Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China.
Chin Med J (Engl). 2019 Aug 20;132(16):1909-1918. doi: 10.1097/CM9.0000000000000345.
Little study has investigated the differences between Talatomyces marneffei (T. marneffei) respiratory infection and tuberculosis and the prognostic factors of such infection. This study investigated the characteristics and prognostic factors of T. marneffei infections with respiratory lesions and the causes of misdiagnosis.
Clinical characteristics and prognoses of patients with T. marneffei infections with respiratory system lesion were investigated. T. marneffei diagnosis followed isolation from clinical specimens using standard culture, cytology, and histopathology. Survival curves were estimated by using Kaplan-Meier analysis, with log-rank test to compare differences in survival rates between groups. Univariate and multivariate Cox regression analyses were also performed to assess significant differences in clinical characteristics of overall survival.
Of 126 patients diagnosed with T. marneffei infections, 63 (50.0%) had T. marneffei respiratory system infections; 38.1% (24/63) were misdiagnosed as having tuberculosis. Human immunodeficiency virus (HIV) infection, CD4/CD8 < 0.5, percentage of CD4 T cells <42.8%, and length of time from onset to confirmation of diagnosis >105 days were potential risk factors for poor prognoses. Length of time from onset to confirmation of diagnosis persisted as an independent predictor of all-cause mortality in multivariate analysis (odds ratio: 0.083, 95.0% confidence interval: 0.021-0.326, P < 0.001). However, the size of the lung lesions, dyspnea, thoracalgia, mediastinal lymphadenopathy, and pleural effusion did not significantly predict overall survival. There was no significant difference in prognosis according to the type of treatment.
T. marneffei infections involving the respiratory system are common. The critical determinants of prognosis are HIV infection, CD4/CD8, percentage of CD4 T cells, type of treatment, and the time range from onset to confirmation of diagnosis. Rapid and accurate diagnosis is crucial for improving prognosis.
鲜有研究调查过马尔尼菲青霉菌（T. marneffei）呼吸道感染与肺结核之间的差异，以及此类感染的预后因素。本研究旨在调查具有呼吸道病变的马尔尼菲青霉菌感染的特征和预后因素，以及导致误诊的原因。
对患有呼吸系统病变的马尔尼菲青霉菌感染患者的临床特征和预后进行了研究。采用标准培养、细胞学和组织病理学方法从临床标本中分离出 T. marneffei 进行诊断。采用 Kaplan-Meier 分析估计生存曲线，对数秩检验比较组间生存率的差异。还进行了单因素和多因素 Cox 回归分析，以评估总生存率的临床特征的显著差异。
在 126 例诊断为 T. marneffei 感染的患者中，有 63 例（50.0%）患有 T. marneffei 呼吸系统感染；38.1%（24/63）被误诊为肺结核。人类免疫缺陷病毒（HIV）感染、CD4/CD8＜0.5、CD4 T 细胞百分比＜42.8%以及从发病到确诊的时间＞105 天是预后不良的潜在危险因素。从发病到确诊的时间在多因素分析中仍然是全因死亡率的独立预测因素（比值比：0.083，95.0%置信区间：0.021-0.326，P＜0.001）。然而，肺部病变的大小、呼吸困难、胸痛、纵隔淋巴结肿大和胸腔积液对总生存期没有显著预测作用。根据治疗类型，预后没有显著差异。
涉及呼吸系统的马尔尼菲青霉菌感染很常见。预后的关键决定因素是 HIV 感染、CD4/CD8、CD4 T 细胞百分比、治疗类型和从发病到确诊的时间范围。快速准确的诊断对于改善预后至关重要。
