Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China; Laboratory of Emerging Infectious Diseases, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
Guangzhou Centre for Disease Control and Prevention, Guangzhou, China.
Clin Microbiol Infect. 2015 May;21(5):484-9. doi: 10.1016/j.cmi.2014.12.014. Epub 2014 Dec 26.
Prevalence of disseminated Penicillium marneffei infection is not known in human immunodeficiency virus (HIV)-infected patients. This retrospective study aimed to evaluate the prevalence of and risk factors for disseminated P. marneffei infection in HIV-infected patients during 2004-11 in Guangzhou, China. We tested 8131 archived HIV-infected patient serum samples for P. marneffei-specific mannoprotein (Mp1p) antigen using a highly sensitive and specific ELISA that we previously established. The CD4 count of 2686 cases was determined by flow cytometry. Logistic regression was used to assess predictors of Mp1p antigenaemia. The overall prevalence of disseminated penicilliosis as detected by positive serum Mp1p antigen was 9.36% (761/8131), in good concordance with Platelia™ Aspergillus immunoassay. During 2004-11, the prevalence increased to a peak of 12.58% (158/1256) in 2010 and decreased in 2011. Penicilliosis was strongly associated with progression from HIV to AIDS (OR 4.66, 95% CI 3.94-5.51, p <0.001) and humidity (OR 1.02, 95% CI 1.01-1.03, p 0.002). Disseminated penicilliosis occurred mainly during the rainy seasons (p <0.001). For 2686 cases with known CD4 count, logistic regression showed that CD4 count of <200 cells/μL was a risk factor for penicilliosis (OR 2.90, 95% CI 1.10-7.66, p 0.032), especially when it was <50 cells/μL (OR 24.26, 95% CI 10.63-55.36, p <0.001) during which 28.06% of patients developed disseminated penicilliosis. In conclusion, approximately 9.36% of the HIV-infected patients in our study developed disseminated penicilliosis. Rapid diagnosis may be achieved by performing serological surveillance for Mp1p antigenaemia as a routine procedure for all HIV-infected patients with CD4 count of <50 cells/μL.
在中国广州，2004-11 年间，我们评估了人类免疫缺陷病毒（HIV）感染者中播散性马尔尼菲青霉病感染的流行率和危险因素。我们使用之前建立的高度敏感和特异的酶联免疫吸附试验（ELISA），检测了 8131 例 HIV 感染者血清样本中马尔尼菲青霉特异性甘露糖蛋白（Mp1p）抗原。通过流式细胞术测定了 2686 例患者的 CD4 计数。采用 logistic 回归分析评估了 Mp1p 抗原血症的预测因子。通过血清 Mp1p 抗原阳性检测到的播散性Penicilliosis 的总体流行率为 9.36%（761/8131），与 Platelia™ Aspergillus 免疫测定法的结果一致。2004-11 年间，2010 年播散性青霉病的流行率达到 12.58%（158/1256）的峰值，随后在 2011 年下降。Penicilliosis 与 HIV 向 AIDS 的进展密切相关（OR 4.66，95%CI 3.94-5.51，p <0.001）和湿度（OR 1.02，95%CI 1.01-1.03，p 0.002）。播散性青霉病主要发生在雨季（p <0.001）。对于 2686 例已知 CD4 计数的病例，logistic 回归显示，CD4 计数 <200 个细胞/μL 是青霉病的危险因素（OR 2.90，95%CI 1.10-7.66，p 0.032），尤其是当 CD4 计数 <50 个细胞/μL 时（OR 24.26，95%CI 10.63-55.36，p <0.001），28.06%的患者发生播散性青霉病。总之，本研究中约 9.36%的 HIV 感染者发生了播散性 Penicilliosis。对于所有 CD4 计数 <50 个细胞/μL 的 HIV 感染者，通过常规检测血清 Mp1p 抗原进行血清学监测，可能会快速诊断该病。
