title: A Clinical Study of Acquired Immunodeficiency Syndrome Associated Penicillium Marneffei Infection from a Non-Endemic Area in China.
abstract: OBJECTIVE
  To investigate the clinical characteristics, diagnosis, treatment and prognosis of penicilliosis among the patients with acquired immunodeficiency syndrome (AIDS) in non-endemic areas of China, and then to discuss its incubation period and the diagnostic performance of serum galactomannan test for penicilliosis.
  
  
  METHODS
  Medical records and travel histories of penicilliosis patients in Zhongnan hospital from January 2006 to December 2013, and the interval from when the patients left the endemic area to the onset of the disease was analyzed. Serum galactomannan levels of penicilliosis patients and AIDS patients with fever were measured by the Platelia Aspergillus Enzyme Immunoassay Kit.
  
  
  RESULTS
  A total of 47 AIDS-associated penicilliosis were confirmed by fungal culture, which accounted for 4.8% of 981 AIDS-related admissions. The sensitivity and specificity of serum galactomannan test for penicilliosis were 95.8% (23/24) and 90.9% (30/33), respectively, (cutoff index = 1.0). Two independent predictors for early mortality (death within 12 weeks) of the patients (21.3%, 10/47) were a delayed diagnosis and no treatment with antifungal therapy. Among 14 patients who became ill after leaving endemic areas, ten patients presented with the onset symptoms within 12 months (from 11 days to 360 days). We found a patient living with asymptomatic P. marneffei fungemia who had not received any antifungal therapy until 18 months' follow up.
  
  
  CONCLUSIONS
  The co-infection of P. marneffei and HIV was not uncommon in the non-endemic areas of penicilliosis in China. There exists a latent form of infection for P. marneffei. The incubation period of penicilliosis may be quite different from one patient to another. In AIDS patients, the serum galactomannan test has utility for the diagnosis of penicilliosis. When patients with penicilliosis/AIDS were diagnosed early and treated with standardized antifungal therapy and combined antiretroviral therapy, their prognosis improved.
authors.affiliation: Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
authors.forename: Jinding
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
authors.forename: Xien
authors.initials: X
authors.lastname: Gui
authors.affiliation: Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Cao
authors.affiliation: Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
authors.forename: Rongrong
authors.initials: R
authors.lastname: Yang
authors.affiliation: Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
authors.forename: Yajun
authors.initials: Y
authors.lastname: Yan
authors.affiliation: Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
authors.forename: Liping
authors.initials: L
authors.lastname: Deng
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lio
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D002681:China / Q000453:epidemiology; D060085:Coinfection; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D006678:HIV / Q000472:pathogenicity*; D006801:Humans; D008297:Male; D008351:Mannans / Q000097:blood; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D010407:Penicillium / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity*; D015995:Prevalence; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D008351:Mannans; C012990:galactomannan; D005690:Galactose