| Objective:To study the differences in the clinical and laboratory.characteristics of penicillium marneffei(PM)pneumonia in patients with and without human immunodeficiency virus(HIV)infection.Methods:The clinical data of 60 patients with penicillium marneffei pneumonia in our hospital from 2003 to 2014 were retrospectively analyzed.The patients were divided into 2 groups,an HIV infection group(n=26)and a non-HIV infection group(n=34).The data of the 2 groups were compared.Results:①In the non-HIV infection group,male:22case,female:12case,agedl to 64 years old,were 43.25±20.02 years old and the duration of the disease was 120(59,249)days.the HIV infection group,male:24case,female:2case,aged 1.7 to 65 years old,were 34.6±12.24years old and the duration of the disease was 72(34,162)days.gender,age,the duration of the disease,the two groups have statistical significance(P<0.05).In the non-HIV infection group,with underlying diseases(14/34)and misdiagnosis of pulmonary tuberculosis(10/34).In the HIV infection group,with underlying diseases(5/26)and misdiagnosis of ulmonary tuberculosis(1/26),The primary diagnostic bases for the two groups of patients include the etiology obtained from the marrow skin lesion secretions of blood,tissue culture or lymph node biopsy in addition to pulmonary exudative lesion and ineffective antibiotic therapy.The group with negative HIV antibodies was misdiagnosed during recurrence with long disease course due to low positive rate in early etiological detection.The etiology of a few patients with negative HIV antibodies was obtained from their sputum,bronchoalveolar lavage fluid and lung tissue culture or pathology,but the positive rate was low(17.65%);②High,persistent fever,acute dyspnea and molluscum of the skin were more common in the HIV infection group,but intermittent fever,subcutaneous nodules and abscess were the features of the non—HIV infection group.Generalized chest pain(12/34).anhelation(13/34)and lung rale(22/34)were also more common in the non—HIV infection group(2/26,6/26,7/26,respectively in the HIV infection group,P<0.05;③The total white cell counts were mostly increased in the non-HIV infection group(32/34),but were mostly in the normal range(12/26)or decreased(9/26)in the HIV infection group,The blood CD4/CD8 ratio was normal or higher than 0.5 in the non-HIV infection group,but Was,less than 0.5 in the HIV infection group(P=0.000);④ Ground-glass opacity,maculas shadows,nodules,millet shadow,cavity,and pleural thickening were the main manifestations of chest radiology in the 2 groups,Pleural effusion and hilar node enlargement were Common in the non-HIV infection group.and osteolysis occurred only in the non-HIV infection group(n=12,P<0.05);⑤The prognosis of the non-HIV infection group was better(P<0.05),but more likely to relapse.27 cases improved,6 cases aggravated,1 case died and 9 case pneumonia relapse,2 case disseminated relapse in this group.However,13 cases improved,12 cases aggravated,1 cases died and 1 case pneumonia relapse in the HIV infection group.Conclusion:① Pneumonia of penicillium marneffei is a manifestation of pulmonary involvement by disseminated penicillium marneffei.In addition to the clinical characteristics of disseminated penicillium marneffei,the potential manifestations include fever,cough,expectoration,dyspnea,chest pain,weakness,emaciation,and moist rales in lungs.It is difficult to differentiate pneumonia of penicillium marneffei,bacterial pneumonia and tuberculosis.②It was found after comparison between these two groups that patients in the group of negative HIV antibodies were frequently misdiagnosed and presented consequently long disease course and recurrent condition due to a more difficult diagnosis resulted from low positive rate of etiological detection.In the group of positive HIV antibodies,total white blood cells were decreased or normal,lymphocytes decreased and bilateral lungs presented major characteristics of diffuse interstitial injuries.Meanwhile in the group of negative HIV antibodies,total white blood cells and neutrophils increased and lymphocytes were normal.Severe systemic inflammatory response existed and the progressive dyspnea,chest pain and pulmonary rales were even more significant than those in the positive group.Chest imaging examinations indicated unilateral exudative pulmonary lesions or consolidations occasionally accompanied by pleural effusion,mediastinum and pulmonary hilum lymphadenectasis,extrapulmonary ostealgia and osteolysis with tendency of recurrence.Antifungal agents or combined atomization or intrapulmonary local instilling of amphotericin:B was applied intravenously for treatment.The complete absorption of pulmonary focus takes 1-2 months but is not the indicator of drug withdrawal.A full treatment course according to the therapeutic schedule for disseminated penicillium mameffei is still required.The clinical outcome in the group of negative HIV antibodies was superior to that in the positive group. |
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