Clinical Analysis Of Penicillium Marneffei Infection In 160 Patients With Varied Immune States

Objective: To investigate the clinical characteristics of Penicilliosis marneffei (PSM) under different immune status.Methods: Through reviewing clinical data of 160 cases with PSM admitted to the first affiliated hospital of Guangxi Medical University from January 2003 to December 2015.Results: PSM was diagnosed in 160 cases, including 33 cases of immunocompetent, immunodeficiency in 127 cases. the group with immunodeficiency was older than that with immunocompetent group (P<0.05).In both groups, the clinical manifestation were fever (92.1%), anemia(89.3%),weight loss(88.1%), fatigue(86.2%), cough(80.0%), expectoration(76.3%), skin lesions(64.3%), superficial lymph nodes(61.2%), hepatomegaly(21.9%), chest pain(16.2%), bone and joint pain( 15.6%)), splenomegaly( 12.5%),dyspnea(11.2%), immunocompetent group of superficial lymph nodes,hepatomegaly and bone and joint pain were more common than immunodeficiency group (P<0.05). Two groups of patients laboratory results were shown immunodeficiency white blood cell count and neutrophils were significantly higher than immunocompetent group(P<0.05), and CD4+T lymphocyte count was significantly lower than the immunocompetent group(P<0.05). Amphotericin B and itraconazole groups of patients survival rate was higher than that of itraconazole and fluconazole group (P<0.05), the prognosis of immunocompetent group was better than immunodeficiency group (P<0.05).Conclusions: ?PM was deep opportunistic pathogen, with insidious onset,virulent and other characteristics, in addition to immunodeficiency patients can cause invasive infection, immunocompetent host may be ill. ?The incidence of PSM was mainly in spring and summer, and the occupation distribution was mostly farmers and unemployed.?The clinical manifestations of PSM were complex and varied, may be associated with systemic inflammatory response and multiple organ dysfunction, diagnosis mainly depends on the pathogenic examination.Comparison of 2 groups, immunocompetent group shallow table lymph node enlargement, hepatomegaly and bone and joint pain are more common,immunodeficiency group systemic inflammatory response, CD4 + T cell count reduction is more obvious.?PSM chest imaging disease types often showed nodule / mass shadow, spot film, the distribution of the area in the middle and lower lung, the number of lesions often occurred more frequently.?PSM rapid development, if not timely treatment, the mortality rate is very high. By comparison, immunocompetent group than in the immunodeficiency groups have good prognosis, suggesting that the prognosis of the disease is closely related to the immune status of the patients. Therefore, in the course of treatment should early nutritional support on immune function and recovery treatment.