1434. Clinical and laboratory characteristics of penicilliosis marneffei among patients with and without HIV infection at Maharaj Nakorn Chiang Mai hospital
Session: Poster Abstract Session: Fungal Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Chaiwarith_IDWEEK2013.pdf (201.2 kB)
  • Background: Penicilliosis marneffei is a common human immunodeficiency virus (HIV)–associated opportunistic infection. It is increasingly diagnosed in HIV-uninfected individuals. This study aimed to compare the clinical and laboratory features among HIV infected and HIV-uninfected individuals. In addition, the risk factors for death among patients infected with P. marneffeiwere determined.

    Methods: A retrospective study was conducted among patients age ≥ 15 years old and had positive microbiologic specimens for P. marneffei. from January 1, 2007 to December 31, 2011.

    Results: During the study period, 116 HIV-infected and 34 HIV-uninfected patients were enrolled. Among HIV-infected patients, 37 patients (31.9%) were female, and the median age was 39 (IQR 32, 48.5) years. The most common previous opportunistic infection was tuberculosis (23 patients, 54.8%). Among non-HIV infected individuals, 17 patients (50%) were female, and the median age was 55 (50, 64) years. The most common co-infection was non-tuberculous mycobacteria (15 patients, 48.4%). Comparing to HIV-infected patients, HIV-uninfected patients were older, less likely to have fever and splenomegaly, less likely to have umbilicated skin lesions, more likely to have Sweet’s syndrome, more likely to have bone and joint involvement, had higher white blood cell count (WBC), platelet count, and CD4 cell count, lower alanine transaminase (ALT), and less positive blood cultures. Multivariate analysis showed that factors associated with being HIV-infection were age<40 years (OR 7.63, 95% CI 2.05, 28.43), WBC < 5000 cells/mm3(OR 9.74, 95% CI 3.03, 31.27), and ALT > 40 IU/L (OR 3.68, 95% CI 1.32, 10.31). The mortality rate was 17.3% (20 patients) among HIV-infected and 23.5% (8 patients) among HIV-uninfected patients. Risk factors of death included albumin <2.5 mg/dL (OR 6.60, 95% CI 2.07, 21.04, p-value = 0.001), duration of illness < 14 days (OR 7.37, 95% CI 2.24), the absence of lymphadenopathy (OR 6.94, 95% CI 1.38, 34.85, p-value = 0.019), and did not receive treatment (OR 4.36, 95% CI 1.18, 16.17, p-value = 0.027).

    Conclusion: Clinical and laboratory characteristics of penicilliosis marneffei are different in HIV-uninfected compared to HIV-infected patients. Physician’s awareness of this disease in HIV-uninfected patients in Southeast Asia may improve prompt diagnosis and treatment and lead to improved clinical outcome.

    Romanee Chaiwarith, MD, MHS1, Rathakarn Kawila, MD1 and Khuanchai Supparatpinyo, MD2, (1)Internal Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand, (2)Internal Medicine, Chiang Mai University, Maung, Chiang Mai, Thailand

    Disclosures:

    R. Chaiwarith, None

    R. Kawila, None

    K. Supparatpinyo, None

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