| Epidemiology, seasonality, and predictors of outcome of AIDS-associated Penicillium marneffei infection in Ho Chi Minh City, Viet Nam. | |
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MedLine Citation:
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PMID: 21427403 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Penicillium marneffei is an important human immunodeficiency virus (HIV)-associated opportunistic pathogen in Southeast Asia. The epidemiology and the predictors of penicilliosis outcome are poorly understood. METHODS: We performed a retrospective study of culture-confirmed incident penicilliosis admissions during 1996-2009 at the Hospital for Tropical Diseases in Ho Chi Minh City, Viet Nam. Seasonality of penicilliosis was assessed using cosinor models. Logistic regression was used to assess predictors of death or worsening disease based on 10 predefined covariates, and Cox regression was performed to model time-to-antifungal initiation. RESULTS: A total of 795 patients were identified; hospital charts were obtainable for 513 patients (65%). Cases increased exponentially and peaked in 2007 (156 cases), mirroring the trends in AIDS admissions during the study period. A highly significant seasonality for penicilliosis (P<.001) but not for cryptococcosis (P=.63) or AIDS admissions (P=.83) was observed, with a 27% (95% confidence interval, 14%-41%) increase in incidence during rainy months. All patients were HIV infected; the median CD4 cell count (62 patients) was 7 cells/μL (interquartile range, 4-24 cells/μL). Hospital outcome was an improvement in 347 (68%), death in 101 (20%), worsening in 42 (8%), and nonassessable in 23 (5%) cases. Injection drug use, shorter history, absence of fever or skin lesions, elevated respiratory rates, higher lymphocyte count, and lower platelet count independently predicted poor outcome in both complete-case and multiple-imputation analyses. Time-to-treatment initiation was shorter for patients with skin lesions (hazard ratio, 3.78; 95% confidence interval, 2.96-4.84; P<.001). CONCLUSIONS: Penicilliosis incidence correlates with the HIV/AIDS epidemic in Viet nam. The number of cases increases during rainy months. Injection drug use, shorter history, absence of fever or skin lesions, respiratory difficulty, higher lymphocyte count, and lower platelet count predict poor in-hospital outcome. |
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Authors:
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Thuy Le; Marcel Wolbers; Nguyen Huu Chi; Vo Minh Quang; Nguyen Tran Chinh; Nguyen Phu Huong Lan; Pham Si Lam; Michael J Kozal; Cecilia M Shikuma; Jeremy N Day; Jeremy Farrar |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Volume: 52 ISSN: 1537-6591 ISO Abbreviation: Clin. Infect. Dis. Publication Date: 2011 Apr |
Date Detail:
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Created Date: 2011-03-23 Completed Date: 2011-07-18 Revised Date: 2012-09-19 |
Medline Journal Info:
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Nlm Unique ID: 9203213 Medline TA: Clin Infect Dis Country: United States |
Other Details:
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Languages: eng Pagination: 945-52 Citation Subset: IM |
Copyright Information:
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© The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. |
Affiliation:
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Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam. thuyl@oucru.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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AIDS-Related Opportunistic Infections
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epidemiology*,
microbiology Adult Female Humans Incidence Male Mycoses / epidemiology*, microbiology Penicillium / growth & development, isolation & purification* Retrospective Studies Risk Factors Seasons Vietnam / epidemiology |
| Grant Support | |
ID/Acronym/Agency:
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//Wellcome Trust |
| Comments/Corrections | |
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