Session:

Mycology, Fungal Infections and Antifungal Drugs

Abstract No.:

49.014

Title:

Establishing role of CD4+ cell count in predicting Penicillium marneffei infection among HIV positive patient in infectious disease centre, Malaysia

Author(s):

F. Mohd Nor @ Ghazali¹, S. A. Shaari¹, O. Mohammad Faisol Hamdi², Z. Abdul Wahab³; ¹Universiti Teknologi Mara, Faculty of Medicine, Sg. Buloh, SELANGOR/MY, ²Sungai Buloh, Hospital, Pathology, Sungai Buloh, SELANGOR/MY, ³Sungai Buloh Hospital, Pathology, Sungai Buloh, SELANGOR/MY

Abstract:

Background: Penicillium marneffei infection (penicilliosis) is endemic particularly in Southeast Asia and has emerged as an AIDS-defining illness.  To date, there are minimal reports regarding penicilliosis amongst HIV-positive patient from Malaysia.  The objective of this study is to establish the role of CD4+ cell count in administration of early treatment and prophylaxis.
Methods: A retrospective study was conducted on P. marneffei  isolates collected from Microbiology Unit, Hospital Sg. Buloh, Selangor, Malaysiafrom December 2010 to December 2011.  The CD4+ cell count of all patients with penicilliosis were collected, along with clinical history.
Results: The CD4+ cell count level was divided into four categories: less than 10 cells/µL, 11-50 cells/µL, 51-100 cells/µL and more than 100 cells/µL.  Majority of the patients (43%) contracted penicilliosis only when CD4+ cell count level falls below 10 cells/µL.  Another 33% of patients developed penicilliosis when CD4+ cell count level is between 11 to 50 cells/µL.  The remaining 7% and 10% of patients acquired penicilliosis when CD4+ cell count level are 51-100 cells/µL and more than 100 cells/µL, respectively.In addition to CD4+ cell count, other clinical parameters were documented.  There was 70 isolates of P. marneffei from 30 HIV positive patients, isolated from blood (87%), skin (20%), followed by bone marrow and body fluid (3% respectively). Thirteen (44%) of those patients develop penicilliosis within a year of being diagnosed with HIV.   The commonest presenting complaint was fever (60%), followed by respiratory (50%), gastrointestinal (44%) and dermatological manifestations (20%).  Tuberculosis (30%) is the other identified predisposing factor. The most frequent treatment administered was amphotericin B followed by itraconazole (37%), and amphotericin B followed by fluconazole (27%). 
Conclusion: The CD4+ cell count has the potential to be a useful predictive tool for penicilliosis in HIV positive patient.  Prophylaxis should be considered once these group of patients’ CD4+ cell count falls below 50 cells/µL with presence of suspicious clinical manifestation.  This should be performed even prior to the presence of any microbiological evidence of penicilliosis.