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Disseminated Penicillium marneffei infection in HIV-infected subject
Abstract:
Penicillium marneffei is a rare human pathogen predominantly affecting residents of South-east Asia. We report four fatal cases from Hong Kong in human immunodeficiency virus-infected patients. The diagnosis was established by histological examination and confirmed by isolation of the fungus. The infection was disseminated with involvement of lymph nodes, liver, spleen, lung, intestine and bone marrow. The involved organs showed an exclusively anergic tissue reaction characterized by a diffuse infiltrate of fungi-laden macrophages, multiple co-existing opportunistic infections and lymphoid cell depletion. This organism has to be distinguished from Histoplasma capsulatum and Pneumocystis carinii. Establishment of the diagnosis is important not only because this infection is potentially curable, but also it is a likely indicator disease of AIDS in South-east Asia. Penicilliosis marneffei should be suspected in any symptomatic HIV-positive patient who comes from or has visited endemic areas of South-east Asia.
Insights
Penicillium marneffei causes fatal infections in HIV-positive individuals in Southeast Asia. Early diagnosis of this disseminated fungal infection is crucial for treatment and identifying AIDS indicator disease.
Area of Science:
- Mycology
- Infectious Diseases
- Immunology
Background:
- Penicillium marneffei is a fungal pathogen endemic to Southeast Asia.
- It primarily affects individuals with compromised immune systems, particularly those with human immunodeficiency virus (HIV).
Observation:
- This report details four fatal cases of Penicillium marneffei infection in HIV-infected patients in Hong Kong.
- The infection disseminated to multiple organs including lymph nodes, liver, spleen, lungs, intestines, and bone marrow.
- Histological examination revealed anergic responses with fungi-laden macrophages and lymphoid depletion.
Findings:
- Diagnosis was confirmed through histological examination and fungal isolation.
- The observed tissue reaction was characterized by anergy, opportunistic infections, and lymphoid cell depletion.
- Distinguishing Penicillium marneffei from Histoplasma capsulatum and Pneumocystis carinii is essential.
Implications:
- Penicilliosis marneffei is a potentially curable infection and a significant indicator disease for Acquired Immunodeficiency Syndrome (AIDS) in Southeast Asia.
- Clinicians should suspect this infection in symptomatic HIV-positive patients from or who have visited endemic regions.
- Prompt diagnosis and treatment are vital for patient outcomes.