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Disseminated Penicillium marneffei infection in southeast Asia
K Supparatpinyo1, C Khamwan, V Baosoung
1Faculty of Medicine, Chiang Mai University, Thailand.
Abstract:
Disseminated infection with the fungal pathogen Penicillium marneffei is, after extrapulmonary tuberculosis and cryptococcal meningitis, the third most common opportunistic infection in HIV disease in northern Thailand. We report the clinical, microbiological, and therapeutic features of a large series of HIV-infected adults with disseminated P marneffei infection. From August, 1987, to June, 1992, 92 patients with P marneffei infection confirmed by culture were seen at Chiang Mai University Hospital, of whom 86 were also infected with HIV. Clinical information was available for 80 of these patients. The most common presenting symptoms and signs were fever (92%), anaemia (77%), weight loss (76%), and skin lesions (71%). 87% of patients presenting with skin lesions had generalised papules with central umbilication. Presumptive diagnosis was made in 50 patients by microscopic examination of Wright's-stained bone-marrow aspirate and/or touch smears of skin biopsy or lymph-node biopsy specimens. Most patients who were diagnosed responded initially to amphotericin or itraconazole, whereas most who were not diagnosed and treated died. 12 patients relapsed within 6 months of cessation of treatment. P marneffei has become an important pathogen of HIV-associated opportunistic infection in Thailand.
Insights
Penicillium marneffei is a significant fungal infection in HIV patients in Thailand. Early diagnosis and treatment with amphotericin or itraconazole are crucial for survival and preventing relapse.
Area of Science:
- Mycology
- Infectious Diseases
- HIV/AIDS Research
Background:
- Penicillium marneffei disseminated infection is a leading opportunistic infection in HIV-positive individuals in Northern Thailand.
- It ranks third, following extrapulmonary tuberculosis and cryptococcal meningitis, in prevalence among HIV-associated infections.
Purpose of the Study:
- To document the clinical, microbiological, and therapeutic characteristics of disseminated Penicillium marneffei infection in a large cohort of HIV-infected adults.
- To highlight the significance of P. marneffei as an opportunistic pathogen in the context of HIV disease in Thailand.
Main Methods:
- A retrospective review of 92 patients with culture-confirmed P. marneffei infection from August 1987 to June 1992 at Chiang Mai University Hospital.
- Clinical data analysis for 80 patients, focusing on presenting symptoms, diagnostic methods, and treatment outcomes.
- Microscopic examination of Wright's-stained bone-marrow aspirates and biopsy smears for presumptive diagnosis.
Main Results:
- Fever, anemia, weight loss, and skin lesions were the most common symptoms in 80 patients.
- Generalized papules with central umbilication were observed in 87% of patients with skin lesions.
- Prompt diagnosis and treatment with amphotericin or itraconazole improved survival, while delayed diagnosis led to mortality.
- Relapse occurred in 12 patients within six months of treatment cessation.
Conclusions:
- Disseminated Penicillium marneffei infection is a critical opportunistic infection in HIV-positive individuals in Thailand.
- Timely diagnosis and appropriate antifungal therapy are essential for managing P. marneffei infections and improving patient outcomes.
- The high rate of relapse underscores the need for continued monitoring and potentially longer treatment durations.