Chest Infections: Infections: Fungal |

Retrospective Analysis of 18 Cases of Penicilliosis marneffei Complicated With Serous Effusion FREE TO VIEW

Jianquan Zhang; Wen Zeng; Ye Qiu; Xiaoning Zhong
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The First Affiliated Hospital of Guangxi Medical University, Nanning, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A132. doi:10.1016/j.chest.2016.02.137
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SESSION TITLE: Infections: Fungal

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: There are few studies have examined serous effusion caused by infections with P. marneffei.

METHODS: A retrospective study was conducted between January 1, 2003 and March 31, 2015 at the First Affiliated Hospital of Guangxi Medical University.

RESULTS: 17 cases were HIV-uninfected and only one patient with the HIV infected 4 females and 14 males with a median age of 49.5+-10.2 years (range, 23∼ 67 years). All of them were repeatedly misdiagnosed, include tuberculous pleurisy, malignant pleural effusion, tuberculous peritonitis, tuberculous meningitis, pericarditis, vertebra or sacroiliac joint tuberculosis. All patients presented with fever and cough. Additionally, 10 patients had white sputum, 4 cases had bloody sputum, 12 cases had chest pain, 10 cases had dyspnea, 14 cases had generalised or cervical lymphadenopathy, The white blood cell levels were increased in 14 patients, The mean white cell count was 17.8 ± 4.6 × 109 cells/L, The neutrophil were increased in almost patients and in a mean count 15.8 ± 4.8 × 109 cells/L. The 17 cases (except 1 infected with HIV) were normal in the the T lymphocyte count, the mean ratio of the CD4+ T cells/CD8+ T cells was 1.56 ± 0.42[all of them >0.9]. There were 18 cases with pleural effusion, including 3 cases with pericardial effusion, 6 cases with ascites and 2 cases with abnormal cerebrospinal fluid. The pleural effusion and ascites were yellowish, even some were hemorrhagic fluid. The cell count especially neutrophil count, protein content and Lactate dehydrogenase (LDH) was increasing in it. Anti- eumycete medicine were administered to 10 cases and achieved improvement. 5 cases died of respiratory failure, cardiac failure, hepatic and renal failure. 2 patient’s condition agg ravated and one patient voluntarily leaved hospital without treatment.

CONCLUSIONS: Penicilliosis marneffei often occurs in serous cavity of normal immune functioncrowd. Clinical characteristics manifest with chronic pyogenic and infected diseases which appear significant increase in neutrophil count. It invades lung, abdominal organ and might be complicated with pleura leffusion, ascites and abnomal cerebrosp inalfluid. The property of effusion is consistent with inflammatory efflusion which can be totally absorbed under effective anti-fungal treatment.

CLINICAL IMPLICATIONS: To provide evidence for correct diagnosis and teaching in the treatment of similar cases

DISCLOSURE: The following authors have nothing to disclose: Jianquan Zhang, Wen Zeng, Ye Qiu, Xiaoning Zhong

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