Clinical And CT Manifestations Of AIDS Associated With Common Fungal Infection In Chest

Objective:Through the clinical and imaging analysis of AIDS combined with pulmonary fungal infection,to explore the thoracic features and characteristics of AIDS patients with different fungal infections,and combine them with clinical date to improve the diagnosis of AIDS with differert fungal infections,which is beneficial to the early treatment of patients and reduces the mortality of fungal infections.Material and methods:A retrospective analysis was made of 4102 cases of AIDS patients admitted to the eighth people's hospital of guangzhou from January 2014 to December2016.A total of 642 patients with fungal infection were screened by BALF and histopathology,of which 487 were mixed infection(? 2)and 155 cases of single infection,there were 144 common fungi in the single infection,including 59 cases of PM infection,53 cases of pulmonary Candida(PC)infection and 32 cases of pulmonary aspergillus(PA)infection.All patients underwent chest CT examination to compare the clinical and chest imaging findings of AIDS with different fungal infections.Results:The ages of 155 cases of AIDS with fungal infection from 22-80 years old,the average age of them was 42.76±13.04,It mainly in the middle and young adults(30-59 years old,accounting for 69.68%),the incidence of adolescent and elderly,and the131 cases were male(accounting for84.52%),24 cases were female(accounting for15.48%).(2)The mainly symptoms of the patients with AIDS are fever,cough,spuum,and weight loss.AIDS/PM patients with skin damage(54.23%)significantly more than PC and PA patients(p=0.001).(3)Patients with AIDS infected fungal mostly occurred in CD4+T cells <50/?l,with a statistically significant difference(p=0.000).CD4+T cells was statistically significant between the three groups: PM,PC,and PA(p=0.001).The PM[(21.49 ± 34.06)/?l] was significantly lower than the PC [(52.09 ± 71.12)/?l] and PA[(90.44 ± 109.29)/?l];there was no significant difference between the PA and PC groups.(4)The image features of AIDS combined with PM,PC and PA were mainly in the lungs with multiple patches,nodules,large confluent consolidation,miliaries,ground glass opacity,pleural effusion,and mediastinal lymph node enlargement,and some may have cavity,pericardial effusion,pleural thickening,etc.The probability of pericardial effusion of AIDS/PM(33.9%)was higher than that of PA and PC,and the difference was statistically significant(P=0.004).There was no significant difference between PA and PC.The probability of larger confluent consolidation of AIDS/PC(33.96%)was higher than that of PM and PA,and the difference was statistically significant(P=0.001).There was no significant difference between PM and PA.The probability of pleural thickening in AIDS/PA(43.75%)was higher than that in PM and PC,and the difference was statistically significant(P=0.000).There was no significant difference between PM and PC.(5)There was no significant difference in the imaging findings and CD4+ T cell levels in thoracic CT of AIDS patients with different fungal infections(P<0.05).Conclusion:(1)In patients with AIDS combined with PM,AIDS with PC,and AIDS with PA infection,the immune function was severely low,which most frequently occurred in CD4+ T cells < 50/?l,especially in patients with AIDS complicated with PM infection.(2)The clinical symptoms of common fungal infections associated with AIDS in the lungs are mostly similar and mainly manifest as fever,with or without chills,cough,sputum,and weight loss.When the skin lesions of AIDS patients are characterized by central umbilical necrosis,it should be highly suspected the infection of PM.(3)The image of AIDS with fungal infections is complex and diverse,with a wide range of lesions.More often than not,two or more lesions appear at the same time.The incidence of nodules,patches,and ground-glass opacities in the lungs is high,often accompanied by pleural effusion and mediastinal lymph node enlargement.(4)The image of AIDS with fungal infections was similar,with statistically significant differences in pericardial effusion,pulmonary consolidation and pleural thickening.Pericardial effusion is more common in the infection of AIDS with PM.Larger confluent consolidation is more common in the infection of AIDS with PC,and pleural thickening is more common in the infection of AIDS with PA.(5)The level of CD4+T cells did not have a significant effect on the pathological type of pulmonary fungal infection damage.