Objective: To study the differences in the clinical and laboratory characteristics of disseminated penicilliosis marneffei (PSM) in patients with and without human immunodeficiency virus (HIV) infection.
Methods: The clinical data of 33 patients with PSM in our hospital from 2002 to 2007 were retrospectively analyzed. The patients were divided into 2 groups, an HIV infection group (n = 22) and a non-HIV infection group (n = 11). The data of the 2 groups were compared.
Results: The common features in the 2 groups included that, the majority of the patients were manual laborers with a low educational level, and the most common clinical characteristics were fever, multiple organ involvement especially the lung, skin, digestive system, and generalized lymphadenopathy. Different characteristics between the 2 groups included, (1) In the non-HIV infection group, the duration of the disease was longer (median: 45 vs 180 d, P < 0.01), with more underlying diseases (5/11) and higher misdiagnosis rate (7/11) as compared to those of the HIV infection group; (2) High, persistent fever, acute dyspnea and molluscum of the skin were more common in the HIV infection group, but intermittent fever, subcutaneous nodules and abscess were the features of the non-HIV infection group. Generalized lymphadenopathy (10/11), bone ache (5/11) and chest pain (7/11) were also more common in the non-HIV infection group (10/22, 2/22, 0/22, respectively in the HIV infection group, P < 0.05; (3) The total white cell counts were mostly increased in the non-HIV infection group (9/11), but were mostly in the normal range (15/22) or decreased (7/22) in the HIV infection group (P = 0.000). The total white cell count, the neutrophil and the lymphocyte counts in the non-HIV infection group were significantly higher than those in the HIV infection group (median: 18.6 x 10(9)/L vs 4.71 x 10(9)/L; 14.24 x 10(9)/L vs 4.16 x 10(9)/L; 2.08 x 10(9)/L vs 0.42 x 10(9)/L, P < 0.01, respectively; (4) The blood CD(4)/CD(8) ratio was normal or higher than 0.5 in the non-HIV infection group, but was, less than 0.5 in the HIV infection group (P = 0.000); (5) The positive rate of blood culture (18/18) or bone marrow culture (14/20) was significantly higher in the HIV infection group than those in the non-HIV infection group (7/10, 2/8, P < 0.05, respectively); (6) Diffuse parenchymal and interstitial changes were the main manifestations of chest radiology in the 2 groups. High-density consolidation and pleuritis were common in the non-HIV infection group, and osteolysis occurred only in the non-HIV infection group (n = 4, P < 0.05); (7) The prognosis was better in the non-HIV infection group (P < 0.05).
Conclusion: Fever, multiple organ dysfunction and poor prognosis are common clinical characteristics of PSM in the 2 groups, but there are significantly different characteristics between the 2 groups in underlying diseases, clinical presentations, disease progress and some laboratory studies.