Clinical And Histopathological Analysis Of AIDS Patients Complicated With Penicilliosis Marneffei

Objective:To explore the clinical and histopathological characteristics of AIDS patients with Penicilliosis marneffei (PSM). To elaborate relationship between the clinical and pathological features, including preliminary discussion between the relationship of inflammatory cells in skin lesions and the progression of pathological changes.Methods:Data collection of 6 AIDS patients with Penicilliosis marneffei treated at the department of dermatology, First affiliated hospital of Kunming medical university from December 2005 to December 2015. Clinical data of all AIDS patients was retrospectively analyzed and summarized. Intervention of HE, PAS and immunohistochemistry staining (CD3、CD4、CD8、CD20、CD79a、CD68) was applied. To analyze differences in distribution and pathological changes in skin tissue of Penicillium marneffei, Neutrophils, Macrophage, T and B lymphocytes by image analyzer (Image-Pro Plus 6.0).Results:All patients age ranged from 29 to 50 years, median age distribution was 31 years, male to female ratio was 1:1 and the median clinical course consisted of 3 months. All of the patients presented with weight loss, anemia and cutaneous lesions. Only four patients presented with fever, hepatosplenomegaly and lymphadenopathy along with deranged liver function tests (LFTs). All the patients CD4 count was below 200 cells/μl. Patients with CD4 count<50 cells/μl consisted of cutaneous lesions characterized by widely distributed necrotic papules,while the patients with CD4 count> 50 cells/μl consisted of limited cutaneous lesions characterized by ulcerative plaques, nodules or papules (simple & umbilicated). The histopathological examination of necrotic papules revealed necrotizing reaction type whereas histopathological examination of ulcerative plaques, nodules or papules (simple & umbilicated) revealed granulomatous reaction type. The positive expression of CD3, CD4 and CD8 levels were higher in granulomatous reaction type as compared to necrotizing type, but expression intensity of CD79a declined. Amount of neutrophils and fungi for granulomatous reaction type was considerably lower than necrotizing reaction type. There was no significant difference in the positive expression of CD68 in granulomatous and necrotizing reaction types between the two groups.Conclusion:1. The clinical features of PSM showed no profound specificity. While the clinical features of PSM remain unclear but history of unexplained fever, weight loss, hepatosplenomegaly, lymphadenopathy, leukopenia, liver-enzyme abnormalities, anemia and appearance of umbilicated or necrotic papular lesions should raise high suspicion of AIDS with deep fungal infection, especially PSM.2. Penicillium marneffei infection and macrophage infiltration are pathophysiological base of PSM. The granulomatous reaction possibly assists hosts immune response to PM and is beneficial to the hosts. CD4+ & CD8+T cells to form granulomatous reaction after post-infection, however neutrophils and plasmocytes participate in necrotic pathogenic process. 3. The clinical manifestations and pathological findings from cutaneous lesions facilitated in the diagnosis and prognosis of AIDS patients with Penicillium marneffei infection.