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Objective:To investigate the clinical and pathological characteristics of acquired immunodeficiency syndrome (AIDS) patients with intestinal Talaromycosis marneffei (TM) infection. Methods:A total of 64 AIDS patients who underwent colonoscopy in Guangzhou Eighth People′s Hospital from January, 2010 to December, 2018 were retrospectively collected. Among them, 32 patients were co-infected with TM (AIDS with intestinal TM infection group) and 32 patients were not (AIDS without intestinal TM infection group) according to the colonic mucosa pathology. The clinical manifestations and pathological differences were compared between the two groups. Nonparametric rank sum test and Fisher exact probability method were used for statistical analysis.Results:The proportions of patients presented with fever, cough, retroperitoneal lymph nodes tume faction, nausea and vomiting, abdominal muscle tension, abdominal tenderness and rebound pain in AIDS with intestinal TM infection group were 28 (87.5%), 16 (50.0%), 13 (40.6%), 9 (28.1%), 8 (25.0%), 20 (62.5%) and 12 (37.5%), respectively, which were all significantly higher than those in AIDS without intestinal TM infection group 11 (34.4%), 6 (18.8%), 3 (9.4%), 2 (6.2%), 1 (3.1%), 8 (25.0%) and 1 (3.1%), respectively, the differences were statistically significant (Fisher exact test, all P<0.05). The median counts of peripheral blood CD4 + T lymphocyte, lymphocytes, monocytes, hemoglobin, platelet and albumin in AIDS with intestinal TM infection group were 13.5/μL, 0.30×10 9/L, 0.16×10 9/L, 88 g/L, 122×10 9/L and 23.5 g/L, respectively, which were all significantly lower than those in AIDS without intestinal TM infection group 207.0/ μL, 1.35×10 9/L, 0.35×10 9/L, 128 g/L, 201×10 9/L and 37.5 g/L, respectively, the differences were all statistically significant ( Z=-6.111, -6.191, -4.273, -5.353, -2.974 and-6.666, respectively, all P<0.05). Multivariate logistic regression analysis showed that CD4 + T lymphocytes <50/μL, hemoglobin <90 g/L and fecal occult blood positive were independent risk factors for AIDS with intestinal TM infection. The main manifestations of colonoscopy in AIDS with intestinal TM infection group were discontinuous ulcers (31.2%(10/32)), erosion (31.2%(10/32)) or co-exitance of ulcer and erosion (21.9%(7/32)), while suspected tumor-like eminence lesions were less common (15.6%(5/32)). The pathological features of colon mucosa were ulcer and/or erosion (53.1%(17/32)), chronic inflammation (46.9%(15/32)) and inflammatory granuloma (43.8%(14/32)). Oval or round spore with apparent septum could be seen by special staining. In AIDS with intestinal TM infection group, 27 patients were cured or improved, five patients died or deteriorated, while all patients in the AIDS without intestinal TM infection group improved after treatment without death. Conclusions:There are no specific gastrointestinal symptoms in AIDS patients with intestinal TM infection, while the patients present with decreased immunological cells and multiple colony pathological features. Specific fungal spores can be seen.
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Objective To investigate the histopathological characteristics of colonoscopic biopsy specimens from AIDS patients .Methods A total of 310 clinically confirmed AIDS patients with abdominal pain, diarrhea or tenesmus were enrolled from Guangzhou NO .8 People’s Hospital during 2010 and 2014. All patients underwent colonoscopic examination , and the biopsy specimens were collected .Conventional HE staining, special stainings including Gomori’s methenamine silver ( GMS), Periodic Acid-Schiff stain (PAS), acid-fast staining, and immunohistochemical staining of cytomegalovirus (CMV) were performed. Results The biopsy specimens showed mucosa chronic inflammation (93.9%), epithelial degeneration and necrosis;the local erosion and ulcer formation were observed in severe cases .Among 310 patients, the infective pathogens were identified in 139 ( 44.8%) cases, including 47 ( 15.2%) cases with CMV infections, 36(11.6%) cases with mycobacterium infections , 21(6.8%) cases with penicillium marneffei infections, 10(3.2%) cases with Cryptococcus infections, 3(1.0%) cases with candida infections, 2(0.6%) cases with cryptozoite infections and the rest 20(6.5%) cases were with uncertain pathogens . Conclusion Chronic inflammatory lesions are common in patients with AIDS , and colonoscopic mucosal biopsy can help to identify the pathogens of intestinal opportunistic infection .
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Objective To examine the gene expression levels of matrix metalloproteinase-1(MMP-1), tissue inhibitor of metalloproteinase-1 ( TIMP-1) in peripheral blood mononuclear cells (PBMC) and sera in the patients with chronic hepatitis B (CHB) and to investigate the value of message RNA(mRNA) expression of MMP-1 and TIMP-1 for diagnosing liver fibrosis. Methods PBMC and sera samples were collected from 37 CHB patients and 20 healthy controls. The total RNA isolated from PBMC was reversely transcribed into cDNA. The mRNA levels of MMP-1 and TIMP-1 in PBMC were examined by real-time fluorescence quantitative reverse transcription polymerase chain reaction (FQ-RT-PCR). The serum levels of MMP-1 and TIMP-1 were determined by sandwich enzyme-linked immunosorbent assay (ELISA). Liver tissues were obtained from all these patients by biopsy and subsequently used for evaluating liver fibrosis stages (S). Intergroup comparison was performed by non parametric test. The correlation analysis was performed by Spearman. Results The MMP-1 and TIMP-1 mRNA levels in PBMC from healthy controls were low. The MMP-1 mRNA levels in PBMC from CHB patients were not significantly different from those in healthy controls,while the TIMP-1 mRNA levels were remarkably higher in CHB patients' PBMC compared to healthy controls. Both the MMP-1 mRNA levels in PBMC and the MMP-1 protein levels in sera were not significantly different among CHB patients at different disease stages and healthy controls (χ~2 =8. 960,P=0.111l ;χ~2 =7. 898, P = 0.211). However, the TIMP-1 mRNA levels in PBMC and the TIMP-1 protein levels in sera increased gradually along with the disease progressed from S1 to S4. The TIMP-1 mRNA levels in PBMC were (1.67±0. 84) lg copy/μL, (3. 48±2. 08) lg copy/μL,(5. 86±3. 47) lgcopy/μL and (8. 14 ± 6. 48) lg copy/μL from stage 1 to 4 respectively, while the protein levels of TIMP-1 in sera were (233. 73±64. 84) ,μg/L, (262. 10±71. 12) μg/L, (301. 15±62. 74)μg/L and(381. 15 ± 152. 75)μg/L, respectively. The differences between each stages were statistically significant (χ~2'= 14. 290, P=0.002,χ~2 = 12.209, P=0. 007). The TIMP-1 mRNA levels in PBMC and the TIMP-1 serum levels were positively correlated with liver fibrosis stage (r=0. 752, P<0. 01;r=0. 530, P=0. 008). Conclusions The TIMP-1 mRNA level in PBMC and TIMP-1 protein level in serum are closely related with liver fibrosis stages. These two parameters, especially the TIMP-1 mRNA level in PBMC, can be potentially new markers for diagnosing liver fibrosis.
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Objective To study the clinical characteristics, diagnostic methods and therapeutic efficacy of pneumocystis pneumonia (PCP) in patients with acquired immunodeficiency syndrome (AIDS). Methods Sixty-nine AIDS cases of PCP were diagnosed according to the criteria of USA Centers for Disease Control and Prevention revised in 1993. The clinical symptoms and signs of the patients were observed. The peripheral blood lymphocyte counts, blood gas analysis and bronchoalveolar lavage fluid (BALF) were checked and transbronchoscopic lung biopsy was performed. Results All studied patients were in the late stage of AIDS. The main clinical manifestations included fever (100.0%), cough (97.1%), and dyspnea (92.80%). Pulmonary rales could be heard in 42 cases (60.9% ). Peripheral CD4+ T lymphocyte counts ranged from 1 × 106 -88 × 106/L. Fifty-two cases (75.4% ) had low arterial partial pressure of oxygen value of less than 10.7 kPa (1 kPa = 7.5 mm Hg). Sixty-one cases (88.4 %) had elevated serum lactate dehydrogenase (LDH) level. Bilateral diffused interstitial change (46.4%) and ground-glass shadow (29.0%) were the most common abnormal chest radiological findings. Pneumocystis organisms were detected in the BALF from 2 patients and in the transbronchial biopsy (TBB) tissue from 35 patients. All patients were treated with compound sulfamethoxazole. Thirty-three were treated with corticosteroid simultaneously and 27 were assisted with mechanical ventilation. Fifty patients recovered or got improved, eleven died, and eight left hospital because of deteriorated condition. Conclusions When an AIDS patient represents with fever, cough, dyspnea, hypoxemia, elevated serum I.DH level, CD4+ T lymphocyte count below 100 × 106/L, and interstitial pneumonia or ground-glass shadow in chest images, the diagnosis of PCP could be made presumptively. It is difficult to make a nosogenic diagnosis of PCP, but TBB considerably increases the positive rate of pneumocystis. Compound sulfamethoxazole is recommended as the first selected drug. In severe cases, corticosteroid and assisted mechanical ventilation combined with compound sulfamethoxazole could remarkably improve the prognosis of PCP.