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In order to increase awareness of infection of Penicillium marneffei combined with Pneumocystis carinii pneu monia,we analysed and discussed the diagnosis and treatment of a P.marneffei combined with Pneumocystis carinii pneumonia and reviewed relevant literaure.Pharynx and larynx P.marneffei infection uozhes logy and molecullar was confirmed by physical examination,sputum culture and biopsy.Pneumocystis carinii pneumonia was diagnosed by CT findings and tested positive by PCR for P.carinii (PC).After antifungal treatment,the patient's symptoms and signs showed significant im provement.In conclusion,to achieve early diagnosis and appropriate treatment,sputum culture,biopsy and chest radiograph are suggested for pharynx and larynx recurrent ulcer which is difficult to heal.
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[Abstract ] Objective To understand the identification and in vitro antifungal susceptibility of Penicillium marneffei(PM)in yeast phase,and guide clinic antifungal application.Methods Strains isolated from blood and bone marrow of 23 patients infected with PM in a hospital between 2009 and 2016 were collected,colony morpholo-gy of PM in yeast phase was observed,susceptibility to itraconazole,voriconazole,amphotericin B,and fluconazole were detected with E-test method.Results Colony morphology of PM were as follows:direct microscopic examina-tion of Wright’s staining of tissue specimens found visible oval or round spore with apparent septum,and mainly lo-cated in macrophage;Gram staining of blood culture specimens found that strains were with bulbous and slightly curved ends,occasionally branched and with septum. PM was dimorphic fungi,presented mycelium at 28° C,pro-duced red pigment and diffused into medium;PM presented yeast form at 35° C,there were typical colony morpholo-gy. Minimum inhibitory concentrations (MICs)of itraconazole,voriconazole,amphotericin B,and fluconazole to PM in yeast phase were 0.002-0.016,0.012-0.125,0.002-0.500,and 0.500-16.000μg/mL respectively. Conclusion Typical colony morphology and fungal spore of PM in bone marrow and peripheral blood are important features for identification. PM is most susceptible to itraconazole,followed by voriconazole and amphotericin B, while fluconazole is less susceptible.
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Disseminated penicilliosis marneffei is rarely seen in immunocompetent persons. We report here two cases of disseminated penicilliosis marneffei in immunocompetent hosts. Penicillium marneffei disseminated to the brain in one patient and to the bone marrow in the other patient. Both patients received amphotericin B liposome. The cases illustrate the importance of considering penicilliosis marneffei as causes of systemic infections in immunocompetent patients.
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Objective To explore the factors affecting the duration of secondary prophylaxis for penicilliosis marneffei in patients with acquired immunodeflciency syndrome (AIDS).Methods A retrospective analysis was conducted.The study included 92 adult patients with AIDS and penicilliosis mameffei which were confirmed at the Guangxi Centers for Disease Control and Prevention/Medecins Sans Frontieres clinic.The patients were divided into two groups based on the counts of CD4+ T cells at the time of discontinuation of secondary prophylaxis with itraconazole.The patients with a CD4+ lymphocyte count ＞ or =200 × 106 cells/L at the discontinuation of secondary prophylaxis were assigned to Group Ⅰ,and those with a CD4+ lymphocyte count ranging from 100 × 106 to 200 × 106 cells/L to Group Ⅱ.The treatment duration and clinical outcome were compared between the two groups,and factors which might affect the duration of secondary prophylaxis,including organ involvement,complications,antifungal regimen,antiviral treatment timing,and so on,were assessed.The SPSS 13.0 ~ftware package was used for statistical analysis.Results All the 92 patients received highly active antiretroviral therapy (HAART).No significant difference was observed in the sex ratio,age,follow up duration,number of organs involved,occurrence of complications,composition and duration of antifungal treatment regimens between the two groups (all P ＞ 0.05).The duration of secondary prophylaxis was significantly shorter in Group Ⅱ than in Group Ⅰ (8.13 ± 5.13 vs.12.44 ± 9.51 months,P＜0.05).The commencement of HAART after the treatment of penicilliosis,coinfection with other pathogens or mycobacterium tuberculosis were associated with a longer duration of secondary prophylaxis,and the influence degree of these factors decreased in order,whereas the commencement of HAART before the treatment of penicilliosis was associated with a shorter secondary prophylaxis (P ＜ 0.05).Conclusions For AIDS/PSM patients receiving HAART,secondary prophylaxis could be discontinued 3 to 6 months after the CD4 +lymphocyte count restores to 100 × 106 cells/L or more.The duration of secondary prophylaxis may be extended by the commencement of HAART after the treatment of penicilliosis,coinfection with other pathogens or mycobacterium tuberculosis,but shortened by the commencement of HAART before the treatment of penicilliosis.
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OBJECTIVE To master the pathogenic conditions,clinical characteristic,and diagnostic clues about AIDS combinated with penicilliosis marneffei and malignant lymphoma.METHODS The clinical data about AIDS combinated with penicilliosis marneffei and malignant lymphoma were summarized in order to learn by experience.RESULTS The clinical symptoms of AIDS combinated with penicilliosis marneffei and malignant lymphoma could be unique,but most were various,the primary symptoms were always fever and enlargement of liver and spleen.CONCLUSIONS AIDS combinated with penicilliosis marneffei is common to be seen,but with penicilliosis marneffei and malignant lymphoma are rarely seen in the clinics,which should be taken high attention.
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The authors surveyed the present situation for imported (introduced) mycoses from papers published in Japan by the end of December, 2001. The results revealed 31 cases of coccidioidomycosis, 33 of histoplasmosis, 17 of paracoccidioidomycosis and one of penicilliosis marneffei. In coccidioidomycosis the ages ranged from 12 to 55, for 27 males and 4 females of which 2 were fatal. For histoplasmosis, the ages ranged from 17 to 74 of which 24 cases were male and 8 female. All of the patients with paracoccidioidomycosis were infected in Latin American countries. They consisted of 15 males and 2 females, and the ages ranged from 24 to 68. A single case of penicilliosis marneffei (38 years old, male) was reported very recently. The case was complicated by AIDS and became critical. Blastomycosis has not yet been reported. This survey indicates that the number of the imported mycoses in Japan is increasing. It is necessary for the persons concerned to counter measures to cope with this situation.
Subject(s)
Female , Humans , Male , Blastomycosis , Coccidioidomycosis , Histoplasmosis , Japan , Mycoses , ParacoccidioidomycosisABSTRACT
The authors surveyed the present situation for imported (introduced) mycoses from papers published in Japan by the end of December, 2001. The results revealed 31 cases of coccidioidomycosis, 33 of histoplasmosis, 17 of paracoccidioidomycosis and one of penicilliosis marneffei. In coccidioidomycosis the ages ranged from 12 to 55, for 27 males and 4 females of which 2 were fatal. For histoplasmosis, the ages ranged from 17 to 74 of which 24 cases were male and 8 female. All of the patients with paracoccidioidomycosis were infected in Latin American countries. They consisted of 15 males and 2 females, and the ages ranged from 24 to 68. A single case of penicilliosis marneffei (38 years old, male) was reported very recently. The case was complicated by AIDS and became critical. Blastomycosis has not yet been reported. This survey indicates that the number of the imported mycoses in Japan is increasing. It is necessary for the persons concerned to counter measures to cope with this situation.
Subject(s)
Female , Humans , Male , Blastomycosis , Coccidioidomycosis , Histoplasmosis , Japan , Mycoses , ParacoccidioidomycosisABSTRACT
Two cases of disseminated Penicilliosis marneffei are reported; both were middle-aged female patients from the central part of Thailand who presented with multiple cystic skin lesion. Their systemic symptoms included chronic fever, weight loss, malaise, anemia, cervical lymphadenopathy and osteolytic bone lesions. They had no underlying disease causing immunosupression and both were HIV-negative. Skin manifestations occurred frequently in disseminated penicilliosis and abscesses were the most common manifestation in HIV-negative patients whereas umbillicated papules were common in HIV-positive ones. A biopsy from the skin lesions was good specimens for histopathological study and frequently yielded positive culture results. The characteristic histopathological feature is granulomatous inflammation with macrophages containing yeast-like organisms with septa which show a lack of budding. The characteristic mycologic feature of P.marneffei is a thermally dimorphic fungus which produces a mycelial phase colony appearing within 2 days at room temperature (25-30oC) and which produces a bright, purple-red, water-soluble pigment into the surrounding agar. The yeast form grows at 37oC as a whitish colony produced in 4 days and this produces less red pigment compared with the mycelial form. The first case was treated with oral itraconazole intermittently as a result of multiple recurrent episodes until she died of the disease after one year. The second case was treated with amphotercin B intravenously followed by oral itraconazole with a satisfactory result.
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Visceral leishmaniasis,progressive disseminated histoplasmosis and penicilliosis marneffei are infections found in both human and animals.Their clinical manefestations,morphology of the pathogens under microscope are similar.Misdiagnosis was common and prognosis was poor when wrong therapy was given.This article is to introduce the epidemiology,clinical manefestation,laboratory findings and the treatment of these infections.