| OBJECTIVE: To study the clinical characteristics of disseminatedpenicilliosis marneffei (PSM) in patients without human immunodeficiencyvirus (HIV) infection.METHODS: The clinical data of20disseminated PSM patients withoutHIV infection in our hospital from March2003to December2011wereretrospectively analyzed. They were divided into2groups, a with underlyingdiseases group（n=9）and a without underlying diseases group(n=11). The dataof the2groups were compared.RESULTS:①The patients in with underlying diseases group were56（43,67）years old and the duration of the disease was120（30,1080）days. Thepatients in without underlying diseases group were37（1,62） years old and theduration of the disease was30（4,90） days. In with underlying diseases group,the average onset age was elder and the duration of the disease was longer ascompared to those of the without underlying diseases group (P<0.05). Both ofthem had been misdiagnosed as many diseases and the misdiagnosis rate oftuberculosis was the highest (65%).②Fever and anemia could be found in allpatients.18cases had fatigue, anorexia and weight loss,15cases hadlymphadenectasis and lung wet rales.14cases had cough and skin lesion.13 cases had hepatomegaly.12cases had splenomegaly.11cases had dyspnea andpain in both muscle and joint. The diversity between the two groups had nostatistically significant.③In20cases, the serum albumin (A) decreased, theserum globulin (G) increased, A/G ratio reversed, ESR and CRP increasedobviously too. The diversity between the two groups had no statisticallysignificant. The total white cell counts were increased with neutrophils in17cases. The counts of the lymphocytes decreased a little. The total white cellcounts and neutrophils in with underlying diseases group were significantlyhigher than those of the without underlying disease group (P<0.05). The serumtotal bilirubin was increased in11cases. Eight of them were with underlyingdiseases and three were without underlying diseases. The damage of renalfunction appeared in7cases. Five of them were with underlying diseases andthree were without underlying diseases. The damage of liver and kidneyfunction in with underlying diseases group was more serious（P<0.05）.④13patients had tested blood T lymphocyte substock. The percentage of the total Tlymphocyte in8cases and the CD4in4cases were decreased. The bloodCD4/CD8ratio was normal or higher than0.5in all cases and even higher than0.9in11cases. All of the serum immunoglobulin which had been tested in8cases were increased. The diversity between the two groups had no statisticallysignificant.⑤The chest radiology in all patients were abnormal. The patchyconsolidation and fibrous cords in15cases, lymphadenectasis of the hiluspulmonis and mediastinum in8cases could be found respectively. Masses andcavitas also could be seen in3cases. Mutli-node could be found in2cases.There were15cases with inflammatory serous effusion including pleuraleffusion, ascites, pericardial effusion and pelvic effusion. There were8caseswith osteolytic lesion and3of them with fracture. The diversity between the two groups had no statistically significant.⑥All patients were defined according toetiology including tissue culture73%(8/11), abscess secretion cultures64%(7/11), pathology61%(11/18), bone marrow culture33%(2/6), blood culture30%(6/20), bone smear6.7%(1/15) and sputum culture6.2%(1/16). Granuloma,small abscess, caseous necrosis and proliferation of macrophage were thepathological characteristics. The diversity between the two groups had nostatistically significant.⑦The prognosis of the without underlying diseasesgroup was better(P<0.05).8cases improved,2cases aggravated and1case diedin this group. However,4cases aggravated,3cases died and only2casesimproved in with underlying diseases group.12cases improved after the initialtreatment while7cases relapsed.4of them were in the with underlying diseasesgroup and relapsed in76(23,450) days.3of them were in the without underlyingdiseases group which recurrence time (630(120,1460) days) was longer thanwith underlying diseases group (P<0.05). The morality of the patients thatrelapsed was29%.8cases could be followed-up finally.3cases improved and1case died in the without underlying diseases group while1case improved and3cases died in the with underlying diseases group. The final morality of the twogroups was40%. The main cause of death was multiple organ dysfunction(MODS) and resistance of drugs.CONCLUSIONS:①PM can infect the people without humanimmunodeficiency virus (HIV) infection. The infection rate has nothing to dowith the host whether be with underlying diseases or not. PM can result indisseminated and suppurative infection. The main characteristic is that thesignificantly increase of neutrophils, the formation of multiple abscess in thewhole body, including severe inflammation and multiple organ dysfunction. It isvery difficult to distinguish with tuberculosis and nontuberculous mycobacteria (NTM) infection in terms of the clinical and pathological characteristic. It willnot be identified but etiology.②T here are not significant differences in clinicalcharacteristics between the two groups. But in with underlying diseases group,the onset age is bigger, the duration of the disease is longer, the systemicinflammatory response is more obvious, the damage of liver and kidney functionis more serious and the prognosis was poorer. The recurrence rates are high inboth of the two groups and the recurrence time is uncertain. The patients in thewith underlying diseases group relapse earlier. The effect of retreatment is poor,even resistant to all kinds of antifungal drugs. It shows that the treatment of thedisseminated penicilliosis marneffei (PSM) without human immunodeficiencyvirus infection is significantly complicated. So there are many problems requireimmediately solution, such as how to select the antifungal drugs, determine theclinical cure and the discontinuation time of treatment, prevent relapse and soon. |
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