Related Experiment Videos
Infection due to Penicillium marneffei
1Department of Medicine, Faculty of Medicine, Chiang Mai University, Thailand.
Abstract:
Penicillium marneffei is endemic in Southeast Asia, the Guangxi province of China, and Hong Kong. Cases of patients infected with P. marneffei have been very rare, but the incidence has increased markedly during the past several years. This increase is exclusively due to infection among patients infected with human immunodeficiency virus (HIV). The patients usually presented with symptoms and signs similar to other patients with late HIV diseases. These included fever (99% of the patients), anaemia (78%), pronounced weight loss (76%), generalised lymphadenopathy (58%) and hepatomegaly (51%). Skin lesions were seen in 71% of our patients. These lesions were most commonly papules with central necrotic umbilication. It was easy to culture P. marneffei from various clinical specimens. Bone marrow culture was the most sensitive (100%), followed by culture of the specimen obtained from skin biopsy (90%) and blood culture (76%). The fungus was sensitive to amphotericin B, itraconazole, and ketoconazole. Our regimen is to give amphotericin B for 2 weeks, followed by itraconazole 400 mg/day orally for the next 10 weeks. After the initial treatment, the patient is given itraconazole 200 mg/day as secondary prophylaxis for life.
Insights
Penicillium marneffei infections are rising in HIV patients in Southeast Asia. Early treatment with amphotericin B and itraconazole, followed by lifelong prophylaxis, is crucial for managing this opportunistic fungal infection.
Area of Science:
- Mycology
- Infectious Diseases
- Public Health
Background:
- Penicillium marneffei is endemic in Southeast Asia, China, and Hong Kong.
- Cases of P. marneffei infection have increased, primarily in individuals with human immunodeficiency virus (HIV).
Purpose of the Study:
- To describe the clinical presentation, diagnosis, and treatment of P. marneffei infections in HIV-positive patients.
- To evaluate the efficacy of a specific treatment regimen for P. marneffei infection.
Main Methods:
- Retrospective analysis of clinical data from P. marneffei infected patients.
- Microbiological culture from various clinical specimens (bone marrow, skin biopsy, blood).
- Antifungal susceptibility testing.
Main Results:
- Common symptoms include fever, anemia, weight loss, lymphadenopathy, hepatomegaly, and characteristic skin lesions.
- Bone marrow culture demonstrated 100% sensitivity for P. marneffei detection.
- The fungus was sensitive to amphotericin B, itraconazole, and ketoconazole.
Conclusions:
- P. marneffei infection presents similarly to other late-stage HIV diseases.
- A treatment regimen of initial amphotericin B followed by prolonged itraconazole is effective.
- Lifelong secondary prophylaxis with itraconazole is recommended for P. marneffei patients.