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Volume 7, Number 7—June 2001
THEME ISSUE
International Conference on Emerging Infectious Diseases 2000
Conference Panel Summary

Penicillium marneffei Infection in Patients with AIDS

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Author affiliation: Chiang Mai University, Chiang Mai, Thailand

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Penicillium marneffei infection (PM) is an important disease among HIV-infected persons in Southeast Asia. Discovered in 1956 from the bamboo rat, Rhizomys sinensis, in Vietnam (1), PM was first identified in HIV-infected persons in 1988 (2). The disease has now been reported among HIV-infected persons in Thailand, Myanmar (Burma), Vietnam, Cambodia, Malaysia, northeastern India, Hong Kong, Taiwan, and southern China (3). Cases of PM also have been reported among HIV-infected persons from the United States, the United Kingdom, The Netherlands, Italy, France, Germany, Switzerland, Sweden, Australia, and Japan after they visited the PM-endemic region (3).

PM occurs late in the course of HIV infection. Our study found that the CD4+ cell count at the time of the diagnosis of PM was consistently less than 50 cells/ml. Clinical presentation included fever (in 99% of the patients), anemia (78%), pronounced weight loss (76%), generalized lymphadenopathy (58%), and hepatomegaly (51%). However, these conditions were not specific for PM and could be caused by HIV or other HIV-related opportunistic infections. A more specific finding was skin lesions, most commonly papules with central necrotic umbilication (4), which were seen in 71% of the patients.

In 63% of the patients with PM, a presumptive diagnosis could be made several days before the results of fungal culture were available. This was done by microscopic examination of a Wright-stained sample of bone marrow aspirate, touch smears of a skin biopsy specimen, or a lymph node biopsy specimen. It was easy to culture P. marneffei from various clinical specimens. Bone marrow culture was the most sensitive (100%), followed by culture of the specimen obtained from skin biopsy (90%) and blood culture (76%) (4).

The fungus was sensitive to amphotericin B, itraconazole, and ketoconazole (5). The current recommended treatment regimen is to give amphotericin B, 0.6 mg/kg/day for 2 weeks, followed by itraconazole, 400 mg/day orally in two divided doses for the next 10 weeks (6). After initial treatment, the patient should be given itraconazole, 200 mg/day, as secondary prophylaxis for life (7).

P. marneffei has been isolated from several species of bamboo rats in the disease-endemic area, but epidemiologic studies have thus far failed to define an environmental exposure associated with the disease (8-10).

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References

  1. Segretain  G. Description d'une nouvelle espece de Penicillium: Penicillium marneffei n. sp. Bull Soc Mycol Fr. 1959;75:4126.
  2. Piehl  MR, Kaplan  RL, Haber  MH. Disseminated penicilliosis in a patient with acquired immunodeficiency syndrome. Arch Pathol Lab Med. 1988;112:12624.PubMedGoogle Scholar
  3. Sirisanthana  T, Supparatpinyo  K. Epidemiology and management of penicilliosis in human immunodeficiency virus-infected patients. Int J Infect Dis. 1998;3:4853. DOIPubMedGoogle Scholar
  4. Supparatpinyo  K, Khamwan  C, Baosoung  V, Nelson  KE, Sirisanthana  T. Disseminated Penicillium marneffei infection in Southeast Asia. Lancet. 1994;344:1103. DOIPubMedGoogle Scholar
  5. Supparatpinyo  K, Nelson  KE, Merz  WG, Breslin  BJ, Cooper  CR Jr, Kamwan  C, Response to antifungal therapy by human immunodeficiency virus-infected patients with disseminated Penicillium marneffei infection and in vitro susceptibilities of isolates from clinical specimens. Antimicrob Agents Chemother. 1993;37:240711.PubMedGoogle Scholar
  6. Sirisanthana  T, Supparatpinyo  K, Perriens  J, Nelson  KE. Amphotericin B and itraconazole for treatment of disseminated Penicillium marneffei infection in human immunodeficiency virus-infected patients. Clin Infect Dis. 1998;26:110710. DOIPubMedGoogle Scholar
  7. Supparatpinyo  K, Perriens  J, Nelson  KE, Sirisanthana  T. A controlled trial of itraconazole to prevent relapse of Penicillium marneffei infection in patients infected with the human immunodeficiency virus. N Engl J Med. 1998;339:173943. DOIPubMedGoogle Scholar
  8. Chariyalertsak  S, Vanittanakom  P, Nelson  KE, Sirisanthana  T, Vanittanakom  N. Rhizomys sumatrensis and Cannomys badius, new natural animal hosts of Penicillium marneffei. J Med Vet Mycol. 1996;34:10510. DOIPubMedGoogle Scholar
  9. Chariyalertsak  S, Sirisanthana  T, Supparatpinyo  K, Praparattanapan  J, Nelson  KE. Case-control study of risk factors for Penicillium marneffei infection in human immunodeficiency virus-infected patients in northern Thailand. Clin Infect Dis. 1997;24:10806. DOIPubMedGoogle Scholar
  10. Chariyalertsak  S, Sirisanthana  T, Supparatpinyo  K, Nelson  KE. Seasonal variation of disseminated Penicillium marneffei infection in northern Thailand: a clue to the reservoir? J Infect Dis. 1996;173:14903. DOIPubMedGoogle Scholar

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Cite This Article

DOI: 10.3201/eid0707.017734

Table of Contents – Volume 7, Number 7—June 2001

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Please use the form below to submit correspondence to the authors or contact them at the following address:

Thira Sirisanthana, Division of Infectious Diseases, Department of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; fax: 66-53-217144

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Page created: April 27, 2012
Page updated: April 27, 2012
Page reviewed: April 27, 2012
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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