马尔尼菲青霉血流感染的 HIV 患者预后不良的临床特征和危险因素。
Clinical characteristics and risk factors for poor prognosis among HIV patients with Talaromyces marneffei bloodstream infection.
机构信息
Department of Infection and Immunity, Shanghai Public Health Clinical Center, Shanghai, China.
Department of Obstetrics and Gynecology, Shanghai Public Health Clinical Center, Shanghai, China.
出版信息
BMC Infect Dis. 2021 Jun 1;21(1):514. doi: 10.1186/s12879-021-06232-2.
BACKGROUND
Talaromyces marneffei (TM) bloodstream infection is common in Acquired Immunodeficiency Syndrome (AIDS) patients with extreme immunodeficiency in Southeast Asia and South China, however, clinical case study on TM bloodstream infection is scarce. We retrospectively analyzed the clinical characteristics of TM bloodstream infection in hospitalized AIDS patients and determined the outcomes of hospitalization after diagnosis in our hospital over the past 5 years.
METHODS
From January 2015 to July 2020, 87 cases of TM detected by blood culture in patients admitted to our center were collected. The admission complaints, blood cells, biochemistry, CD4 and CD8 cell counts and 1,3-β-D-glucan (BDG), procalcitonin (PCT), CRP level on the day of blood culture test, and outcomes during hospitalization were analyzed. Logistic regression analysis was performed for the risk factors for poor prognosis (60 cases). Spearman correlation analysis was used to analyze the correlation between peripheral blood cells, albumin and the time required for TM turnaround in blood culture. The difference was statistically significant when the P value was < 0.05.
RESULTS
A total of 87 patients were collected, with a median age of 34 years, a median hemoglobin of 94 g/L and CD4 count of 7/μl. The rate of TM bloodstream infection among all in-hospital patients increased from 0.99% in 2015 to 2.09% in 2020(half year). Patients with TM bloodstream infection with CD8 count < 200/μl had a 12.6-fold higher risk of poor prognosis than those with CD8 count > 200/μl (p = 0.04), and those with BDG < 100 pg/mL had a 34.9-fold higher risk of poor prognosis than those with BDG > 100 pg/mL (p = 0.01).
CONCLUSIONS
TM bloodstream infection is becoming more common in advanced AIDS patients in endemic areas. For those patients with extremely low CD4 and CD8 cell counts below 200/μl is with an increased risk of poor prognosis.
背景
马尔尼菲青霉（TM）血流感染在东南亚和中国南方极度免疫缺陷的艾滋病（AIDS）患者中很常见，但关于 TM 血流感染的临床病例研究较少。我们回顾性分析了我院过去 5 年住院 AIDS 患者 TM 血流感染的临床特征，并确定了诊断后住院的结局。
方法
2015 年 1 月至 2020 年 7 月，我们共收集了 87 例我院患者血培养检出 TM 的病例。分析入院时的主诉、血细胞、生化、CD4 和 CD8 细胞计数及血培养当天的 1,3-β-D-葡聚糖（BDG）、降钙素原（PCT）、C 反应蛋白（CRP）水平，以及住院期间的结局。对预后不良（60 例）的危险因素进行 logistic 回归分析。采用 Spearman 相关分析外周血细胞、白蛋白与血培养 TM turnaround 时间的相关性。当 P 值<0.05 时差异有统计学意义。
结果
共收集 87 例患者，中位年龄 34 岁，中位血红蛋白 94 g/L，CD4 计数 7/μl。TM 血流感染在所有住院患者中的发生率从 2015 年的 0.99%上升到 2020 年的 2.09%（半年）。CD8 计数<200/μl 的 TM 血流感染患者预后不良的风险是 CD8 计数>200/μl 的患者的 12.6 倍（p=0.04），BDG<100pg/mL 的患者预后不良的风险是 BDG>100pg/mL 的患者的 34.9 倍（p=0.01）。
结论
TM 血流感染在流行地区 AIDS 患者中越来越常见。对于那些极度低 CD4 和 CD8 细胞计数低于 200/μl 的患者，预后不良的风险增加。
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