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Marrow penicilliosis: a readily missed diagnosis

K F Wong1

  • 1Dept. of Pathology, Queen Elizabeth Hospital, Hong Kong SAR, China.

American Journal of Clinical Pathology
|July 28, 2010
PubMed

Insights

Penicillium marneffei infection in AIDS patients can be diagnosed by examining bone marrow. Histiocytes may contain yeast-like cells, and silver stain aids detection.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Hematology

Background:

  • Penicillium marneffei is a significant opportunistic pathogen in human immunodeficiency virus (HIV)-infected individuals, particularly in Asia.
  • Diagnosis of P. marneffei infection typically relies on microbiologic culture, which can take several days.
  • Bone marrow biopsy is a valuable diagnostic tool for opportunistic infections in patients with AIDS, especially those presenting with fever or hematologic abnormalities.

Purpose of the Study:

  • To describe the bone marrow findings in patients with culture-proven Penicillium marneffei infection.
  • To highlight the diagnostic utility of bone marrow examination for P. marneffei.

Main Methods:

  • Retrospective analysis of bone marrow biopsy specimens from patients with culture-proven P. marneffei infection.
  • Histologic examination of bone marrow, including special stains like silver methenamine.

Main Results:

  • Histiocytes in bone marrow can be numerous or subtle and may contain intracellular yeast-form P. marneffei.
  • Granuloma formation may be absent despite histiocytic proliferation.
  • Yeast-form cells can resemble cellular debris; characteristic septate forms and lack of budding aid differentiation from other infections.

Conclusions:

  • Bone marrow biopsy can provide a prompt diagnosis of P. marneffei infection in patients with AIDS.
  • Routine use of silver methenamine stain on bone marrow biopsy specimens is recommended for febrile AIDS patients to detect subtle P. marneffei infections.

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