Volume 7, Number 7—June 2001
International Conference on Emerging Infectious Diseases 2000
Conference Panel Summary
Penicillium marneffei Infection in Patients with AIDS
Penicillium marneffei infection (PM) is an important disease among HIV-infected persons in Southeast Asia. Discovered in 1956 from the bamboo rat, Rhizomys sinensis, in Vietnam (1), PM was first identified in HIV-infected persons in 1988 (2). The disease has now been reported among HIV-infected persons in Thailand, Myanmar (Burma), Vietnam, Cambodia, Malaysia, northeastern India, Hong Kong, Taiwan, and southern China (3). Cases of PM also have been reported among HIV-infected persons from the United States, the United Kingdom, The Netherlands, Italy, France, Germany, Switzerland, Sweden, Australia, and Japan after they visited the PM-endemic region (3).
PM occurs late in the course of HIV infection. Our study found that the CD4+ cell count at the time of the diagnosis of PM was consistently less than 50 cells/ml. Clinical presentation included fever (in 99% of the patients), anemia (78%), pronounced weight loss (76%), generalized lymphadenopathy (58%), and hepatomegaly (51%). However, these conditions were not specific for PM and could be caused by HIV or other HIV-related opportunistic infections. A more specific finding was skin lesions, most commonly papules with central necrotic umbilication (4), which were seen in 71% of the patients.
In 63% of the patients with PM, a presumptive diagnosis could be made several days before the results of fungal culture were available. This was done by microscopic examination of a Wright-stained sample of bone marrow aspirate, touch smears of a skin biopsy specimen, or a lymph node biopsy specimen. 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%) (4).
The fungus was sensitive to amphotericin B, itraconazole, and ketoconazole (5). The current recommended treatment regimen is to give amphotericin B, 0.6 mg/kg/day for 2 weeks, followed by itraconazole, 400 mg/day orally in two divided doses for the next 10 weeks (6). After initial treatment, the patient should be given itraconazole, 200 mg/day, as secondary prophylaxis for life (7).
P. marneffei has been isolated from several species of bamboo rats in the disease-endemic area, but epidemiologic studies have thus far failed to define an environmental exposure associated with the disease (8-10).
- Segretain G. Description d'une nouvelle espece de Penicillium: Penicillium marneffei n. sp. Bull Soc Mycol Fr. 1959;75:412–6.
- Piehl MR, Kaplan RL, Haber MH. Disseminated penicilliosis in a patient with acquired immunodeficiency syndrome. Arch Pathol Lab Med. 1988;112:1262–4.
- Sirisanthana T, Supparatpinyo K. Epidemiology and management of penicilliosis in human immunodeficiency virus-infected patients. Int J Infect Dis. 1998;3:48–53.
- Supparatpinyo K, Khamwan C, Baosoung V, Nelson KE, Sirisanthana T. Disseminated Penicillium marneffei infection in Southeast Asia. Lancet. 1994;344:110–3.
- Supparatpinyo K, Nelson KE, Merz WG, Breslin BJ, Cooper CR Jr, Kamwan C, Response to antifungal therapy by human immunodeficiency virus-infected patients with disseminated Penicillium marneffei infection and in vitro susceptibilities of isolates from clinical specimens. Antimicrob Agents Chemother. 1993;37:2407–11.
- Sirisanthana T, Supparatpinyo K, Perriens J, Nelson KE. Amphotericin B and itraconazole for treatment of disseminated Penicillium marneffei infection in human immunodeficiency virus-infected patients. Clin Infect Dis. 1998;26:1107–10.
- Supparatpinyo K, Perriens J, Nelson KE, Sirisanthana T. A controlled trial of itraconazole to prevent relapse of Penicillium marneffei infection in patients infected with the human immunodeficiency virus. N Engl J Med. 1998;339:1739–43.
- Chariyalertsak S, Vanittanakom P, Nelson KE, Sirisanthana T, Vanittanakom N. Rhizomys sumatrensis and Cannomys badius, new natural animal hosts of Penicillium marneffei. J Med Vet Mycol. 1996;34:105–10.
- Chariyalertsak S, Sirisanthana T, Supparatpinyo K, Praparattanapan J, Nelson KE. Case-control study of risk factors for Penicillium marneffei infection in human immunodeficiency virus-infected patients in northern Thailand. Clin Infect Dis. 1997;24:1080–6.
- Chariyalertsak S, Sirisanthana T, Supparatpinyo K, Nelson KE. Seasonal variation of disseminated Penicillium marneffei infection in northern Thailand: a clue to the reservoir? J Infect Dis. 1996;173:1490–3.