The AIDS epidemic in Southeast Asia has led to a marked rise in the incidence of talaromycosis (penicilliosis) marneffei. The aim of this cross-sectional study was to determine the clinico-epidemiological features and outcome predictors of talaromycosis in Malaysia. We identified Talaromycosis marneffei cases from cultures of sterile specimens from 191 human immunodeficiency virus (HIV)- infected patients. Talaromycosis increased from 20-25 (2010-2011) to 45-50 cases per year (2012-2014). Talaromycosis was the HIV-presenting illness in 117 (61.3%) patients. The incidence of talaromycosis as HIV-presenting illness showed an increasing trend from 10.7 (2010) to 26.4 (2014) cases per 1000 new HIV patients. The patients were between 19 and 74 of age (mean 37.2+9.4 years) and the male to female ratio was 7.7:1. Malay (73, 38.2%) and Chinese (70, 36.3%) were the most prevalent ethnic groups. Common clinical manifestations included loss of weight (85.9%), fever (84.8%) and cough (67%), while skin lesions were only presentin 42.9% cases. Common concurrent infections were oral candidiasis (79.6%), tuberculosis (36.1%) and hepatitis C infection (20.9%). Most patients (93.7%) were anaemic with mean haemoglobin level of 9.9+2.3 g/dL, 39% had impaired liver function, and 18.8% were neutropaenic. Median CD4 cell count was 16 cells/L. Most patients (70.4%) received intravenous amphotericin B followed by itraconazole. At 8-month follow up, 148 (81.8%) patients were alive while 33 (18.2%) had died. Intravenous drug abuse, concurrent toxoplasma encephalitis and concurrent Pneumocystis jiroveci pneumonia independently predicted death outcome in both univariate and multivariate logistic regression analyses.
Epidemiological and Clinical Features of Talaromycosis (Penicilliosis) Marneffei among Human Immunodeficiency Virus-Infected Patients in Malaysia
Abstrak
Wabak AIDS di Asia Tenggara telah menyebabkan kenaikan insiden talaromikosis (penicilliosis) marneffei. Kajian keratan rentas ini bertujuan untuk menentukan ciri-ciri kliniko-epidemiologi dan peramal akibat talaromikosis. Kami telah mengenalpasti 191 kes talaromikosis marneffei daripada kultur spesimen steril daripada 191 pesakit jangkitan human immunodeficiency virus (HIV). Talaromikosis meningkat daripada 20-25 (2010-2011) kepada 45-50 kes setahun (2012-2014). Talaromikosis merupakan penyakit petunjuk HIV pada 117 (61.3%) pesakit. Insiden talaromikosis sebagai penyakit petunjuk HIV telah menunjukkan peningkatan daripada 10.7 (2010) kepada 26.4 (2014) kes bagi setiap 1000 pesakit baru HIV. Para pesakit berusia antara 19 dan 74 tahun (purata 37.2+9.4 tahun) dan nisbah lelaki kepada wanita adalah 7.7:1. Kaum Melayu (73, 38.2%) dan Cina (70, 36.3%) adalah yang paling ramai. Manifestasi klinikal yang kerap adalah hilang berat badan (85.9%), demam (84.8%) dan batuk (67%), manakala lesi kulit cuma 42.9% kes. Penyakit seiring yang kerap adalah kandidiasis oral (79.6%), tuberkulosis (36.1%) dan jangkitan hepatitis C (20.9%). Kebanyakan pesakit (93.7%) adalah anemik dengan bacaan haemoglobin purata 9.9+2.3 g/dL, 39% terjejas fungsi hati dan 18.8% pula neutropenik. Kiraan sel CD4 median adalah 16 sel/L. Kebanyakan pesakit (70.4%) menerima amphotericin B intravena diikuti oleh itraconazole. Pada 8 bulan perjumpaan susulan, 148 (81.8%) pesakit masih hidup manakala 33 (18.2%) lagi telah meninggal dunia. Penyalahgunaan dadah intravena, jangkitan serentak enkefalitis toxoplasma dan pneumonia Pneumocystis jiroveci telah meramal secara berasingan kesudahan kematian dalam kedua-dua analisis regresi logistik univariat dan multivariat.
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