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Hepatic penicilliosis in patients without skin lesions
P Kantipong1, V Panich, V Pongsurachet
1Department of Medicine, Chiangrai Regional Hospital, Thailand.
Abstract:
Penicillium marneffei is a common cause of opportunistic fungal infection in patients with AIDS in Thailand. The diagnosis of penicilliosis is easily made when typical skin lesions appear but is frequently missed in their absence. We therefore attempted to identify noncutaneous indicators of P. marneffei infection in order to provide early curative treatment. We recognized a characteristic syndrome in six AIDS patients with penicilliosis involving primarily the liver but not the skin who presented with fever of short duration, hepatomegaly, and markedly elevated serum alkaline phosphatase levels. The diagnosis was confirmed by demonstrating the causative organism in the liver or in the blood. Increased awareness of hepatic penicilliosis and more-rapid diagnostic methods are needed to reduce the high mortality rate associated with this syndrome. P. marneffei is predominantly an Asian pathogen, but as a result of international travel, the need for increased awareness of penicilliosis is worldwide.
Insights
Penicillium marneffei causes opportunistic infections, often missed in AIDS patients without skin lesions. Early detection of hepatic penicilliosis, indicated by fever and elevated alkaline phosphatase, is crucial for treatment.
Area of Science:
- Mycology
- Infectious Diseases
- Immunocompromised Hosts
Background:
- Penicillium marneffei is a significant opportunistic fungal pathogen, particularly in Thailand.
- Penicilliosis diagnosis is straightforward with characteristic skin lesions but often delayed or missed in their absence.
Observation:
- A distinct clinical syndrome of hepatic penicilliosis was identified in six patients with Acquired Immunodeficiency Syndrome (AIDS).
- This syndrome presented with short-duration fever, hepatomegaly (enlarged liver), and significantly elevated serum alkaline phosphatase levels, without cutaneous manifestations.
Findings:
- The causative organism, Penicillium marneffei, was confirmed in liver biopsies or blood samples.
- Elevated serum alkaline phosphatase is a key noncutaneous indicator of P. marneffei infection in AIDS patients.
Implications:
- Increased awareness of hepatic penicilliosis is vital for early diagnosis and treatment in immunocompromised individuals.
- Development of rapid diagnostic methods for P. marneffei is essential to reduce mortality.
- Global travel necessitates worldwide vigilance for this emerging fungal infection.