Clinical characteristics and risk factors for poor prognosis among HIV patients with Talaromyces marneffei bloodstream infection

Zhenyan Wang,Jiangrong Wang,Weiwei Sun,Jun Chen,Li Liu,Renfang Zhang,Yinzhong Shen,Hongzhou Lu,Jianjun Sun,Yixiao Lin,Yang Tang,Wei Song,Tangkai Qi,Shuibao Xu

doi:10.1186/s12879-021-06232-2

Abstract

BackgroundTalaromyces marneffei (TM) bloodstream infection is common in Acquired Immunodeficiency Syndrome (AIDS) patients with extreme immunodeficiency in Southeast Asia and South China, however, clinical case study on TM bloodstream infection is scarce. We retrospectively analyzed the clinical characteristics of TM bloodstream infection in hospitalized AIDS patients and determined the outcomes of hospitalization after diagnosis in our hospital over the past 5 years.MethodsFrom January 2015 to July 2020, 87 cases of TM detected by blood culture in patients admitted to our center were collected. The admission complaints, blood cells, biochemistry, CD4 and CD8 cell counts and 1,3-β-D-glucan (BDG), procalcitonin (PCT), CRP level on the day of blood culture test, and outcomes during hospitalization were analyzed. Logistic regression analysis was performed for the risk factors for poor prognosis (60 cases). Spearman correlation analysis was used to analyze the correlation between peripheral blood cells, albumin and the time required for TM turnaround in blood culture. The difference was statistically significant when the P value was < 0.05.ResultsA total of 87 patients were collected, with a median age of 34 years, a median hemoglobin of 94 g/L and CD4 count of 7/μl. The rate of TM bloodstream infection among all in-hospital patients increased from 0.99% in 2015 to 2.09% in 2020(half year). Patients with TM bloodstream infection with CD8 count < 200/μl had a 12.6-fold higher risk of poor prognosis than those with CD8 count > 200/μl (p = 0.04), and those with BDG < 100 pg/mL had a 34.9-fold higher risk of poor prognosis than those with BDG > 100 pg/mL (p = 0.01).ConclusionsTM bloodstream infection is becoming more common in advanced AIDS patients in endemic areas. For those patients with extremely low CD4 and CD8 cell counts below 200/μl is with an increased risk of poor prognosis.

Highlights

Talaromyces marneffei (TM) bloodstream infection is common in Acquired Immunodeficiency Syndrome (AIDS) patients with extreme immunodeficiency in Southeast Asia and South China, clinical case study on TM bloodstream infection is scarce
A meta-analysis [12] showed that the prevalence of TM among Human immunodeficiency virus (HIV) patients in China ranged from 0.2% to 26.5%
Because Shanghai Public Health Clinical Center (SPHCC) is a referral hospital in east China, and all TM bloodstream infection cases were scattered throughout many provinces

Summary

Introduction

Talaromyces marneffei (TM) bloodstream infection is common in Acquired Immunodeficiency Syndrome (AIDS) patients with extreme immunodeficiency in Southeast Asia and South China, clinical case study on TM bloodstream infection is scarce. We retrospectively analyzed the clinical characteristics of TM bloodstream infection in hospitalized AIDS patients and determined the outcomes of hospitalization after diagnosis in our hospital over the past 5 years. In clinical settings, because the onset of the disease is relatively insidious and mild, the clinical symptoms are non-specific, and patients often experience delayed diagnosis or misdiagnosis by doctors who are not familiar with the symptoms of TM disease They are diagnosed with TM, there are multiple organ lesions, such as lymphadenopathy, anemia, leucopenia, thrombocytopenia, hepatosplenomegaly, and bone marrow involvement [16]. The aim of this study was to retrospectively analyze the clinical characteristics of TM bloodstream infection in hospitalized AIDS patients and determine the outcomes of hospitalization after diagnosis in our hospital over the past 5 years

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