Penicillium marneffei is a thermal dimorphic fungus which is endemic in an ecologic niche restricted to the Far East and which may cause deep-seated infection in humans and rodents. Discovered in the late 1950s from the bamboo rat Rhizomys sinensis, in Vietnam, P. marneffei was initially identified in HIV-infected individuals. A disseminated and progressive infection, it is the third most common opportunistic morbidity in the late course of HIV infection. We report the clinical and therapeutic features of a series of 12 HIV-infected adults with disseminated P. marneffei infection in Vietnam. From May to September, 2001, 12 patients with P. marneffei infection confirmed by culture were identified among 273 HIV-infected patients studied at the Tropical Diseases Centre, Ho Chi Minh City, Vietnam. The clinical signs were related to the reticuloendothelial system involvement. Common clinical features included fever, cutaneous manifestations, lymphadenopathy, hepatomegaly, splenomegaly, and marked anemia. The organism was identified from skin specimens or blood culture. Cases were consistently found with low CD4 (+) cell count. Treatment with parenteral amphotericin B and itraconazole was relatively effective, although treatment with a delaying diagnosis remained associated with pejorative prognosis.
Copyright John Libbey Eurotext 2003