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Volume 7, Number 7—June 2001
THEME ISSUE
International Conference on Emerging Infectious Diseases 2000
Conference Panel Summary

Penicillium marneffei Infection in Patients with AIDS

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Thira SirisanthanaComments to Author 
Author affiliation: Chiang Mai University, Chiang Mai, Thailand

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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).

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References

  1. Segretain  G. Description d'une nouvelle espece de Penicillium: Penicillium marneffei n. sp. Bull Soc Mycol Fr. 1959;75:4126.
  2. Piehl  MR, Kaplan  RL, Haber  MH. Disseminated penicilliosis in a patient with acquired immunodeficiency syndrome. Arch Pathol Lab Med. 1988;112:12624.PubMed
  3. Sirisanthana  T, Supparatpinyo  K. Epidemiology and management of penicilliosis in human immunodeficiency virus-infected patients. Int J Infect Dis. 1998;3:4853. DOIPubMed
  4. Supparatpinyo  K, Khamwan  C, Baosoung  V, Nelson  KE, Sirisanthana  T. Disseminated Penicillium marneffei infection in Southeast Asia. Lancet. 1994;344:1103. DOIPubMed
  5. 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;37:240711.PubMed
  6. 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;26:110710. DOIPubMed
  7. 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;339:173943. DOIPubMed
  8. 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;34:10510. DOIPubMed
  9. 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;24:10806. DOIPubMed
  10. 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;173:14903. DOIPubMed

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Cite This Article

DOI: 10.3201/eid0707.017734

Table of Contents – Volume 7, Number 7—June 2001

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Thira Sirisanthana, Division of Infectious Diseases, Department of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; fax: 66-53-217144

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