Penicillium marneffei infection is caused by a dimorphic fungus (grows in mycelial form at 25 deg C and yeast form at 37 deg C). In northern Thailand, it is the 4th most common opportunistic AIDS-related infection after tuberculosis, cryptococcosis, and pneumocystis.
CASES/YEAR
0 (US); 500 (Global)
AGENT TYPE
Fungi (Endemic-Dimorphic)
OTHER NAMES
Penicilliosis; Talaromyces marneffei;
INCUBATION
Not known; Disease may represent reactivation--in one case a patient developed disease 10 years after visiting an endemic area; [PPID, p. 3230] Grows in culture within 2-5 days; [Guerrant]
INITIAL SYMPTOMS
Fever, gen. lymphadenopathy, hepatosplenomegaly, anemia, thrombocytopenia, & papular skin lesions; [Harrison ID. p. 850] Skin lesions on face & neck, umbilicated like molluscum contagiosum, & indicate disseminated disease; [Cohen: contagiosum-like]
PRECAUTIONS
"There is no evidence of human-to-human transmission." [Guerrant, p. 588] Disease probably occurs after inhaling conidia; therefore Biosafety Level II precautions are reasonable when working with the mold form. [PPID, p. 3231]
COMMENTS
The agent is a dimorphic fungus (grows in mycelial form at 25 deg C and yeast form at 37 deg C); In northern Thailand, it is the fourth most common opportunistic AIDS-related infection after tuberculosis, cryptococcosis, and pneumocystis. P. marneffei infects four species of bamboo rats in the endemic area. Most cases are in AIDS patients with CD4 cell counts <100 cells/uL. More than 70% of patients have distinctive skin lesions with central necrosis giving them an umbilicated appearance. Respiratory symptoms (cough, dyspnea, chest pain and infiltrates) may reflect an inhalation route of exposure. Disseminated findings include skin lesions, arthritis, and osteomyelitis. "In the immunocompetent host, the cell-mediated immune response is prominent, with the formation of epithelioid granulomas similar to tuberculosis." [Guerrant, p. 586-8] Of 795 HIV-infected patients admitted to a hospital in Vietnam for penicilliosis from 1996 to 2009, findings included fever, fatigue, cough, hepatomegaly, splenomegaly, pneumonia, anemia, thrombocytopenia, and elevated transaminase levels. [Le 2011; PMID 21427403] Of 668 cases in southern China, 88% of patients were HIV infected, and 4% were immunocompromised from other diseases. 8% had no underlying diseases detected. Mortality was 25% in 569 cases treated with antifungal therapy and 51% in 99 patients not treated with antifungal therapy. [Hu 2013; PMID 22983901]
DIAGNOSTIC
Culture (blood, bone marrow, skin scrapings, or lymph node); Organism grows within 1 week and produces a red pigment. [Harrison ID, p. 1027]
SCOPE
Southeast Asia & southern China (Thailand, Myanmar, Hong Kong, Indonesia, Laos, Malaysia, Singapore, Taiwan, Vietnam & Guangxi province of China); {PPID, p. 3230] Also in India (Manipur State), Cambodia, & Guangdong province (China); [Guerrant]
SIGNS & SYMPTOMS
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>fatigue, weakness
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>fever
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E pharyngitis
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E stomatitis
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G diarrhea
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G hepatomegaly
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G liver function test, abnormal
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H anemia
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H leukocytosis
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H leukopenia
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H lymphadenopathy
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H splenomegaly
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H thrombocytopenia
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R chest pain
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R cough
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R dyspnea
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R hemoptysis
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S papules or plaques
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S pustule
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S skin or subcutaneous nodule
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S ulcer of skin
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X cystic or cavitary lesions
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X lung infiltrates
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*arthritis
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*osteomyelitis
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*pericarditis
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*pneumonia
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*weight loss
SOURCE
Soil or Dust (Ingesting or Inhaling)
RISK FACTORS
- AIDS patients
- Travel to endemic area
TREATMENT
"Treatment is with amphotericin B followed by itraconazole until the CD4+ T cell count is >100 cells/uL for at least 6 months." [Harrison ID, p. 850]
REFERENCES FOR CASES/YEAR
1.
2. (Global) First reported in 1959 and only 30 cases reported before the AIDS epidemic; 6000 infections diagnosed in Thailand from 1984 to 2004; [PPID, p. 3230] In Ho Chi Minh City, cases peaked in 2007 (156 cases). 668 cases from 1984 to 2009 in southern China (Guangxi and Guangdong provinces) were reviewed. [Hu2013: PMID 22983901] Guesstimate: 500 cases/year;