| [Objective]To explore early molecular detection methods for HIV/AIDS patients with invasive fungal infections,and to provide a basis for clinical diagnosis of invasive fungal infections.To explore the in vitro susceptibility test of five antifungal drugs to Talarmoyces marneffei’s yeast infection,and provide theoretical reference for the clinical treatment of Marneffe’s sclerotia.[Methods]Blood samples of inpatients with confirmed HIV/AIDS and invasive fungi were collected,and the ITS region of the fungus was amplified,sequenced and homologously analyzed by Nested PCR to determine the type of fungus infected by the patient and clinically cultured.The results were analyzed and compared.Collect clinical specimens(blood,bone marrow,pleural effusion,sputum,etc.)of inpatients who have been diagnosed with HIV/AIDS combined with Talarmoyces marneffei,and transplant the Sabouraud Gentamicin Chloramphy Agar into a 37℃incubator for 5-Five antifungal drugs,flucytosine,voriconazole,itraconazole,fluconazole and amphotericin B,were tested in vitro for their MIC.[Results]Among the 107 inpatients with HIV/AIDS and invasive fungal infections,71.03%were males and 28.97%were females,more men than women.The age ranged from 10 to 81 years old,with an average age of 45.87 years.The median CD4+T lymphocyte count was 62 cells/μl,with ≤200 cells/u I.In the 107 samples,48(44.86%)were Aspergillus,35(32.71%)were Yeast-likefungi,and 24(22.43%)were other fungi.Five kinds of fungi were detected in,namely,Penicillium citrinum,Talarmoyces marneffei,Exophiala,Cladosporium and Aspergillus.Among them,Penicillium citrinum was the most,accounting for 56.25%(27/48);yeast-like fungi Five fungi were detected,including Malassezia,Candida,Cryptococcus,Yeast and Alternaria Nees,of which Yeast was the most common,accounting for 34.29%(12/35);10 species were detected in other fungi,including Schizophyllum commune Franch,Sac fung,Engyodontium album,White Rot Fung,Streptomyces verticillus,Rhizoctonia solanacearum,Cladosporium,Rhizoctonia,Rhizoctoniapale yellow and Pseudoporus mutans.Among them,Schizophyllum and Ascomycetes accounted for 20.83%(5/24)and 16.67%(4/24),respectively.In 107 patients,there were 22 sterile samples in clinical culture samples,and 4 of them were consistent with PCR amplification results;85 samples of other samples were inconsistent with PCR amplification results.According to Fisher’ s exact probability method,P<0.05,the degree of coincidence between PCR and clinical culture results was statistically significant in the sterile samples and other samples.Among the 119 patients with HIV/AIDS combined with Talarmoyces marneffei.,the number of male patients was 2.61 times that of female patients.The average age is 37.08 years old,and the age range is 3 to 70 years old,mainly young and middle-aged.The number of sexually transmitted infections among patients infected with HIV is mostly 105,88.24%of the total.The median CD4+T lymphocyte count was 23 cells/μl,and most patients were in advanced AIDS.In this paper,the MIC values of five antifungal agents of Talarmoyces marneffei.,were determined:the MIC value of 5-fluorocytosine was<4-16 mg/L,and the MIC value of amphotericin B was<0.5.-0.5 mg/L,itraconazole MIC value is<0.125,fluconazole MIC range is<1-16 mg/L,voriconazole MIC value range is<0.06-0.125 mg/L.[Conclusion]HIV/AIDS patients with CD4+T lymphocyte counts ≤50 cells/pl are more susceptible to invasive fungal infections.Nested PCR methods are more sensitive to the amplification of fungal ITS regions and can be combined with traditional assay methods.To determine the type of fungus.HIV/AIDS patients with CD4+T lymphocyte counts ≤50 cells/μl are more susceptible to infection with Talarmoyces marneffei.,voriconazole,amphotericin B and itraconazole.The effect of Talarmoyces marneffei.is better than 5-fluorocytosine and fluconazole,and clinicians can give preference to these three antifungal drugs. |
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