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Environmental Predictors and Incubation Period of AIDS-Associated Penicillium marneffei Infection in Ho Chi Minh City, Vietnam

Bulterys, Philip L. and Le, Thuy and Quang, Vo Minh and Nelson, Kenrad E. and Lloyd-Smith, James O. (2013) Environmental Predictors and Incubation Period of AIDS-Associated Penicillium marneffei Infection in Ho Chi Minh City, Vietnam. Clinical Infectious Diseases, 56 (9). pp. 1273-1279. ISSN 1058-4838. doi:10.1093/cid/cit058.

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Background. Penicillium marneffei is an emerging dimorphic mycosis endemic in Southeast Asia, and a leading cause of mortality among human immunodeficiency virus (HIV)–infected people in the region. Factors governing the seasonal incidence of P. marneffei infection are unknown, and may yield critical insights into possible reservoirs or modes of acquisition. Methods. This study included HIV-infected patients presenting with P. marneffei (n = 719) and Cryptococcus neoformans (n = 1598) infection to the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam, from 2004 to 2010, and temperature, humidity, wind, precipitation, and HIV-related admissions data for the corresponding period. We used multivariate regression modeling to identify factors associated with P. marneffei and C. neoformans admissions. We estimated the P. marneffei incubation period by considering profile likelihoods for different exposure-to-admission delays. Results. We found that P. marneffei admissions were strongly associated with humidity (P < .001), and that precipitation, temperature, and wind did not add explanatory power. Cryptococcus neoformans admissions were not seasonal, and P. marneffei admissions were more common relative to C. neoformans admissions during months of high (≥85%) humidity (odds ratio, 1.49; 95% confidence interval [CI], 1.10–2.01). Maximum likelihood estimation suggested a P. marneffei incubation period of 1 week (95% CI, 0–3 weeks). Conclusions. Our findings suggest that humidity is the most important environmental predictor of P. marneffei admissions, and may drive exposure by facilitating fungal growth or spore release in the environment. In addition, it appears that a high proportion of penicilliosis patients present to the hospital with primary disseminated infection within 3 weeks of exposure.

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Additional Information:© 2013 The Author. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. Received 2 March 2012; accepted 30 October 2012; electronically published 5 February 2013. We thank the Microbiology Department and the Scientific and Planning Office of the Hospital for Tropical Diseases for providing access to the hospital records. We thank members of the Lloyd-Smith lab, especially Ruian Ke and Claude Loverdo, for helpful discussion and comments. Financial support. P. L. B. is supported by the UCLA-Caltech Medical Scientist Training Program and the Paul and Daisy Soros Fellowships for New Americans. T. L. is supported by the Fogarty International Clinical Research Fellowship, Hawaii Center for AIDS, and Wellcome Trust Major Overseas Program. J. O. L.-S. is supported by the De Logi Chair in Biological Sciences, and the RAPIDD program of the Science and Technology Directorate, Department of Homeland Security and the Fogarty International Center, National Institutes of Health. Potential conflicts of interest. All authors: No reported conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
Funding AgencyGrant Number
UCLA-Caltech Medical Scientist Training ProgramUNSPECIFIED
Paul and Daisy Soros Fellowships for New AmericansUNSPECIFIED
Fogarty International Clinical Research FellowshipUNSPECIFIED
Wellcome Trust Major Overseas ProgramUNSPECIFIED
De Logi Chair in Biological SciencesUNSPECIFIED
Science and Technology Directorate RAPIDD ProgramUNSPECIFIED
Department of Homeland SecurityUNSPECIFIED
NIH Fogarty International CenterUNSPECIFIED
Subject Keywords:Penicillium marneffei; penicilliosis; seasonality; humidity; HIV/AIDS
Issue or Number:9
Record Number:CaltechAUTHORS:20130509-104923410
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Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:38384
Deposited On:09 May 2013 21:44
Last Modified:09 Nov 2021 23:37

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