[A comparative analysis of the clinical and laboratory characteristics in disseminated penicilliosis marneffei in patients with and without human immunodeficiency virus infection].

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.