Disseminated Penicilliosis Marneffei Research Articles

A Case of Non-human Immunodeficiency Virus Infected Host with Disseminated Penicilliosis Marneffei

A Case of Non-human Immunodeficiency Virus Infected Host with Disseminated Penicilliosis Marneffei

Clinical characteristics of disseminated penicilliosis marneffei in non-HIV patients

The clinical data of 5 non-HIV patients with disseminated penicilliosis marneffei (PSM) admitted in Peking Union Medical College Hospital between January 2004 to December 2014 were analyzed retrospectively.The median age of 5 patients (4 males and 1 female) was 45 years.They had lived in or traveled to areas of high prevalence. The median duration from onset of the infection to the diagnosis was 9 months. Four of them had ostealgia. The imaging results showed that they all had osteolytic lesions. Three patients had skin multi-abscesses. Cultures of the pus from skin lesions were more sensitive than cultures of blood and sputum. Two patients were also confirmed to be co-infected with non-tuberculosis mycobacteria. Disseminated PSM was easily misdiagnosed in non-HIV patients since clinicians might be unfamiliar with the clinical characteristics of the disease. The diagnosis of disseminated PSM should be considered for patients who lived in or traveled to areas of high prevalence and presented with fever, skin multi-abscesses and osteolytic lesions. And the complication with other opportunistic infections should be considered in these patients. Key words: Penicilliosis marneffei; Opportunistic infection

Autoantibody to Interferon-gamma Associated with Adult-Onset Immunodeficiency in Non-HIV Individuals in Northern Thailand

BackgroundAutoantibody to interferon-gamma (IFN-γ) has been reported to be associated with adult-onset immunodeficiency in patients from Asian countries. This study aimed to determine the prevalence of autoantibody to IFN-γ among non-HIV patients in northern Thailand who were repeatedly infected with unusual intracellular pathogens.MethodsA cross-sectional, case-control study was conducted between March 2011 and March 2012 at Chiang Mai University Hospital. 20 cases, non-HIV, aged 18–60 years, presented with at least 2 episodes of culture or histopathology proven opportunistic infections were enrolled. Controls comprised 20 HIV-infected patients and 20 healthy adults who were age- and sex-matched with cases. Enzyme-linked immunosorbent assay (ELISA) was used to detect the presence of antibody to IFN-γ.Results11 participants in each group were female. The mean ages were 48.1±6.4, 48.3±6.3, and 47.1±6.5 years among cases, HIV-infected, and healthy controls, respectively. The opportunistic infections among 20 cases included disseminated non-tuberculous mycobacterial (NTM) infection (19 patients/24 episodes), disseminated penicilliosis marneffei (12 patients/12 episodes), and non-typhoidal Salmonella bacteremia (7 patients/8 episodes). At the cutoff level of 99 percentile of controls, the prevalence of autoantibody to IFN-γ were 100%, 0%, and 0%, among cases, HIV-infected, and healthy controls, respectively (p-value <0.001). The mean concentrations of antibody to IFN-γ were 3.279±0.662 and 0.939±0.630 O.D. among cases with and without active opportunistic infection, respectively (p-value<0.001).ConclusionsIn northern Thailand, autoantibody to IFN-γ was strongly associated with adult-onset immunodeficiency. The level of antibody to IFN-γ in patients who had active opportunistic infection was relatively higher than those without active infection.

Analysis of death causes of 345 cases with HIV/AIDS in Guangdong area

To analyze the death causes of 345 cases with HIV/AIDS in Guangdong area. The situations of 345 hospitalized death cases with HIV/AIDS were conducted by retrospective analysis. (1)There were total 3406 hospitalized cases with HIV/AIDS in a hospital from January 2001 to December 2011 and 345 cases died, the fatality rate was 10. 13%. Since 2005 the introduction of free anti-viral treatment, the fatality rate of HIV/AIDS declined. The fatality rate of the patients whose CD4+ T lymphocyte counts <200 cells/microl was 14.61% (299/2046) and it was significantly higher than that of patients whose CD4 T lymphocyte counts >or=200 cells/microl (P <0.01). (2) 99.42% of the death cases had more than one kind of opportunistic infections (OI) and there were 924 cases of OI totally. 84. 64% of OI related to the death directly. Fungal infection was the most common in OI, followed by bacterial infection. Most OI occurred in the lungs, mouth, other systemic disseminated diseases, gastrointestine, central nerver system, septicemia, skin. The AIDS defining opportunistic infections such as several pneumonia, disseminated penicilliosis marneffei and CNS infections accounted for 29.65%. Other factors that caused HIV/AIDS death included opportunistic tumors, HIV related disease and non AIDS-related disease accounted for 15.36%. No accepted effective highly active antiretroviral therapy (HARRT) also constituted factors of death. Among cases which accepted HARRT treatment, only 6.96% had the period of treatment over three months. The fatality rate of end-stage AIDS patients was high and the opportunistic infections was the most important cause of death. Early diagnosis and treatment for opportunistic infections, timely effective HARRT were the key to improve the quality of life of AIDS patients.

Hemophagocytic Syndrome in a Patient with Acquired Immunodeficiency Syndrome and Acute Disseminated Penicilliosis

Penicilliosis marneffei, which is caused by the opportunistic fungus Penicillium marneffei, is one of the troublesome infections in patients infected with human immunodeficiency virus (HIV) in southeast Asia. We report an HIV-positive patient with acute disseminated penicilliosis marneffei that manifested as hemophagocytic syndrome. Numerous nucleated erythrocytes were also found in peripheral blood of the affected patient. Bone marrow aspirate histopathologically showed hemophagocytosis and abundant P. marneffei. The hemophagocytic syndrome and peripheral nucleated erythrocytes improved after therapy with amphotericin B. Our report underscores the importance of recognition of this peculiar phenomenon in penicilliosis marneffei. This awareness may alert clinicians to potential penicilliosis marneffei in HIV-positive patients, therefore making early diagnosis and timely effective treatment of the infectious disease possible.

Rapid Fatality of Disseminated Penicilliosis Marneffei in a Patient With Acquired Immunodeficiency Syndrome

The incidence of penicilliosis marneffei a disseminated and progressive Penicillium marneffei infection, was reported to be markedly increased in Southeast Asia over the past decade, and P. marneffei has become 1 of the important opportunistic pathogens among patients with HIV infection in Taiwan over the previous 5 years. We report a white man who had stayed in Thailand for years before he developed fever for 1 week and present to our hospital with multiple skin papules with or without central necrosis over his face, trunk, and limbs. He died of septic shock and multiorgan failure on the second day of hospitalization. The subsequent blood cultures yielded P. marneffei, and serological assay proved that the patient had an underlying acquired immunodeficiency syndrome. Our report underscores the importance of a timely diagnosis and initiation of antifungal therapy for patients who have disseminated P. marneffei infection in immunocompromised patients.

Diagnostic antigenemia tests for penicilliosis marneffei.

Disseminated penicilliosis marneffei is an emerging opportunistic mycosis seen in severely immunocompromised human immunodeficiency virus (HIV)-infected patients and is caused by the dimorphic fungus Penicillium marneffei. Early diagnosis and treatment improve clinical outcome. Proper diagnosis is complicated by nonspecific signs and symptoms and by difficulties in histologic recognition and species identification of the pathogen. Since no established immunodiagnostic methods for penicilliosis marneffei are available, we attempted to develop separate immunodiffusion tests to detect P. marneffei antigens and antibodies in patient serum specimens and a latex agglutination test for antigenemia. Antigens consisted of 2-week-old fission arthroconidial filtrates produced in Pine's broth at 37 degrees C. Rabbit antisera were prepared against the 10 x -concentrated filtrate antigens. Studies were carried out with 17 serum specimens from HIV-seropositive adult Thai patients with penicilliosis marneffei and 15 control serum specimens from Thai persons free of HIV and P. marneffei infection. The immunodiffusion tests detected P.marneffei antigenemia in 10 (58.8%) of 17 patients, whereas the latex agglutination test detected antigenemia in 13 (76.5%) of the 17 patients. Antibody was demonstrated in only 2 of the 17 patient sera. All of the tests appeared to be highly specific, since none were positive with sera from 15 Thai control patients, six serum samples containing cryptococcal antigen, or six urine specimens positive for Histoplasma polysaccharide antigens.

Infection due to Penicillium marneffei, an emerging pathogen: review of 155 reported cases.

A disseminated and progressive infection, penicilliosis marneffei is the third most common opportunistic infection in human immunodeficiency virus (HIV)-infected patients in certain parts of Southeast Asia. Penicillium marneffei is endemic in Southeast Asia and the southern part of China. Cases have been reported from both Eastern and Western countries. This review discusses the history, epidemiology, mycology, clinical manifestations, diagnosis, and treatment of penicilliosis marneffei, on the basis of 155 cases of the infection. About 80% of the patients are immunocompromised. P. marneffei can infect various organs, particularly the lung, liver, and skin. The most common clinical features include fever, weight loss, and anemia. The organism has been isolated most commonly from skin, blood, and bone marrow. Immunologic identification of fungal isolates can be done with exoantigen tests and immunohistochemical methods. Treatment of disseminated penicilliosis marneffei in HIV-infected patients with parenteral amphotericin B and itraconazole is relatively effective and safe.

Treatment and serological studies of an Italian case of penicilliosis marneffei contracted in Thailand by a drug addict infected with the human immunodeficiency virus

A case of disseminated penicilliosis marneffei, the first to be diagnosed in Italy, is described in a male HIV-positive drug addict. The patient had visited Thailand several times in the two years prior to his hospitalization. The presenting signs were fever, productive cough, facial skin papules and pustules, nodules on both thumbs and oropharyngeal candidiasis. Penicillium marneffei was isolated from a series of blood specimens with the lysis centrifugation procedure. Septate, yeast-like cells were observed in histological sections of the nodules and sputum smears. The patient was treated for 6 weeks with amphotericin B (total dosage 1,400 mg) and flucytosine (150 mg/kg/die) for the first 3 weeks. Prompt clinical improvement and sterilization of all biological specimens were attained. Itraconazole was administered as maintenance therapy (400 mg/die for the first month and 200 mg afterward). During the follow-up period, no relapse was observed. The patient, however, did succumb to a variety of non-mycotic infections and died nine months after start of therapy. At autopsy, P. marneffei was not detected in his tissues. Serological studies were performed with a micro-immunodiffusion procedure using a mycelial culture filtrate antigen of P. marneffei. Sera taken early in the course of the disease gave positive antibody reactions. Whereas sera taken 3-5 months following therapy were negative. All known cases of penicilliosis marneffei in bamboo rats and in humans among the inhabitants and visitors to the endemic areas of P. marneffei in South East Asia and Indonesia are summarized.