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Penicilliosis marneffei: another AIDS defining illness in Southeast Asia
1Department of Stomatology, Faculty of Dentistry, Prince of Songkla University, Haadyai, Songkhla 90112, Thailand.
Abstract:
Penicilliosis marneffei, a common mycosis among AIDS patients living in Southeast Asia, has been recently suggested for inclusion in the AIDS surveillance case definition. Infections with Penicillium marneffei were rare in the past, but infections with this dimorphic fungus have increased with the endemic of AIDS in the region. The reservoir of P. marneffei in nature is still unknown, although it seems likely that inhalation may be the route of entry of the organism leading to infection in humans. P. marneffei can cause two clinical types of the disease; focal and fatal progressive, disseminated infections, characterized by a variety of symptoms which can mimic those of other diseases. Oral P. marneffei lesions usually occur in patients with disseminated infections, presenting as shiny papules, as erosions or as shallow ulcers covered with whitish yellow, necrotic slough which may be found on the palate, gingiva, labial mucosa, tongue and oropharynx. Biopsy and culture provide definitive diagnoses, while serologic tests for both antibody and antigen are useful in rapid presumptive diagnoses as well as in surveillance studies of the prevalence and latency of the infection. Penicilliosis marneffei is a treatable disease, but late diagnosis and treatment may be fatal. Itraconazole and ketoconazole are the drugs of first choice for mild to moderately severe forms of the disease, whereas parenteral therapy with amphotericin B may be required for seriously ill patients. Recurrence of the disease is common, therefore maintenance is recommended. As reported, prophylaxis generating resistant strains are likely to develop.
Insights
Penicilliosis marneffei is a fungal infection increasingly seen in AIDS patients in Southeast Asia. Early diagnosis and treatment are crucial for survival, as the disease can be fatal if neglected.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Public Health
Background:
- Penicilliosis marneffei, a fungal infection caused by Penicillium marneffei, is prevalent in Southeast Asia, particularly among individuals with Acquired Immunodeficiency Syndrome (AIDS).
- The incidence of Penicillium marneffei infections has risen with the AIDS epidemic, highlighting its significance in regional public health surveillance.
- The natural reservoir and transmission routes of P. marneffei remain largely unknown, though inhalation is suspected as the primary route of human infection.
Discussion:
- Penicilliosis marneffei presents with diverse clinical manifestations, including focal and disseminated forms that can mimic other illnesses, complicating diagnosis.
- Oral lesions are common in disseminated cases, presenting as papules, erosions, or ulcers on oral mucosal surfaces.
- Definitive diagnosis relies on biopsy and culture, while serological tests aid in rapid presumptive diagnosis and epidemiological surveillance.
Key Insights:
- Penicilliosis marneffei is treatable, but delayed diagnosis and treatment can lead to fatal outcomes.
- First-line treatments include itraconazole and ketoconazole for mild to moderate cases, with amphotericin B reserved for severe infections.
- Recurrence is frequent, necessitating long-term maintenance therapy to prevent relapse.
Outlook:
- The potential development of resistant strains due to prophylactic measures warrants further investigation.
- Inclusion in AIDS surveillance case definitions is being considered to improve monitoring and control of this opportunistic infection.
- Continued research into the environmental reservoir and pathogenesis of P. marneffei is essential for effective prevention strategies.