| Part Ⅰ Clinical Epidemiological Analysis of AIDS Complicated with Talaromyces Marneffei in Western GuangxiObjective: Talaromyces Marneffei distribution in warm and humid environment,mainly infected the HIV/AIDS patients,Western Guangxi region belongs to subtropical climate,HIV/AIDS infection rates is high,there are suitable for Talaromyces Marneffei growth and epidemic,However,the situation of AIDS combined with Talaromyces Marneffi infection in Western Guangxi has not been analyzed yet,The purpose of this study is to clarify the clinical and epidemiological characteristics of AIDS with Talaromyces Marneffei in Western Guangxi.Methods: From January 1,2016 to December 31,2020,AIDS patients in Baise City People’s hospital were enrolled to the study.Etiological culture and real-time fluorescent quantitative PCR detection of bacterial load were used as the basis for the diagnosis of Talaromyces Marneffei.Demographic data,clinical characteristics and outcome were collected.Excel 2019 and IBM SPSS23.0were used for data collation and statistical analysis.Results:(1)A total of 1874 patients were included in this study,including202 patients diagnosed with Talaromyces Marneffei,with an infection rate was10.78%.The age of patients with Talaromyces Marneffei ranged from 20 to 70 years old,and were mainly male,farmer,married,Zhuang,and had not received HAART treatment.(2)The infection rate of unmarried patients was higher than that of married patients,and the infection rate of patients without HAART treatment was higher.The infection rate was statistically significant among different age groups,marital status and antiviral treatment status(P<0.05),but there was no statistical significance among different genders and ethnic groups.(3)The infection rate of AIDS complicated with Talaromyces Marneffei was the highest in April and the highest in spring.(4)Fever,digestive system symptoms,respiratory system symptoms,weight loss and rash were the most common symptoms in patients with Talaromyces Marneffei,and bacterial and viral pneumonia,oral fungal infection and tuberculosis were the most common complications.(5)Talaromyces Marneffei patients with lower in white blood cells and red blood cells,hemoglobin,platelet,serum albumin,CD4 than Talaromyces Marneffei negative patients(P < 0.05),while serum bilirubin,alanine aminotransferase,aspertate aminotransferase,lactate dehydrogenase,serum calcitonin were higher than the Talaromyces Marneffei negative patients,the difference is statistically significant(P < 0.05).The creatinine,erythrocyte sedimentation rate and lactic acid in 2 groups were all increased,and there was no statistical difference between 2 groups(P>0.05).(7)Less than 50 years old,CD4 less than 50/ul,April were the risk factors for AIDS complicated with Talaromyces Marneffei infection.(8)The fatality rate of Talaromyces Marneffei was 5.45%,and the median length of hospitalization was 16 days,which was significantly higher than that of Talaromyces Marneffei negative patients(P=0.004).Conclusion:(1)Age below 50 years old and CD4 less than 50/ul are risk factors for AIDS complicated with Talaromyces Marneffei.The incidence is highest in spring.(2)Fever,digestive symptoms,weight loss and respiratory symptoms are the main symptoms of Talaromyces Marneffei.Bacterial and viral pneumonia,oral candidiasis and fungal esophagitis are common complications of Talaromyces Marneffei.(3)Talaromyces Marneffei infection is more likely to lead to abnormal blood routine,liver function and lactate dehydrogenase,serum calcitonin increase.(4)Talaromyces Marneffei infection may be the cause of long hospital stay.Part Ⅱ Study on the Value of qPCR Technique to Measure the Bacterial Load of Talaromyces Marneffei in the Diagnosis of AIDS Complicated with Talaromyces Marneffei InfectionObjective: The traditional diagnosis of Talaromyces Marneffei depends on pathogen culture,but pathogen culture takes a long time,and it is qualitative detection.At present,there is no quantitative index to evaluate the condition of Talaromyces Marneffei patients.The purpose of this study is to explore a reliable method for rapid and accurate diagnosis of Talaromyces Marneffei and to evaluate the value of qPCR in the diagnosis and evaluate the condition of patients with Talaromyces Marneffei.Methods: AIDS patients who were hospitalized on January 1,2016 and December 31,2020 in Baise People’s Hospital and were performed simultaneously for blood and/or bone marrow culture and qPCR tested for bacterial load of Talaromyces Marneffei were enrolled the study.Etiological culture of Talaromyces Marneffei as the gold standard,positive predictive value(PPV),the negative predictive value(NPV),sensitivity and specificity of bone marrow smear and real-time fluorescent quantitative PCR for detection of bacterial load were analyzed.APACHEII scoring system for condition evaluation,and analyzes the relationship between bacterial load and the condition of patients with Talaromyces Marneffei.Statistics were performed using IBM SPSS 23.0 statistical software.Results:(1)The negative predictive value,and positive predictive value,sensitivity and specificity of qPCR for the diagnosis of Talaromyces Marneffei were 92.96%,91.18%,93.94% and 95.45%.(2)The consistency between qPCR and etiological culture detection was high,and the Kappa value was 0.88.Bone marrow smear had high diagnostic specificity,but low sensitivity.The diagnostic consistency between bone marrow culture and bone marrow smear was general,Kappa value =0.35.(3)The duration of bone marrow culture was 2-12 days,with an average of 6.10 days,and the duration of blood culture was 2-16 days,with an average of 6.53 days.There was no statistical significance in the duration of culture between the two methods.qPCR detection of bacterial load and bone marrow smear microscopic examination time is short,can produce results on the one day.(4)Correlation analysis showed that the bacterial load was positively correlated with the patient’s condition,with correlation coefficient =0.430,P=0.007.bacterial load of non-severe patients was less than 1×10~6copies.Conclusion:1.The diagnostic value of qPCR detection of Talaromyces Marneffei in the diagnosis of Talaromyces Marneffei infection is obviously better than that of bone marrow smear.2.The detection of Talaromyces Marneffei by qPCR is a reliable method for early,rapid and accurate diagnosis of Talaromyces Marneffei.Part Ⅲ Efficacy analysis of voriconazole in the treatment of AIDS with Talaromyces MarneffeiObjective: Voriconazole is recommended as the replacement therapy of Talaromyces Marneffei,But there is no unified standard for the time of treatment,and there is no quantitative indicators to evaluate the treatment curative effect,The study was conducted to study the safety and efficacy of voriconazole in the treatment of Talaromyces Marneffei,and the course of treatment,as well as to evaluate the relationship between outcome、prognosis and bacterial load.Methods:Talaromyces Marneffei patients who were hospitalized in Baise people’s Hospital from January 2014 to October 2020 were selected to the study,accept amphotericin B(0.5-0.7 mg/kg.d)or voriconazole(6 mg/kg q12 h,12 hours and turn to 4 mg/kg q12h)as induction therapy,improved to itraconazole consolidate treatment and than secondary prevention,and through qPCR technology to detect bacteria loads,evaluating the effect of concentration of bacteria loads and condition of illness and the relationship between the prognosis.The drug safety was evaluated according to the occurrence of adverse events.Results:(1)A total of 78 patients received voriconazole and 93 patients received amphotericin B induction therapy.(2)The response rates of patients treated with voriconazole and amphotericin B were similar(84.21%,89.77%),but the duration of antifungal induction and hospital stay in the voriconazole group were shorter than those in the amphotericin B group(10.73±4.65 and 13.46±7.45,P =0.015,and the length of hospital stay was 18.06±8.11 and 21.43±8.74,P =0.024).(3)After voriconazole induction,the etiological negative conversion rate was 79.17%,which was higher than that of amphotericin B group(57.14%),and the average time of negative conversion was 10.92±6.65 days.(4)After induction therapy,the bacterial load of patients in voriconazole group and amphotericin B group decreased significantly,and there were significant differences in the bacterial load before and after induction therapy(Z=-3.580,P=0.000 in voriconazole group,Z=-2.803,P=0.005 in amphotericin B groud).(5)The voriconazole group had fewer adverse reactions.Conclusion:1.Voriconazole is an effective and safe antifungal agent for the treatment of AIDS-associated disseminated Talaromyces Marneffei.2.The induction treatment time of voriconazole for Talaromyces Marneffei was 11 days.3.As an induction period treatment drug,voriconazole can be used as a new choice for the treatment of AIDS complicated with Talaromyces Marneffei because of its high rate of negative etiology,short hospitalization time and treatment course during the induction period. |
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