2011-2017 年中国广东 HIV 相关足放线菌病的临床流行病学和结局。
Clinical epidemiology and outcome of HIV-associated talaromycosis in Guangdong, China, during 2011-2017.
机构信息
Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA.
出版信息
HIV Med. 2020 Dec;21(11):729-738. doi: 10.1111/hiv.13024.
OBJECTIVES
Talaromycosis is an invasive mycosis endemic to Southeast Asia. This study aimed to investigate the epidemiology, clinical features and prognostic factors of HIV-associated talaromycosis in Guangdong, China.
METHODS
We retrospectively evaluated HIV patients hospitalized with histopathology- or culture-confirmed talaromycosis between 2011 and 2017. Factors associated with poor prognosis were identified using logistic regression.
RESULTS
Overall, 1079 patients with HIV-associated talaromycosis were evaluated. Both the number and prevalence of talaromycosis among HIV admissions increased from 125 and 15.7% in 2011 to 253 and 18.8% in 2017, respectively, reflecting the increase in HIV admissions. Annual admissions peaked during the rainy season between March and August. Common clinical manifestations included fever (85.6%), peripheral lymphadenopathy (72.3%), respiratory symptoms (60.8%), weight loss (49.8%), skin lesions (44.5%) and gastrointestinal symptoms (44.3%). Common laboratory abnormalities were hypoalbuminaemia (98.6%), anaemia (95.6%), elevated aspartate aminotransferase level (AST) (76.9%), elevated alkaline phosphatase level (55.8%) and thrombocytopenia (53.7%). The median CD4 count was 9 cells/μL. Talaromyces marneffei was isolated from blood and bone marrow cultures of 66.6% and 74.5% of patients, respectively. The rate increased to 86.6% when both cultures were performed concurrently. At discharge, 14% of patients showed worsening conditions or died. Leucocytosis, thrombocytopenia, elevated AST, total bilirubin, creatinine and azole monotherapy independently predicted poor prognosis.
CONCLUSIONS
The incidence of HIV-associated talaromycosis has increased in Guangdong with the high HIV burden in China. Skin lesions were seen in less than half of patients. Induction therapy with azole alone is associated with higher mortality. Findings from this study should help to improve treatment of the disease.
目的
足放线病菌病是一种流行于东南亚的侵袭性真菌病。本研究旨在调查中国广东地区 HIV 相关足放线病菌病的流行病学、临床特征和预后因素。
方法
我们回顾性评估了 2011 年至 2017 年间因组织病理学或培养证实的足放线病菌病住院的 HIV 患者。使用逻辑回归识别与不良预后相关的因素。
结果
总体而言，共评估了 1079 例 HIV 相关足放线病菌病患者。HIV 住院患者中足放线病菌病的数量和患病率均从 2011 年的 125 例和 15.7%增加到 2017 年的 253 例和 18.8%，反映了 HIV 住院患者的增加。每年的住院高峰出现在 3 月至 8 月的雨季。常见的临床表现包括发热（85.6%）、外周淋巴结病（72.3%）、呼吸道症状（60.8%）、体重减轻（49.8%）、皮肤损伤（44.5%）和胃肠道症状（44.3%）。常见的实验室异常包括低白蛋白血症（98.6%）、贫血（95.6%）、天门冬氨酸氨基转移酶（AST）升高（76.9%）、碱性磷酸酶升高（55.8%）和血小板减少症（53.7%）。中位 CD4 计数为 9 个/μL。66.6%和 74.5%的患者血培养和骨髓培养均分离出马尔尼菲青霉菌。当同时进行两种培养时，检出率增加到 86.6%。出院时，14%的患者病情恶化或死亡。白细胞增多、血小板减少、AST 升高、总胆红素、肌酐和唑类单药治疗均独立预测不良预后。
结论
随着中国 HIV 负担的增加，广东地区 HIV 相关足放线病菌病的发病率有所增加。不到一半的患者出现皮肤损伤。单独使用唑类药物诱导治疗与更高的死亡率相关。本研究结果应有助于改善该疾病的治疗。
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