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Clinicopathologic study of hepatic Penicillium marneffei in Northern Thailand
Amnat Yousukh1, Prapan Jutavijittum, Pises Pisetpongsa
1Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand. ayousukh@mail.med.cmu.ac.th
Context:
Penicillium marneffei, an opportunistic fungus, is endemic in Southeast Asia, especially in human immunodeficiency virus-infected individuals living in northern Thailand.
Objective:
We present the results of a clinicopathologic study of hepatic penicilliosis among human immunodeficiency virus/acquired immunodeficiency syndrome patients.
Design:
A search of liver biopsies in one institution from 1998 to 1999 identified 30 cases of penicilliosis.
Results:
Histologically, hepatic lesions could be classified into 1 of 3 patterns: diffuse, granulomatous, and mixed. The diffuse pattern showed a diffuse infiltration of foamy macrophages that contained numerous P marneffei. The granulomatous pattern showed a formation of multiple granulomata with various degrees of inflammatory cell infiltration. The mixed pattern showed features intermediate between the diffuse and granulomatous patterns. Liver function tests of the 3 pathologic pattern groups were evaluated, but there were no statistically significant differences in aspartate aminotransferase, alanine aminotransferase, or alkaline phosphatase levels among the various histologic groups.
Conclusion:
To our knowledge, this is the largest series to date that documents the liver pathology that results from this pathogen. We hypothesize that the histologic patterns seen on biopsy reflect the level of the host's immunity. Hence, in addition to a diagnosis of penicilliosis, a liver biopsy may also provide an assessment of the host's immune status, whereas liver function tests do not.
Insights
This study identified three distinct liver pathology patterns in patients with Penicillium marneffei infection. Liver biopsy can assess host immunity, unlike liver function tests.
Area of Science:
- Mycology
- Pathology
- Immunology
Background:
- Penicillium marneffei is an opportunistic fungus endemic in Southeast Asia.
- It particularly affects individuals with human immunodeficiency virus (HIV) in northern Thailand.
Purpose of the Study:
- To conduct a clinicopathologic study of hepatic penicilliosis in HIV/acquired immunodeficiency syndrome (AIDS) patients.
- To analyze the histopathologic patterns of liver involvement by P. marneffei.
Main Methods:
- A retrospective review of 30 liver biopsy cases of penicilliosis from 1998-1999.
- Classification of hepatic lesions into diffuse, granulomatous, or mixed patterns.
- Evaluation of liver function tests (LFTs) across different histologic groups.
Main Results:
- Three distinct histologic patterns of hepatic lesions were identified: diffuse, granulomatous, and mixed.
- The diffuse pattern showed foamy macrophage infiltration with P. marneffei.
- No statistically significant differences in LFTs (AST, ALT, ALP) were observed among the histologic groups.
Conclusions:
- This is the largest documented series on liver pathology caused by P. marneffei.
- Histologic patterns may reflect the host's immune status.
- Liver biopsy can aid in assessing host immunity, complementing the diagnosis of penicilliosis, whereas LFTs do not provide this information.
