Penicillium marneffei infection (PM) is an important disease among HIV-infected persons in Southeast Asia. Discovered in 1956 from the bamboo rat, Rhizomys sinensis, in Vietnam, PM was first identified in HIV-infected persons in 1988. The disease has now been reported among HIV-infected persons in Thailand, Myanmar (Burma), Vietnam, Cambodia, Malaysia, northeastern India, Hong Kong, Taiwan, and southern China. Cases of PM also have been reported among HIV-infected persons from the United States, the United Kingdom, The Netherlands, Italy, France, Germany, Switzerland, Sweden, Australia, and Japan after they visited the PM-endemic region.

PM occurs late in the course of HIV infection. Our study found that the CD4+ cell count at the time of the diagnosis of PM was consistently less than 50 cells/ml. Clinical presentation included fever (in 99% of the patients), anemia (78%), pronounced weight loss (76%), generalized lymphadenopathy (58%), and hepatomegaly (51%). However, these conditions were not specific for PM and could be caused by HIV or other HIV-related opportunistic infections. A more specific finding was skin lesions, most commonly papules with central necrotic umbilication, which were seen in 71% of the patients.

In 63% of the patients with PM, a presumptive diagnosis could be made several days before the results of fungal culture were available. This was done by microscopic examination of a Wright-stained sample of bone marrow aspirate, touch smears of a skin biopsy specimen, or a lymph node biopsy specimen. It was easy to culture P. marneffei from various clinical specimens. Bone marrow culture was the most sensitive (100%), followed by culture of the specimen obtained from skin biopsy (90%) and blood culture (76%).

The fungus was sensitive to amphotericin B, itraconazole, and ketoconazole. The current recommended treatment regimen is to give amphotericin B, 0.6 mg/kg/day for 2 weeks, followed by itraconazole, 400 mg/day orally in two divided doses for the next 10 weeks. After initial treatment, the patient should be given itraconazole, 200 mg/day, as secondary prophylaxis for life.

P. marneffei has been isolated from several species of bamboo rats in the disease-endemic area, but epidemiologic studies have thus far failed to define an environmental exposure associated with the disease. ........................................................more in ref 1.

References and suggested further readings
1. Sirisanthana T. Penicillium marneffei infection in patients with AIDS. Emerg Infect Dis. 2001;7(3 Suppl):561.click for a pdf file
2. Vanittanakom N and T. Sirisanthana. Penicillium marmeffei infection in patients infected with Human Immunodeficiency Virus. Current Topics in Medical Mycology 1997;8:35-42.
3. Sirisanthana V, Sirisanthana T. Diseminated Penicillium marneffei infection in HIV-infected children Pediatr Infect Dis J 1995;14:935-940.
4. Sirisanthana V. Penicillium marneffei infection in AIDS children. (In Thai) click to for a pdf file