Epidemiologic Feature And Clinical Analysis Of HIV/AIDS With Penicilliosis Marneffei In Yunnan Province

Objective: To understand the epidemiologic features of HIV/AIDS with Penicilliosis Marneffei in Yunnan Province, China. To explore the clinical characteristics of HIV/AIDS with Penicilliosis Marneffei and the death related factors of patients, and to provide evidence for the prevention and treatment of HIV/AIDS with Penicilliosis Marneffei.Methods: The object of study was analysis of HIV/AIDS patients with Penicilliosis Marneffei,that were hospitalized in Yunnan Province Infectious Diseases Hospital and Kunming Third People’s Hospital from January 2014 to June 2016 . To collect the patient’s epidemiological and clinical data. Inspection of related lab records and experiments. Using Excel to establish a database. Statistical analysis was performed with SPSS 17.0 software. Logistic single factor and multivariate unconditional regression analysis were used to analyze the effect of related factors on death.Results:1. Epidemiologic Feature: 315 patients including 241 males and 74 females.The ratio of male to female is 3.3: 1. The average age of patients was 35 48±9.75 years old. Mainly for young patients aged 19 to 40 years. Married patients were 263 cases, 35 of unmarried cases, divorced 14 cases, widowed 3 cases. Ethnic groups to the Han-based, accounting for 89.2%, other ethnic minorities accounting for 10.8%.293 cases of patients were living in Yunnan Province. The other provinces consisted of 19 cases, Myanmar 2 cases, 1 case is not clear. The proportion of patients who were unemployed and farmer were 53.3% and 23.8% respectively. Population of 77.8 percent were junior high school and below. HIV mode of infection was mainly sexually transmission, accounting for 86%. The proportion of injecting drug transmission, mother to child transmission, blood transfusion and unknown is 10.8%,1.3%, 0.3% and 1.6% respectively.2. Clinical features: (1) Clinical manifestations: 92.7% patients had fever, 27.9% had characteristic rash, 25.1% had oral mucosal damage, 28.9% had digestive symptoms,39.0% had respiratory symptoms, and 82.5% had central nervous system symptoms.(2) Imaging examination: B ultrasonic showed 53.7% of patients had splenomegaly,18.7% had liver enlargement, 51.1% had lymphadenopathy, and 11.1% had ascites.(3) Chest radiography showed 51.4% of patients with lung field spotted spotted or spotted infiltrating shadows, 19.4% had miliary nodular changes, 9.2% had pulmonary interstitial changes, 33.7% hilar or mediastinal lymph nodes, 21.0 % had pleural effusion. (4) Laboratory examination showed 84.1% patients CD4 + T lymphocytes <50cells / μL. 58.7% patients with white blood cells <4.0 × 109 / L,58.7% platelet <100 × 109 / L, 79.4% anemia, 31.7% of the three lines were reduced.(5) Fungal culture and identification: 89.2% of the blood culture was positive, 91.1%of bone marrow culture was positive, the positive rate of the two culture showed no significant difference. (6) Combined infection: 60.9% of patients with other infections,21.3% of patients with two or more combined infection, the most common infection for oral candidiasis (23.8%).(7)Rash, fever, gastrointestinal ’symptoms,lymphadenopathy, platelet abnormalities, aspartate aminotransferase abnormalities,combined with other infections occurred in CD4 ’ T lymphocytes <50cells / μL patients. (8) Treatment: amphotericin B combined with itraconazole and voriconazole combined with itraconazole efficacy is basically the same, its efficacy is better than fluconazole combined with itraconazole and itraconazole alone. (9) Prognosis: half of the recurrence rate of 2.9%, the mortality rate of 11.7%.3. Logistic univariate analysis showed that age (middle-aged and elderly people),marital (non-spouse), respiratory symptoms, elevated alanine aminotransferase,elevated aspartate aminotransferase were risk factors for death. Itraconazole treatment,voriconazole treatment, HAART treatment, lymphadenopathy and splenomegaly were protective factor in patients. Logistic multivariate analysis showed that age(middle-aged), marriage (no spouse), interstitial lung changes, alanine aminotransferase increased risk factors for death; itraconazole treatment, voriconazole treatment, HAART treatment were the patient protective factors.Conclusion: Yunnan province is the epidemic area of HIV/AIDS with Penicilliosis Marneffei.The disease can occur in people of different ages and all walks of life. The clinical manifestations of HIV/AIDS with Penicilliosis Marneffei are complex. It can express itself as fever, hepatosplenomegaly, lymph nodes enlargement,anemia,but may also appear as skin rash,mouth, digestive system,respiratory system,the central nervous system and other system damage. For middle-aged, non-spouse, pulmonary interstitial changes, elevated alanine aminotransferase patients should be given high priority. HIV/AIDS with Penicilliosis Marneffei patients should be given timely antiviral and antifungal therapy to reduce mortality.