Disseminated Penicillium marneffei infection among HIV-infected patients in Manipur State, India
Disseminated Penicillium marneffei infection among HIV-infected patients in Manipur State, India
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DOI：
10.1053/jinf.2002.1062
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发表时间：
2002-11-01
影响因子：
28.2
通讯作者：
Chakrabarti, A
中科院分区：
文献类型：
--
作者：
Ranjana, KH;Priyokumar, K;Chakrabarti, A
目的：进一步了解印度人类免疫缺陷病毒（HIV）感染者马尔尼菲青霉感染的临床和流行病学特征。方法：在我们先前报道的4例来自印度东北部曼尼普尔邦的HIV感染患者的本地马尔尼菲青霉病的基础上，我们在19个月（1998年4月至1999年10月）期间研究了来自同一地区的另外46例马尔尼菲青霉病。我们分析了46例患者中36例的临床、微生物学特征和治疗反应，其中10例患者没有随访。结果：在上述期间，在曼尼普尔邦英帕尔J.N.医院就诊的198名艾滋病毒阳性患者中，46名（25%）患有马尔尼菲疟原虫弥散性感染。36例患者中31例（86%）静脉吸毒，1例有多个性伴侣，3例女性从各自配偶处感染HIV。1名9岁儿童通过垂直传播感染艾滋病毒。常见临床症状包括发热（97%）、体重减轻（100%）、虚弱（86%）、贫血（86%）和特征性皮肤损害（81%）。通过显微镜检查，从皮肤病变和淋巴结中细针抽吸物的赖特氏染色涂片显示许多细胞内和细胞外，卵形，细长，酵母样细胞通过裂变分裂。从临床材料中分离病原菌10例。所有患者均口服伊曲康唑治疗。除一名患者外，所有患者在7天内对治疗反应良好。结论：本病例进一步证实了曼尼普尔邦马尔尼菲青霉病的地方性，与东南亚其他地区患者的流行病学和临床病程相似。(C) 2002年英国感染学会。Elsevier Science Ltd.出版。版权所有。
Objective: To further describe the clinical and epidemiological characteristics of Penicillium marneffei infection in human immunodeficiency virus (HIV) infected patients in India.Methods: In continuation of our earlier report of four autochthonous cases of P. marneffei infection in HIV infected patients from Manipur, a northeastern state of India, we studied additional 46 cases of penicilliosis marneffei from the same area over a period of 19 months (April 1998-October 1999). Clinical, microbiological features, and therapeutic responses were analyzed in 36 of the 46 patients as ten patients were lost to follow-up.Results: Of the 198 HIV positive patients attending the J.N. Medical Hospital, Imphal, Manipur state during the period mentioned, 46 (25%) had P. marneffei disseminated infection. Of the 36 patients analyzed 31 (86%) were intravenous drug abusers, I had multiple sex partners, and 3 females acquired HIV infection from their respective spouses. A 9-year-old child acquired HIV infection by vertical transmission. The common clinical symptoms included fever (97%), weight loss (100%), weakness (86%), anemia (86%), and characteristic skin lesions (81%). Presumptive diagnosis was made by microscopic examination of Wright's-stained smears of fine needle aspirated material from skin lesions and lymph nodes showing numerous intracellular and extracellular, oval, elongated, yeast-like cells dividing by fission. The etiologic agent P. marneffei was isolated in culture from clinical materials in 10 cases when isolation was attempted. All patients were treated with oral itraconazole. All, except one patient, responded favorably to treatment within 7 days.Conclusion: Thus, the present cases further confirm the endemicity of penicilliosis marneffei in Manipur and resemble the epidemiology and clinical course of patients from other parts of south-cast Asia. (C) 2002 The British Infection Society. Published by Elsevier Science Ltd. All rights reserved.