Clinical Analysis Of Talaromyces Marneffei Infection In HIV Negative And HIV Positive Patients

Objective: To compare the similarities and differences of clinical characteristics of HIV negative and HIV positive patients infected with talaromyces marneffei.Methods: A retrospective analysis of the First Affiliated Hospital of Guangxi Medical University from May 2012 to April 2019 through the fungal culture of blood,bone marrow,sputum and other specimens or pathological examination of tissue specimens such as skin tissues and lymph nodes.Diagnosis and clinical considerations of talaromyces marneffei infections.Talaromyces marneffei infections have not been cultured on multiple specimens of fungal culture,but the infection of talaromyces marneffei infections has been positive for the detection of serum Marneffei blue load cells.Clinical characteristics of 175 inpatients.Results: 1.A total of 175 patients were collected,85 were HIV positive,including 72 males and 13 females,with an average age of(39 ± 12)years;90were HIV negative,including 57 males and 33 females,with an average age Is(48 ± 19)years old.Both HIV-positive and HIV-negative groups occur in men,and the age of onset is large.2.Combining underlying diseases: 26 patients(30.59%)in the HIV-positive group had underlying diseases,50 patients(55.56%)in the HIV-negative group had underlying diseases,the difference between the two groups was P <0.05.The underlying diseases of HIV-positive combination are mainly chronic hepatitis B(10.59%)and tuberculosis(5.88%).The basic diseases of HIV-negative combination are tuberculosis(32.22%)and diabetes(7.78%).There was no statistically significant difference in chronic hepatitis B and diabetes between the two groups.The comparison of tuberculosis between the two groups was statistically significant(P <0.05).The rate of basic disease combined with tuberculosis in the HIV-negative group was higher than that in the HIV-positive group.3.Clinical manifestations: including symptoms and signs.The main clinical manifestations of the two groups were fever,chills,pulmonary symptoms(cough,sputum,lung rales),systemic symptoms(anorexia,fatigue,weight loss),hepatosplenomegaly,lymphadenopathy and rash.Symptoms of anorexia,fatigue,nausea,vomiting,weight loss,oral mucosa leukoplakia,liver,splenomegaly,rash,abdominal distension,abdominal pain,are more common in HIV-positive group than in HIV-negative group(P <0.05);Cough,sputum,lung rales,subcutaneous masses were more common than HIV-positive group(P <0.05).In the HIV-negative group,the characteristics of the subcutaneous tumors are diverse,and the characteristics of the tumors lack specificity.4.Clinical classification: The clinical classification is mainly disseminated(93.71%).85 patients in the HIV-positive group were all disseminated in clinical classification,and 79 patients in the HIV-negative group were disseminated.The difference between the two groups was statistically significant(P <0.05).5.Laboratory examination:The total number of white blood cells in the HIV-negative group is more common,and it is mainly due to the increase in neutrophils.The total number of white blood cells in the HIV-positive group is usually normal or decreases.Both groups of patients had anemia,hypoproteinemia and elevated CRP,and the anemia was mainly mild to moderate.135 out of 175 patients were tested for absolute CD4 + T lymphocyte counts(78 in the positive group and 57 in the negative group),and 63 cases(80.77%)in the HIV-positive group with CD4 + T lymphocyte count <50 / μL,1 case(1.75%)in the HIV-negative group.6.Chest imaging features: 173 of 175 patients underwent chest imaging examination(84cases in HIV positive group,89 cases in HIV negative group),and 161 cases were abnormal in chest imaging examination(75 cases in HIV positive group,HIV 86 cases in the negative group),the chest imaging features of the two groups of patients were mainly plaque or cord-like high-density shadows,nodular dense shadows and pleural effusions.Pleural effusion and pleural thickening were more common in HIV negative group(P<0.05).7.Treatment and outcome: Among the 175 patients,one HIV positive group who did not agree to treatment.Among the 174 patients,139 patients improved(62 in the HIV-positive group and 77 in the HIV-negative group).There are two types of medications: combination therapy and single-agent therapy.In the HIV-positive group,37 patients received combination therapy(32 improved cases and 5patients with poor efficacy),and 47 patients received monotherapy(30improved patients and 17 with poor efficacy).Cases),there is a statistically significant difference in the improvement rate of combination therapy and monotherapy in HIV-positive group(P <0.05);13 cases of combination therapy in HIV-negative group(11 cases improved and 2 cases with poor efficacy),single drug There were 77 cases treated(66 cases improved and 11 cases with poor efficacy),and there was no statistically significant improvement in the rate of improvement between the combination therapy and the monotherapy in the HIV-negative group.Conclusion:1.Both HIV positive and HIV negative groups are more likely to occur in men,and the age of onset is longer.HIV negative group of patients with talaromycosis marneffei are mostly infected on the basis of chronic diseases,and tuberculosis is more common.HIV positive group mainly clinically disseminated TM infection.2.In the HIV-positive group,anorexia,weight loss,oral mucosal leukoplakia,skin rash,liver and splenomegaly are common,and subcutaneous tumors are more common in the negative group.3.The white blood cell count is always increased in HIV negative group,and it is mainly increased by neutrophil absolute value.In the HIV positive group,the white blood cell count is mostly normal or decreased,and it is more common in patients with CD4 smaller than 50.The chest imaging features of the HIV positive group and the HIV negative group lacke specificity,pleural effusion,pleural thickening or pericardial thickening were more common in HIV negative group than in positive group.4.There is no difference in the efficacy of antifungal treatment between HIV positive and HIV negative groups,and the combined effect of HIV positive group is better than that of monotherapy.