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Objective: To analyze Helicobacter pylori infection in the gastric mucosa of patients with HIV/AIDS in different clinical stages., Methods: This study involved 170 patients with HIV/AIDS and 34 HIV-negative patients. All the patients underwent upper endoscopy and antral gastric biopsy to determine the status of Helicobacter pylori infection using aniline red staining and rapid urease test. The patients with HIV/AIDS were stratified based on CD4(+)T lymphocyte counts and clinical setting into asymptomatic HIV infection (A1, A2) group, symptomatic HIV infection (B1, B2) group and AIDS (A3, B3, C1-3) group., Results: The prevalence of Helicobacter pylori infection in HIV/AIDS patients was 16.5% (28/170), and in the 3 groups classified, the infection rates were 23.4% (11/47), 14.0% (8/57), and 13.6% (9/66), respectively; the infection rate was 47.1% (16/34) in the control group. Helicobacter pylori infection rate in the gastric mucosa of the patients with HIV/AIDS in different clinical stages was significantly lower than that of the control group (P<0.05); the infection rates in symptomatic HIV-infected (B1, B2) group and AIDS (A3, B3, C1-3) group were significantly lower than that in asymptomatic HIV-infected (A1, A2) group (P<0.05)., Conclusion: The low Helicobacter pylori infection rate in HIV/AIDS patients may result from severe immunodeficiency in the gastric mucosa.

Objective: To study the pathogens and drug resistance profiles of pulmonary infection in patients with AIDS., Methods: The pathogens and their drug susceptibility of pulmonary infection diagnosed by fibrobronchoscopy-induced bronchoalveolar lavage fluid (BALF) culture and/or transbronchial biopsy in 116 AIDS cases were analyzed., Results: Monopathogenic infection in lungs were detected in 18 cases (15.5%) and mixed infection in 98 cases (84.5%). Of the 116 cases, bacteria were present in 91 patients, fungi in 62, tubercle bacillus in 49, pneumocystis jiroveci in 29, and cytomegalovirus in 11. Ninety-five bacterial strains were isolated from BALF, mainly including Streptococci (34), coagulase negative Staphylococcus (20), Klebsiella pneumoniae (10) and Escherichia (7). The isolated bacteria were resistant to beta-lactam, macrolides, quinolones and aminoglycosides, of which were 14 methicillin-resistant Streptococci (MRS) strains and 12 extended spectrum beta-lactamases (ESBL) strains. Sixty-eight fungal strains were isolated, including 36 Candida mycoderma, 19 Penicillium, 6 Aspergilli and 5 Mold fungi; they were sensitive to amphotericin B but resistant to fluconazole (5.6% - 50.0%) and itraconazole (10.5% - 60.0%)., Conclusion: Pneumonia in AIDS patients are usually caused by multiple pathogens, predominantly consisting of multiresistant bacteria and fungi. Therefore, antibiotics should be rationally chosen according to drug susceptibility test.

Objective: To study the differences in the clinical and laboratory characteristics of disseminated penicilliosis marneffei (PSM) in patients with and without human immunodeficiency virus (HIV) infection., Methods: The clinical data of 33 patients with PSM in our hospital from 2002 to 2007 were retrospectively analyzed. The patients were divided into 2 groups, an HIV infection group (n = 22) and a non-HIV infection group (n = 11). The data of the 2 groups were compared., Results: The common features in the 2 groups included that, the majority of the patients were manual laborers with a low educational level, and the most common clinical characteristics were fever, multiple organ involvement especially the lung, skin, digestive system, and generalized lymphadenopathy. Different characteristics between the 2 groups included, (1) In the non-HIV infection group, the duration of the disease was longer (median: 45 vs 180 d, P < 0.01), with more underlying diseases (5/11) and higher misdiagnosis rate (7/11) as compared to those of the HIV infection group; (2) High, persistent fever, acute dyspnea and molluscum of the skin were more common in the HIV infection group, but intermittent fever, subcutaneous nodules and abscess were the features of the non-HIV infection group. Generalized lymphadenopathy (10/11), bone ache (5/11) and chest pain (7/11) were also more common in the non-HIV infection group (10/22, 2/22, 0/22, respectively in the HIV infection group, P < 0.05; (3) The total white cell counts were mostly increased in the non-HIV infection group (9/11), but were mostly in the normal range (15/22) or decreased (7/22) in the HIV infection group (P = 0.000). The total white cell count, the neutrophil and the lymphocyte counts in the non-HIV infection group were significantly higher than those in the HIV infection group (median: 18.6 x 10(9)/L vs 4.71 x 10(9)/L; 14.24 x 10(9)/L vs 4.16 x 10(9)/L; 2.08 x 10(9)/L vs 0.42 x 10(9)/L, P < 0.01, respectively; (4) The blood CD(4)/CD(8) ratio was normal or higher than 0.5 in the non-HIV infection group, but was, less than 0.5 in the HIV infection group (P = 0.000); (5) The positive rate of blood culture (18/18) or bone marrow culture (14/20) was significantly higher in the HIV infection group than those in the non-HIV infection group (7/10, 2/8, P < 0.05, respectively); (6) Diffuse parenchymal and interstitial changes were the main manifestations of chest radiology in the 2 groups. High-density consolidation and pleuritis were common in the non-HIV infection group, and osteolysis occurred only in the non-HIV infection group (n = 4, P < 0.05); (7) The prognosis was better in the non-HIV infection group (P < 0.05)., Conclusion: Fever, multiple organ dysfunction and poor prognosis are common clinical characteristics of PSM in the 2 groups, but there are significantly different characteristics between the 2 groups in underlying diseases, clinical presentations, disease progress and some laboratory studies.

Objective: To study the clinicopathologic features of acquired immunodeficiency syndrome (AIDS)-related lymphadenopathy and to elucidate the salient features helpful in achieving a correct pathologic differentiated diagnosis., Methods: Eighteen cases of AIDS-related lymphadenopathy were retrieved from the files of the First Affiliated Hospital of Guangxi Medical University from 2001 to 2004. Histochemical stains, including periodic acid-Schiff, acid-fast, Giemsa, Grocott stains and immunohistochemistry (EnVision method), were used to detect the presence of pathogens in tissue sections and classify them., Results: Fifteen of the 18 cases (83%) were stage 4 (i.e. follicular and lymphocytic depletion). Twelve cases were co-infected with Penicillium marneffei and 4 other cases with Mycobacterium, and no pathogen was found in 1. The remaining patient was complicated with diffuse large B-cell lymphoma., Conclusions: When presented in early stages, AIDS-related lymphadenopathy may be overlooked, especially in routine pathology practice. Awareness of the entity in patients with persistent fever and generalized lymphadenopathy is thus crucial. Florid infection with Penicillium marneffei is also considered as an important predictor for underlying AIDS. Thorough understanding of morphologic features of AIDS-related lymphadenopathy, including possible co-infection, is essential in arriving at the correct diagnosis.

Objectives: To elucidate the etiology, pathohistology, clinical characteristic and differential diagnosis, reduce missed diagnosis and improve the early detection and treatment of Penicillium Marneffei infection, by means of this case report and literature review., Methods: A patient hospitalized Penicillium Marneffei infection were presented here, together with 27 cases in the literature, among which 10 patients had complications of AIDS and 5 with other diseases., Results: Penicillium Marneffei is a temperature-sensitive, two-phase fungus, which can infect healthy and immunocompromised subjects. The common symptoms are lymphadenopathy and infection of the lung. The infection may be local or diffuse, involving the intestinal tract, soft tissue, bone, liver, spleen and bone marrow etc. The lesion can be classified into the granuloma type, suppurative type and anergy/necrosis type histologically. The yeast-like fungus were mainly found in the cytoplasm of macrophages, which were demonstrated by PAS and Giemsa staining. The wine red color developed on the culture confirms the diagnosis., Conclusions: The diagnosis of Penicillium Marneffei infection should be considered when tuberculosis is suspected but not confirmed, and if the patient has a history of having lived or traveled in Southeast Asia, is anemic or resistant to anti-tuberculosis treatment. The major differential diagnosis is histoplasmosis. Early administration of anti-fungus drugs is essential for recovery.

Objective: To explore the clinical and laboratory features of disseminated Penicillium marneffei infection in patients with AIDS., Methods: The HIV antibody in serum was assayed by both enzyme immunoassay (EIA) and Western immunoblot (WIB) methods. Morphology of the pathogenic fungus in smear and biopsy specimens of bone marrow was observed. The fungus was isolated from the patient's skin lesion and inoculated into the abdominal cavities of 2 rats and 2 mice. Twenty days later the rats and mice were killed and their viscera were taken out. Blood from the organs were cultured in Sabourand glucose agar at 25 degrees C and 37 degrees C. The colonies were observed. The morphology of the fungus was observed by microscopy and scanning electron microscopy., Results: The most common clinical manifestations of Penicilium marneffei infection were fever, weight loss, anemia, papular skin lesion, hepatosplenomegaly, and lymphadenectasis. Yeast-like cells were found in the culture at 37 degrees C or in tissues. The fungi outside the host cells were elongated, often curved, sausage-like and with clear central septi. When cultured at 25 degrees C, the fungus was mycelia-like and produced a characteristic red pigment, diffusing into the medium., Conclusion: Disseminated Penicilliosis marneffei is one of the most important opportunistic infections in patients with AIDS in Southeast Asia and the southern part of China. Since there is no specific clinical manifestation for Penicillium marneffei infection, it is often misdiagnosed. Definite diagnosis requires culture of the pathogenic fungus from clinical specimens. The fungus is thermally dimorphic, produces red pigment, and is sausage-form with clear central septum outside the host cell. Amphotericin B and itraconazole are effective in treating Penicilliosis marneffei.