Abstract
Talaromycosis is a fatal opportunistic infection prevalent in human immunodeficiency virus (HIV)-infected patients, previous studies suggest environmental humidity is associated with monthly talaromycosis hospitalizations of HIV-infected patients, but the acute risk factor remains uncertain. In this study, we evaluated the associations between talaromycosis hospitalizations of HIV-infected patients (n = 919) and environmental factors including meteorological variables and air pollutants at the event day (assumed “lag 0” since the exact infection date is hard to ascertain) and 1–7 days prior to event day (lag 1–lag 7) in conditional logistics regression models based on a case crossover design. We found that an interquartile range (IQR) increase in temperature at lag 0–lag 7 (odds ratio [OR] [95% CI] ranged from 1.748 [1.345–2.273] to 2.184 [1.672–2.854]), and an IQR increase in humidity at lag 0 (OR [95% CI] = 1.192 [1.052–1.350]), and lag 1 (OR [95% CI] = 1.199 [1.056–1.361]) were significantly associated with talaromycosis hospitalizations of HIV-infected patients. Besides, temperature was also a common predictor for talaromycosis in patients with co-infections including candidiasis (n = 386), Pneumocystis pneumonia (n = 183), pulmonary tuberculosis (n = 141), and chronic hepatitis (n = 158), while humidity was a specific risk factor for talaromycosis in patients with candidiasis, and an air pollutant, SO2, was a specific risk factor for talaromycosis in patients with Pneumocystis pneumonia. In an age stratified evaluation (cutoff = 50 years old), temperature was the only variable positively associated with talaromycosis in both younger and older patients. These findings broaden our understanding of the epidemiology and pathogenesis of talaromycosis in HIV-infected patients.
Highlights
Talaromycosis is one of the most prevalent opportunistic infections among human immunodeficiency virus (HIV)-infected patients in South and Southeast Asia [1,2,3], and talaromycosis cases outside endemic areas were reported partially due to increasing migration and travel to endemic regions, and the causes for some cases in non-endemic regions remain enigmatic [4,5,6]
Based on a case crossover design, we showed an interquartile range (IQR) increase in humidity at lag 0 and lag 1 were significantly associated with talaromycosis hospitalizaitons of HIV-infected patients in Guangzhou, China (Figure 1D and Supplementary Table S2), consistent with previous findings
It was proposed that humidity may facilitate inhalation of infectious spores or hyphal fragment from the environmental reservoir driving talaromycosis pathogenesis [2, 16], our study adds new evidence of the theory
Summary
Talaromycosis is one of the most prevalent opportunistic infections among human immunodeficiency virus (HIV)-infected patients in South and Southeast Asia [1,2,3], and talaromycosis cases outside endemic areas were reported partially due to increasing migration and travel to endemic regions, and the causes for some cases in non-endemic regions remain enigmatic [4,5,6]. HIV-infected patients with a CD4 count lower than 100 cells per μL are susceptible to Talaromyces marneffei, Acute Risk Factors for Talaromycosis the pathogen of talaromycosis, and have a high risk of death [8,9,10]. It was reported that a meteorological factor, humidity, was the most important predictor for monthly talaromycosis hospitalizations of HIV-infected patients in Vietnam based on Poisson regression analyses [16]. Air pollutants have attracted more and more attention due to their significant associations with various infectious diseases including Pneumocystis pneumonia, an opportunistic infection in HIV patients [17, 18]. To our knowledge, there is no study regarding the associations between air pollutants and talaromycosis in HIV-infected patients
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