Epidemiological and Clinical Features of Talaromycosis (Penicilliosis) Marneffei among Human Immunodeficiency Virus-Infected Patients in Malaysia
-
Vol. 13 No. 2 : 2018 (103-113)
Abstract
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.
Keywords :
AIDS,
HIV,
Malaysia,
marneffei,
penicillium,
talaromyces,
Correspondance Address
Assoc. Prof. Dr. Tzar Mohd Nizam. Department of
Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical
Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91455920
Email: tzar@ppukm.ukm.edu.my
References
Chariyalertsak, S., Sirisanthana, T., Khuanchai, S.,
Praparattanapan, J., Nelson, K.E. 1997. Casecontrol
study of risk factors for Penicillium
marneffei infection in human immunodeficiency
virus-infected patients in northern Thailand.
Clin Infect Dis 24(6): 1080-6.
Drouhet, E. 1993. Penicilliosis due to Penicillium
marneffei: a new emerging systemic mycosis
in AIDS patient traveling or living in Southeast
Asia: review of 44 cases reported in HIV infected
patients during the last 5 years compared to 44
cases of non-AIDS patients reported over 20
years. J Mycol Med 4: 195-224.
Gadpayle, A.K., Kumar, N., Duggal, A., Rewari, B.B.,
Ravi, V. 2012. Survival trend and prognostic
outcome of AIDS patients according to age,
sex, stages, and mode of transmission-A
retrospective study at ART centre of a tertiary
care hospital. JIACM 13(4): 291-8.
Hung, C.C., Hsueh, P.R., Chen, M.Y., Hsiao, C.H.,
Chang, S.C., Luh, K.T. 1998. Invasive infection
caused by Penicillium marneffei: an emerging
pathogen in Taiwan. Clin Infect Dis 26(1): 202-3.
Imwidthaya, P. 1994. Update of penicilliosis marneffei
in Thailand. Mycopathologica 127(3):135-7
Kawila, R., Chaiwarith, R., Supparatpinyo, K. 2013.
Clinical and laboratory characteristics of
Penicilliosis marneffei among patients with and
without HIV infection in Northen Thailand:
a retrospective study. BMC Infect Dis 13: 464.
Kish, L. 1965. Survey sampling. 1965. NY: John Wiley
& Sons.
Kurup, A., Leo, Y.S., Tan, A.L., Wong, S.Y. 1999.
Disseminated Penicillium marneffei infection: a
report of five cases in Singapore. Ann Acad Med
Singapore 28(4): 605-9.
Le, T., Wolbers, M., Chi, N.H., Quang, V.M., Chinh,
N.T., HuongLan, N.P., Lam, P.S., Kozal, M.J.,
Shikuma, C.M., Day, J.N., Farrar, J. 2011.
Epidemiology, seasonality, and predictors
of outcome of AIDS-associated Penicillium
marneffei infection in Ho Chi Minh City,
Vietnam. Clin Infect Dis 52(7): 945-52.
Li, H.R., Cai, S.X., Chen, Y.S., Yu, M.E., Xu, N.L.,
Xie, B.S., Lin, M., Hu, X.L. 2016. Comparison
of Talaromyces marneffei infection in human
immunodeficiency virus-positive and human
immunodeficiency virus-negative patients from
Fujian, China. Chin Med J (Engl) 129(9): 1059-
65.
Ministry of Health Malaysia. 2014. MyNAG.
Computer Software. Google Play. Vers. 1.3.,
Pharmaceutical Services Division MOH. https://
play.google.com/store/apps/details?id=air.
NationalAntibioticGuideline [7 July 2017].
Nissapatorn, V., Lee, C., Fatt, Q.K., Abdullah, K.A.
2003. AIDS-related opportunistic infections in
Hospital Kuala Lumpur. Jpn J Infect Dis 56(5/6):
187-92.
Nor-Hayati, S., Sahlawati, M., Suresh-Kumar, C., Lee,
K.C. 2012. A retrospective review on successful
management of Penicillium marneffei infections
in patients with advanced HIV in Hospital
Sungai Buloh. Med J Malaysia 67(1): 66-70.
Ranjana, K.H., Priyokumar, K., Singh, T.J., Gupta,
C.C., Sharmila, L., Singh, P.N., Chakrabarti,
A. 2002. Disseminated Penicillium marneffei
infection among HIV-infected patients in
Manipur state, India. J Infect 45(4): 268-71.
Rokiah, I., Ng, K.P., Soo-Hoo, T.S. 1995. Penicillium
marneffei infection in an AIDS patient:a first
case report from Malaysia. Med J Malay 50(1):
101-4.
Sirisanthana, T., Supparatpinyo, K. 1998.
Epidemiology and management of penicilliosis
in human immunodeficiency virus-infected
patients. Int J Infect Dis 3(1): 48-53.
Supparatpinyo, K., Chiewchanvit, S., Hirunsri, P.,
Uthammachai, C., Nelson, K.E., Sirisanthana, T.
1992. Penicillium marneffei infection in patients
infected with human immunodeficiency
virus. Clin Infect Dis 14(4): 871-4.
Supparatpinyo, K., Khamwan, C., Baosoung,
V., Sirisanthana, T., Nelson, K.E. 1994.
Disseminated Penicillium marneffei infection
in Southeast Asia. The Lancet 344(8915): 110-3.
Tzar, M.N., Suhaila, B., Shamsul, A.S., Azizah, M.
2013. Epidemiology of fungal infections at
infectious disease reference centre in Malaysia.
IMJM 12(1): 39-42.
Vanittanakom, N., Cooper, C.R., Fisher, M.C.,
Sirisanthana, T. 2006. Penicillium marneffei
infection and recent advances in the
epidemiology and molecular biology
aspects. Clin Microbiol Rev 19(1): 95-110.
Wong, K.H., Lee, S.S., Loo, Y.C., Li, P.C., Ho, H.F.,
Sitt, W.H., Lam, T.Y., Lai, K.Y. 1995. Profile of
opportunistic infections among HIV-1 infected
people in Hong Kong. China Med J (Taipei) 55:
127-36.
