1. Nguyen Duy Phong; Cao Ngoc Nga; Nguyen Thi Hai Men; Nguyen Le Nhu Tung
Epidemiological Characteristics, Clinical Manifestations  and Laboratory findings of P. marneffei Sepsis in HIV/AIDS Patients
Nguyen Duy Phong; Cao Ngoc Nga;
Nguyen Thi Hai Men; Nguyen Le Nhu Tung

2. Outline 1- Introduction 2- Objectives 3- Method 4-Results
5- Conclusion

3. 1- Introduction
Penicillium marneffei has been found in bamboo rat in VN and the tropical Southeast Asia countries The incidence of P. marneffei is increasing as HIV spreads throughout Asia Disseminated Penicillium marneffei sepsis is one of the major causes of death among HIV/AIDS patients

4. 2- Objectives
To discribe epidemiological characteristics, symptoms and laboratory findings in AIDS patients with septicemia by P. marneffei treated at the Hospital for Tropical Diseases – (HTD) HCM city

5. 3- Methods + Study design: Case Series Report
+ Study samples: HIV/AIDS patients with P. marneffei (+) blood culture.

6. 4- Results and Discussion (1)
+ 137 AIDS Patients admitted to HTD with diagnosis: “P. marneffei infection” (1 patient with C.neoformans (+) bood culture) + Male: Female: 29 + Age: 111 < 35 y.o and 21 ≥ 35 y.o. + On admission: 73 patients with diagnosis HIV (+) and 64 patients – don’t know about HIV status

7. 4- Results and Discussion (2)
+ HIV Transmission: IV Drug users= 95 patients; Sexual contact = 34 patients; Unknow= 8 patients. - Treatment with ARV: 15 patients - Prophylactic treatment by Cotrimoxazol: 16 patients and Fluconazol - 09 patients

8. 4- Results and Discussion (3)
Tab. 1: Clinical Manifestations (N=137)
Symptom n %
Fever
127
92,7
Weight loss
105
76,6
Headache 8
5,8
Vomiting
Diarrhea 49
35,8
Abdominal pain 46
33,6
Convulsion 1
0,7

9. 4- Results and Discussion (4)
Symptom n %
Systematic Inflamatory Response Syndrom
111 81
exhaustion 85 62
Mouth Sores 90
65,7
Hepatomegaly
104
75,9
Splenomegaly 94
68,6
Skin lession
59,1
Adenomegaly
59,8
Anaemia 77
56,2
Respiratory failure 47
34,3
Rales 13
9,5
Meningeal signs 6
4,4
Confusion 11 8
Jaundice 18
13,1
Hypertension 10
7,3

10. Skin lession by P. marneffei (1)

11. Skin lession by P. marneffei (2)

12. Skin lession by P. marneffei (3)

13. Skin lession by P. marneffei (4)

14. Skin lession by P. marneffei (5)

15. 4- Results and Discussion (5)
Tab. 3: Blood cells (N=137)
Blood Cells Count n %
 4000/ml 63 46
4000 – 12000/ml 60
47,8
 12000/ml 14
10,2
Neutrophill  8
5,8
Lymphocytes 
121
88,3
Anaemia: RBC  77
56,2
Thrombocytes  88
64,2
WBC, RBC, Thrombocytes  25
18,2

16. 4- Results and Discussion (6)
Tab. 4: P. marneffei (+) Culture (N=137)
Cultures
Number of Cases %
Skin lession 46
33,6
Lymph nodes 2
1,5
Ascite 1
0,7
Pleural effusion
CSF

17. 4- Results and Discussion (7)
+ Duration: 12 days (1 -53 days) + Intraconazole: 400mg/day
Tab. 5: Result of Treatment (N=137)
Result of Treatment
(n=137)
Number of Cases %
No change 16
11,7
Improve 83
60,6
Death 38
27,7

18. 4- Results and Discussion (8)
Tab. 6: Cause of Death (N=137)
Characteristics
Death n=38(%)
Survive n=99(%)
OR (95% CI) p
Admission to ICU
24 (63,2)
19 (19,2)
7,2(3,1-16,5)
0,000
History  7 days
15 (40,5)
18(18,2)
3,1(1,3-7,1)
0,007
Skin lession
13(34,2)
68(68,7)
0,24(0,11-0,52)
Confusion
9(23,7)
2(2,8)
15,1(3,1-73,6)
Shock on Admission
6(15,8)
4(4)
4,4(1,2-16,8)
0,018
Respiratory Faillure on Admission
25(65,8)
22(22,2)
6,7(2,9-15,3)
Renal Faillure
7(19,4)
8,4(1,7-43)
0,003
Lymph.  12000/ml
96(97)
0,1(0,02-0,23)
CD4  50/ml
27(27,3)
0,8(0,4-1,9)
0,67

19. 5- Conclusion
+ P. marneffei infection is diagnosed by the typical skin lesions and the reticuloendothelial system symptoms: hepato-splenomegaly, lymphadenopathy, anemia with the P. marneffei (+) in the skin lesions + The Mortality was 27.7 %. Factors related to patient mortality are short medical history(< 7 days), confusion, shock, renal failure.

20. Thank you