%), peripheral lymphadenopathy (72.3%), respiratory symptoms (60.8%), weight loss (49.8%), skin lesions (44.5%) and gastrointestinal symptoms (44.3%). Common laboratory abnormalities were hypoalbuminaemia (98.6%), anaemia (95.6%), elevated aspartate aminotransferase level (AST) (76.9%), elevated alkaline phosphatase level (55.8%) and thrombocytopenia (53.7%). The median CD4 count was 9 cells/μL. Talaromyces marneffei was isolated from blood and bone marrow cultures of 66.6% and 74.5% of patients, respectively. The rate increased to 86.6% when both cultures were performed concurrently. At discharge, 14% of patients showed worsening conditions or died. Leucocytosis, thrombocytopenia, elevated AST, total bilirubin, creatinine and azole monotherapy independently predicted poor prognosis. CONCLUSIONS: The incidence of HIV-associated talaromycosis has increased in Guangdong with the high HIV burden in China. Skin lesions were seen in less than half of patients. Induction therapy with azole alone is associated with higher mortality. Findings from this study should help to improve treatment of the disease.
Authors: Jun Chen; Renfang Zhang; Yinzhong Shen; Li Liu; Tangkai Qi; Zhenyan Wang; Wei Song; Yang Tang; Hongzhou Lu Journal: Am J Trop Med Hyg Date: 2017-06 Impact factor: 2.345
Authors: Ana C Matos; Daniela Alves; Sofia Saraiva; Ana S Soares; Tatiana Soriano; Luis Figueira; Fátima Fraga; Manuela Matos; Ana C Coelho Journal: J Wildl Dis Date: 2018-06-28 Impact factor: 1.535
Authors: J Jiang; S Meng; S Huang; Y Ruan; X Lu; J Z Li; N Wu; J Huang; Z Xie; B Liang; J Deng; B Zhou; X Chen; C Ning; Y Liao; W Wei; J Lai; L Ye; F Wu; H Liang Journal: Clin Microbiol Infect Date: 2018-04-24 Impact factor: 8.067
Authors: Nguyen T M Thu; Jasper F W Chan; Vo Trieu Ly; Hoa T Ngo; Ha T A Hien; Nguyen P H Lan; Nguyen V V Chau; Jian-Piao Cai; Patrick C Y Woo; Jeremy N Day; Rogier van Doorn; Guy Thwaites; John Perfect; K Y Yuen; Thuy Le Journal: Clin Infect Dis Date: 2020-06-21 Impact factor: 9.079