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Disseminated Penicillium marneffei infection in human immunodeficiency virus-infected children
V Sirisanthana1, T Sirisanthana
1Faculty of Medicine, Chiang Mai University, Thailand.
Abstract:
Disseminated infection with the fungus Penicillium marneffei is one of the most common opportunistic infections in human immunodeficiency virus (HIV) disease in northern Thailand. We report the clinical, laboratory and therapeutic features of 21 human immunodeficiency virus-infected children with disseminated P. marneffei who were prospectively followed. Significant clinical and laboratory features included generalized lymphadenopathy (90%), hepatomegaly (90%), body temperature > 38.5 degrees C (81%), papular skin lesions with central umbilication (67%), splenomegaly (67%), failure to thrive (52%), severe anemia (hemoglobin < 60 g/liter) (43%) and thrombocytopenia (platelet count < 0.5 x 10(11)/liter) (21%). The response rate in patients who were treated with appropriate antifungal therapy (amphotericin B, fluconazole or ketoconazole) was 82%. No relapse was observed in patients given ketoconazole prophylactically. Skin lesions, usually papules with central necrotic umbilication, provide the most significant clue to the diagnosis. Early diagnosis based on finding P. marneffei in the skin smear or lymph node provides the basis for prompt administration of antifungal therapy and improved outcome.
Insights
Disseminated Penicillium marneffei fungal infections are common in children with human immunodeficiency virus (HIV) in Thailand. Early diagnosis via skin or lymph node examination and prompt antifungal treatment significantly improve patient outcomes.
Area of Science:
- Mycology
- Infectious Diseases
- Pediatrics
Background:
- Penicillium marneffei fungal infection is a leading opportunistic infection in human immunodeficiency virus (HIV)-infected individuals in northern Thailand.
- Disseminated P. marneffei infections present unique challenges in pediatric populations.
Purpose of the Study:
- To describe the clinical, laboratory, and therapeutic characteristics of disseminated P. marneffei infection in HIV-infected children.
- To evaluate the effectiveness of antifungal therapies and prophylactic measures.
Main Methods:
- Prospective follow-up of 21 HIV-infected children diagnosed with disseminated P. marneffei infection.
- Clinical and laboratory data collection, including physical examination, blood counts, and diagnostic tests.
- Analysis of treatment responses to antifungal agents (amphotericin B, fluconazole, ketoconazole) and prophylactic ketoconazole.
Main Results:
- Common clinical features included generalized lymphadenopathy (90%), hepatomegaly (90%), fever > 38.5°C (81%), papular skin lesions (67%), and splenomegaly (67%).
- Significant laboratory findings included severe anemia (43%) and thrombocytopenia (21%).
- An 82% response rate was observed with appropriate antifungal therapy; prophylactic ketoconazole prevented relapse.
Conclusions:
- Papular skin lesions with central umbilication are a key diagnostic indicator.
- Early diagnosis through P. marneffei detection in skin smears or lymph nodes is crucial.
- Prompt antifungal therapy and prophylactic ketoconazole improve outcomes in children with disseminated P. marneffei infection.