Epidemiology, seasonality, and predictors of outcome of AIDS-associated Penicillium marneffei infection in Ho Chi Minh City, Viet Nam.
Abstract
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.
Type
Journal articleSubject
AIDS-Related Opportunistic InfectionsAdult
Female
Humans
Incidence
Male
Mycoses
Penicillium
Retrospective Studies
Risk Factors
Seasons
Vietnam
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https://hdl.handle.net/10161/16193Published Version (Please cite this version)
10.1093/cid/cir028Publication Info
Le, Thuy; Wolbers, Marcel; Chi, Nguyen Huu; Quang, Vo Minh; Chinh, Nguyen Tran; Lan,
Nguyen Phu Huong; ... Farrar, Jeremy (2011). Epidemiology, seasonality, and predictors of outcome of AIDS-associated Penicillium
marneffei infection in Ho Chi Minh City, Viet Nam. Clin Infect Dis, 52(7). pp. 945-952. 10.1093/cid/cir028. Retrieved from https://hdl.handle.net/10161/16193.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Thuy Le
Associate Professor of Medicine

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