Heath T, Patel A, Fisher D, Currie B; Australasian Society for HIV Medicine. Conference.
Annu Conf Australas Soc HIV Med. 1993 Oct 28-30; 5: 56 (abstract no. FCP4).
Royal Darwin Hospital, Casuarina NT.
Penicillium marneffei is a dimorphic fungus occasionally causing infection in immunocompetent individuals, but more frequently infecting patients with impaired T-cell immunity, particularly in association with HIV. Infection appears to be confined to residents of, or travellers to, south-east Asia, especially northern Thailand and Guangxi province in China. An interesting fungal ecology is recognised involving bamboo rats and their habitat, but the link to human infection is poorly understood and an independent environmental acquisition is more likely. This patient had lived in northern Thailand for years before migration to Australia. HIV infection and P. marneffei colonisation were presumably acquired in Asia. He presented for the first time in Darwin 5 years after immigration with disseminated P. marneffei infection involving skin, blood and reticuloendothelial system, and with profound lymphopenia (CD4 = 0/cu mm). Typical umbilicated skin lesions were recognised on admission, biopsies and touch smears (Wright's stained) facilitating rapid diagnosis. Amphotericin B therapy was instituted with dramatic clinical response. Full clinical recovery occurred and successful maintenance therapy was instituted with oral itraconazole. No co-existent opportunistic infection was identified. P. marneffei is distinguishable by characteristic skin lesions, pathology and travel/ethnicity history. It needs to be differentiated from tuberculosis, histoplasmosis, leishmaniasis and molluscum contagiosum, all of which it can clinically and histologically mimic. P. marneffei has unique and easily identifiable mycological characteristics. As regional neighbours we should anticipate further imported penicilliosis from Asia. Consideration should be given for its inclusion as an AIDS 'indicator disease' in HIV patients.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Amphotericin B
- Animals
- Asia
- Asia, Southeastern
- Australia
- China
- Communicable Diseases
- Emigration and Immigration
- HIV
- HIV Seropositivity
- HIV-1
- Humans
- Itraconazole
- Molluscum Contagiosum
- Penicillium
- Rats
- Skin Diseases
- Thailand
- Tuberculosis
- therapy
Other ID:
UI: 102207985
From Meeting Abstracts