Penicilliosis

Abstract

Abstract More than 200 species of the Penicillium genus have been described. Penicillium organisms are abundant in nature and are common laboratory contaminants. However, Penicillium marneffei is the only dimorphic species. The organism is commonly responsible for disseminated invasive infections in humans with HIV infection or AIDS in the endemic areas of Southeast Asia and southern China. Penicillium marneffei has also been found to cause natural infections in several species of rodents in the endemic areas and rodents can be infected experimentally. Penicillium marneffei was originally isolated from the liver of a bamboo rat (Rhizomys sinensis) at the Pasteur Institute in Dalat, Viet Nam in 1956. Capponi and colleagues observed the death of bamboo rats due to disseminated infections with P. marneffei involving their reticuloendothelial system (Capponi et al, 1956). These investigators passed the newly discovered organism experimentally in mice, and it was sent to the Pasteur Institute in Paris for further study. At the Pasteur Institute, the fungus was characterized by Segretain and named Penicillium marneffei in honor of Dr. Hubert Marneffe, the Director of the Pasteur Institute of Indochina (Segretain, 1959a). Subsequently, Segretain became the first known human to be infected with the organism in 1959 when he accidentally stuck his finger with a needle he was using to inoculate a hamster. The clinical manifestations of his infection were a subcutaneous nodule at the site of the inoculation and lymphadenitis involving the draining auxiliary lymph nodes. The infection responded to treatment with high doses of oral nystatin. The first natural human infection with P. marneffei was reported in 1973 in a 61-year-old U.S. missionary who was suffering from Hodgkin’s disease. His infection was discovered when he underwent a staging splenectomy for Hodgkin’s disease (Di Salvo et al, 1973). The missionary had visited Southeast Asia after Hodgkin’s disease had been diagnosed 1 year prior to the splenectomy. At surgery the excised spleen contained a tan nodular mass, 9 cm in diameter with a necrotic center, which grew P. marneffei when cultured on Sabouraud dextrose agar at 25°C. The patient survived after being treated with amphotericin B. The second case of penicilliosis was reported in 1984 in a 59-year-old man who had traveled in Southeast Asia (Pautler et al, 1984). He had recurrent episodes of hemoptysis and P. marneffei organisms were isolated from his sputum. Also in 1984, five additional cases who had been seen at Ramathibodi Hospital in Bangkok, Thailand between 1974 and 1982 were reported (Jayanetra et al, 1984). Eight cases of P. marneffei infection were reported from Guangxi province in southern China that had occurred between 1964 and 1983 (Deng et al, 1985). Additional cases were recognized from 1985 to 1991 in southern China (Li et al, 1985; Wang et al, 1989; Li et al, 1991). These patients were not immunocompromised. All cases had occurred prior to the AIDS epidemic in Southeast Asia.