ABSTRACT
Se presenta el primer caso humano de peniciliosis por Penicillium marneffei observado en la República Argentina. El paciente era un joven de 16 años, HIV-positivo, procedente de un área rural del sur de China. El paciente fue internado en el Hospital "F. J. Muñiz" por padecer una neumonía grave con insufciencia respiratoria aguda. El agente causal fue aislado de un lavado broncoalveolar y se lo observó en un citodiagnóstico de piel. La identifcación de P. marneffei fue confrmada por las características fenotípicas del aislamiento y la amplifcación del ADNr. El enfermo padecía una infección muy avanzada por HIV que condujo a la aparición simultánea de infecciones por citomegalovirus, Pneumocystis jirovecii y procesos bacterianos nosocomiales. Este complejo cuadro derivó en una evolución fatal.
The frst case observed in Argentina of AIDS-related human penicillosis is herein presented. The patient was a six- teen year-old young man coming from a rural area of southern China. He was admitted at the F. J. Muñiz Hospital of Buenos Aires city with severe pneumonia and adult respiratory distress. Penicillium marneffei was isolated from bronchoalveolar lavage fuid and was microscopically observed in a skin cytodiagnosis. P. marneffei identifcation was confrmed by rRNA amplifcation and its phenotypic characteristics. The patient suffered an advanced HIV infection and also presented several AIDS-related diseases due to CMV, nosocomial bacterial infections and Pneumocystis jirovecii which led to a fatal outcome.
Subject(s)
Adolescent , Humans , Male , AIDS-Related Opportunistic Infections/microbiology , Dermatomycoses/microbiology , HIV-1 , HIV-2 , Lung Diseases, Fungal/microbiology , Penicillium/isolation & purification , AIDS-Related Opportunistic Infections/epidemiology , Argentina/epidemiology , Bronchoalveolar Lavage Fluid/microbiology , China/ethnology , Cytomegalovirus Infections/complications , Diagnosis, Differential , DNA, Fungal/analysis , Dermatomycoses/epidemiology , Fatal Outcome , Histoplasmosis/diagnosis , Lung Diseases, Fungal/diagnosis , Lung Diseases, Fungal/epidemiology , Pneumocystis carinii , Polymerase Chain Reaction , Penicillium/classification , Pneumonia, Pneumocystis/complications , RibotypingABSTRACT
Objective To explore the clinical and laboratory feature of disseminated Penicillium marneffei(PSM) infection in patients with AIDS and to analysis treatment and prognosis. Methods Study clinical data of eight case with PSM infection in patients with AIDS in our hospital from 1999 were definite diagnosed PSM infection in patients with AIDS. Results (1)Eight patients including five females, at a mean age of 26～53, suffered from the diseases for a period of 1～4 months;(2)The most common clinical presentations include fever, stomatomycosis, lymphadenectasis papular skin lesion, anemia, abdominal pain, hepatomegaly, Plenomegaly, Herpes progenitalis, Subcutaneous nodule, Pleural effusion, bad bone ache. Laboratory examination showed elevated hepatic enzymes,coagulated dysfunction,hemocytopenia. Chest X-ray showed nonspecific include bilateval interstitial or alveolar. (3) Fungus cultured: yeast like cells were found in the culture at 37℃ or in tissues. The fungi outside the host cells were elongated, often curved, Sausage like and with clear cemral septate. When cultured at 25℃,the fungus was mycelia-like and produced a characteristic red Pigment, diffusing into the medium. (4) CD4 cell count was reduced significantly, HIV-RNA was high.(5)Mortality was high. Conclusions Definite diagnosis of disseminated Penicillium marneffei requires culture of the pathogenic fungus from clinical specimens. No specific clinical manifestation for Penicillum marneffei infection was found and Amphotericin B are effective in treating penicillosis marmeffei.