Abstract
We report a case of disseminated fatal Talaromyces (Penicillium) marneffei infection in an HIV-infected, antiretroviral treatment-experienced South African woman who had travelled to mainland China. The 37-year-old woman was admitted to a private hospital in fulminant septic shock and died within 12 h of admission. Intracellular yeast-like bodies were observed on the peripheral blood smear. A serum cryptococcal antigen test was negative. Blood cultures flagged positive after 2 days; on direct microscopy, yeast-like bodies were observed and a thermally dimorphic fungus, confirmed as T. marneffei, was cultured after 5 days. The clinical features of HIV-associated disseminated penicilliosis overlap with those of tuberculosis and endemic deep fungal infections. In the southern African context, where systemic opportunistic fungal infections such as cryptococcosis are more common among HIV-infected patients with a CD4+ count of <100 cells/µL, this infection is not likely to be considered in the differential diagnosis unless a travel history is obtained.
Highlights
We report a case of disseminated fatal Talaro myces (Penicillium) marneffei infection in an HIV-infected antiretroviral treatment (ART)experienced South African (SA) woman who had travelled to mainland China
Intracellular yeast-like bodies were observed on the peripheral blood smear, which was reported to the treating clinician within a few hours
Phase transition to the yeast form was demon strated on brain-heart infusion agar after 12 days (DMP, NHLS) at 37°C (Fig. 1B)
Summary
We report a case of disseminated fatal Talaro myces (Penicillium) marneffei infection in an HIV-infected antiretroviral treatment (ART)experienced South African (SA) woman who had travelled to mainland China. The patient was prescribed broadspectrum antimicrobial therapy on admission, including meropenem, high-dose trimethoprim-sulphamethoxazole and fluconazole.
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