Analysis The Clinical Features And Evaluation The Risk Factors For Relapse Or Death Of Penicilliosis Marneffei

Objectives:To analysis the demographic information, clinical characteristics, laboratory test result, treatment, short-term and long-term follow up assessment of therapy effect between the patients with or without HIV infected, and find out the risk factors for relapse or death of penicilliosis marneffei.Methods:Collected the clinical data of the patients who were diagnose with penicilliosis marneffei between January 1,2012 and October 31,2015 at The First Affiliated Hospital of Guangxi Medical Universiry. We analysis the difference between the case in two groups, which were divided base on the patiants with or without HIV infected. Then use univariate and multiple logistic regression analysis to find out the risk factors for relapse or death of penicilliosis marneffei.Results:A total of 90 cases were enrolled, including.48 HIV-infected and 42 HIV-uninfected. The seasonality term for penicilliosis marneffei has a peak in March and June. The common clinical characteristics were fever(78.9%), weight loss(60.0%), lymphadenectasis(57.8%), anemia(57.1), skin lesion(47.5%), respiratory symptom(43.3%), digestive symptom(22.2%), osteolytic lesions(21.1%), hepatomegaly(14.4%), splenomegaly(6.7%). The patients with HIV infected were more likely to have weight loss and digestive symptom, the HIV-uninfected patients were more likely to have skin lesion, respiratory symptom, digestive symptom. The differences were statistical significance(P<0.05). The HIV-infected patients also have lower white blood cell count and blood platelet count, higher ALT, AST and serum creatinine(P< 0.05). The patients who recieved antifungal therapy in time have higher short-term and long term cure rate compare with the patient who antifungal therapy was delay(P< 0.05). The patients recevied therapy by fluconazole have the highest improvement rate at short-term assessment. The patients received therapy by amphotericin B had lowest relapse rate and mortality rate at long-term assessment. But the differences weren’t statistical significance(P>0.05). The HIV-uninfected patients have higher improvement rate than the HIV-infected patient at short term assessment, but they also have higher relapse rate and mortality rate at long term assessment. Multiple Logistic regression analysis results show:received antifungal in time, lower lymphocyte count were the protective factors of all PSM patients; received antifungal in time, received HARRT were the protective factors of the HIV-infected patients; higher platelet count were the protective factors of the HIV-uninfected patients.Conclusions:The morbidity of PSM in Guangxi province is increasing, and the mortality is decreasing in resent years. Environment temperature and humidity are associative to the infections. PSM clinical manifestations include fever, weight less, anemia, skin lesions and so on. Laboratory tests is non- specificity compare with other infectious disease. Skin lesions culture is most meaningful in mycology test. Amphotericin B is recommend as the first choise drug to severe PSM patients, voriconazole can be the alternative drug to the patients couldn’t tolerate the toxic side effect of amphotericin B or have kidney or liver damage. Fluconazole can be administed in mild to moderately severe patients. The patients with or without HIV infected were different in clinical manifestations and Laboratory tests. The HIV-uninfected patients might have undiscover immunodeficiency due to their infections. Received antifungal therapy, received HARRT and had increasing PLT are the protective factors for provent the relapse or death of PSM.