title: Retrospective analysis of 14 cases of disseminated Penicillium marneffei infection with osteolytic lesions.
abstract: BACKGROUND
  Penicillium marneffei disseminates hematogenously and can infect most organs, though infection leading to osteolysis is extremely rare. We describe the clinical and laboratory features, management, and outcomes of patients with penicilliosis marneffei (PSM) with osteolytic lesions.
  
  
  METHODS
  This retrospective study was conducted between January 1, 2003 and May 1, 2014 at the First Affiliated Hospital of Guangxi Medical University. Patients who presented with culture and/or histopathologic proof of disseminated PSM within osteolytic lesions were included.
  
  
  RESULTS
  P. marneffei infection was diagnosed in 100 patients (65 HIV-infected and 35 HIV-negative). Fourteen patients, all HIV-negative, (14/35, 40%) had osteolytic lesions. The most common comorbidity was diabetes mellitus, though previous glucocorticoid therapy, β-thalassemia, breast cancer, and Langerhans cell histiocytosis also occurred. Five patients had no comorbidity. Fever, malaise, ostealgia, weight loss, and anemia were the most common symptoms, followed by cutaneous lesions, lymphadenopathy, hepatosplenomegaly, cough, sputum, and stethalgia. Ostealgia, joint pain, and joint disorders were also recorded. White blood cell and neutrophil counts were increased (mean 22.3 ± 7.4 × 10(9) cells/L; mean 18.84 ± 4.5 × 10(9) cells/L, respectively). The most common sites were the vertebrae, skull and femur, ribs and ilium, though the clavicle, scapula, humerus, and tibia were also involved. Radiography and computed tomography (CT) showed multiple radiolucencies with moth-eaten bone destruction, periosteal proliferation, bone fracture, and surrounding soft-tissue swelling. Emission CT showed significantly increased uptake in many skeletal regions. Positron emission tomography/CT showed generalized lymphadenopathy, bone metabolic activity, and bone destruction. The (18) F-FDG standard uptake value was increased in the entire skeleton (mean 6.16). Twelve patients received antifungal therapy, four of whom died during treatment, and eight recovered, though four of these eight relapsed within 3-24 months. Two patients discontinued treatment because of severe multiple organ failure and died.
  
  
  CONCLUSIONS
  Osteolysis is often overlooked in HIV-negative individuals with disseminated P. marneffei infection. However, P. marneffei involving the bone and leading to osteolysis may indicate severe systemic disturbance, and is characterized by a poor prognosis, high recurrence rate, and the need for prolonged antifungal treatment.
authors: Department of Integrated Medicine, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China. yeqiu2013graduated@163.com.
authors: Ye
authors: Y
authors: Qiu
authors: Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China. jqzhang2002@sina.com.
authors: Jianquan
authors: J
authors: Zhang
authors: Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China. gnliu63@yahoo.com.cn.
authors: Guangnan
authors: G
authors: Liu
authors: Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China. liguoqiuye@gmail.com.
authors: Xiaoning
authors: X
authors: Zhong
authors: Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China. ldyyy666@163.com.
authors: Jingmin
authors: J
authors: Deng
authors: Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China. zhiyi-river@163.com.
authors: Zhiyi
authors: Z
authors: He
authors: Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China. 287063367@qq.com.
authors: Bai
authors: B
authors: Jing
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D002681:China / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology; D010014:Osteolysis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000382:microbiology*; D010407:Penicillium / Q000254:growth & development / Q000502:physiology*; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
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