Disseminated Penicillium marneffei infection in patients with acquired immunodeficiency syndrome

Abstract

The fungal pathogen Penicillium marneffei is endemic in Southeast Asia and China. The prevalence of disseminated Penicillium marneffei infection has increased markedly over the past few years. This increase is exclusively due to infection among patients infected with human immunodeficiency virus (HIV). In northern Thailand disseminated Penicillium marneffei infection is the third most common opportunistic infection in late HIV disease, after tuberculosis and cryptococcosis. As of early 1995, 550 cases of disseminated Penicillium marneffei in HIV-infected patients had been diagnosed at Chiang Mai University Hospital alone. Signs and symptoms of these patients were fever, marked weight loss, skin lesions, anemia, lymphadenopathy and hepatomegaly. Skin lesions were commonly necrotic papules resembling molluscum contagiosum. They could not be differentiated from skin lesions in AIDS patients with disseminated cryptococcosis or histoplasmosis. Diagnosis of disseminated Penicillium marneffei infection could be made by culture of the blood, skin lesions, or bone marrow and by microscopic examination of Wright's-stained skin smears or bone marrow aspirates. Most patients responded to treatment with amphotericin B and itraconazole. Maintenance therapy with itraconazole should be given in patients who responded initially. With the expected epidemic of HIV infection in southern China and Southern Asian countries other than Thailand, Penicillium marneffei is potentially an organism of great public health importance in the future. Many critical features of the epidemiology and natural history of Penicillium marneffei infection remain unknown and need further elucidation.