Synonym(s)
Penicillium marneffei
HistoryThis section has been translated automatically.
Capponi et al, 1956; Di Salvo et al (1973)
DefinitionThis section has been translated automatically.
Systemic mycosis caused by infection with Penicillium marneffei.
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PathogenThis section has been translated automatically.
Penicillium marneffei (dimorphic fungus), the only human pathogen of the genus Penicillium. Natural reservoirs are bamboo rats (especially Rhizomys pruinous senex, Cannomys badius, Rhizomys pruinosus, R. sumatrensis) and soils contaminated with rat faeces or inhabited by rats.
Occurrence/EpidemiologyThis section has been translated automatically.
Geographical restriction to endemic areas in Southeast Asia (especially Northern Thailand, Hong Kong, Vietnam, Indonesia, Laos, China, Taiwan, Cambodia, Malaysia, Singapore and Myanmar). According to case studies also sporadically occurring in HIV-positive migrants or patients with recent travel to endemic areas in Australia, Japan, USA, Europe, Germany. 10-20% incidence in HIV-infected persons in Asia.
EtiopathogenesisThis section has been translated automatically.
Infection with the pathogen by inhalation. Most infections occur in endemic areas during the rainy season, during which the bamboo rats multiply intensively.
ManifestationThis section has been translated automatically.
Rarely occurring in immunocompetent adults, occasionally in children or the elderly. Very common in HIV-infected persons with advanced immunodeficiency of any age (in Asia, mycosis is considered an AIDS-defining disease, even if it is not yet listed in the CDC classifications). No sex preference.
Clinical featuresThis section has been translated automatically.
- The incubation period depends on the immune status and usually varies between a few days or a few weeks. In case of immunocompetence clinically inapparent course.
- In particular, immunosuppression can lead to dissemination with fever, hepatosplenomegaly, anemia and weight loss. In 60-80% of clinically apparant infections, skin manifestation with molluscum contagiosum-like, isolated or grouped, sometimes linearly arranged, pinhead to pea-sized, usually broadly seated, centrally dented, whitish, yellowish, pale pink or pink nodules 2-5 mm in diameter. Disseminated occurrence of many hundreds of tumours is not uncommon in AIDS. Cutaneous or subcutaneous abscesses are also common.
HistologyThis section has been translated automatically.
Intracellular yeast-like cells, some of which show transverse division.
DiagnosisThis section has been translated automatically.
- Depending on the clinical symptoms: cultural evidence of pathogens from the respiratory tract (smear or lavage), blood cultures, bone marrow biopsy, skin biopsies, urine. P. marneffei can be cultivated on conventional fungal culture media (e.g. Kimmig Agar, Sabouroud Agar) within a few days without problems. Parallel cultivation at 30 °C (mycelium phase) and 37 °C (yeast phase predominates) is recommended.
- Serology: Antibody detection by immunodiffusion, ELISA or Western blot is possible and may also be positive for HIV infection.
TherapyThis section has been translated automatically.
- Treatment of the underlying disease.
- Initial Amphotericin B 0.6 mg/kg bw/day for 2 weeks p.o. or i.v. Subsequently itraconazole (e.g. Sempera) 2 times/day 200 mg p.o. for 10 weeks or until the infection has healed. Then lifelong secondary prophylaxis with itraconazole 200 mg/day p.o.
LiteratureThis section has been translated automatically.
- Capponi M, Sureau P, Segretain G (1956) Penicillosis de Rhizomys sinensis. Bull Soc Pathol Exot Fil 49: 418-421
- Chaiyaroj SC et al (2003) Antigen detection assay for identification of Penicillium marneffei infection. J Clin Microbiol 41: 432-434
- Di Salvo A, Fickling A, Ajello L (1973) Infection caused by Penicillium marneffei: description of first natural infection in man. At J Clin Pathol 60: 259-263
- Ranjana KH et al (2002) Disseminated Penicillium marneffei infection among HIV-infected patients in Manipur state, India. J Infect 45: 268-271
- Walsh TJ et al (2004) Infections due to emerging and uncommon medically important fungal pathogens. Clin Microbiol Infect 10(Suppl1): 48-66
- Wang JL et al (2003) Disseminated Penicillium marneffei infection in a renal-transplant recipient successfully treated with liposomal amphotericin B. Transplantation 76: 1136-1137
- Yousukh A et al (2004) Clinicopathologic study of hepatic Penicillium marneffei in Northern Thailand. Arch Catholic Lab Med 128: 191-194
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Penicillium marneffei;Disclaimer
Please ask your physician for a reliable diagnosis. This website is only meant as a reference.
Prof. Dr. med. Peter Altmeyer