Current Fungal Infection Reports

, Volume 7, Issue 1, pp 44–50

Penicillium marneffei Infection in Immunocompromised Host

Current Management of Fungal Infections (L Ostrosky-Zeichner, Section Editor)

Abstract

Penicillium marneffei (PM) was first described in 1973, causing human infection in a patient with Hodgkin Lymphoma. In the HIV/AIDS epidemic, it has been described as one of the important opportunistic infection following tuberculosis and cryptococcosis in endemic region of Southeast Asia and Southern China. Immunocompromised patients acquire penicilliosis through inhalation of conidia, resulting in disseminated disease characterized by prolonged fever, pancytopenia, hepatosplenomegaly, and classic cutaneous presentation of umbilicated papular eruption. Nowadays, rare manifestations such as fungemia, pneumonia, enterocolitis, genital ulcers, oral ulcer, and central nervous system infection have been reported. Over the past decade, molecular and genomic studies have revealed more knowledge of PM, and vaccines are under development. Modern era PM has become a serious threat in immunocompromised travelers, rather than HIV/AIDS patient in the endemic area, who receive an effective prophylaxis strategy along with the highly active antiretroviral therapy (HAART) initiation.

Keywords

Penicilliosis Penicillium marneffei HIV/AIDS Immunocompromised 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Chariyalertsak S, Vanittanakom P, Nelson KE, et al. Rhizomys sumatrensis and Cannomys badius, new natural animal hosts of Penicillium marneffei. J Med Vet Mycol. 1996;34:105–10.PubMedCrossRefGoogle Scholar
  2. 2.
    DiSalvo AF, Fickling AM, Ajello L. Infection caused by Penicillium marneffei: description of first natural infection in man. Am J Clin Pathol. 1973;60:259–63.PubMedGoogle Scholar
  3. 3.
    Supparatpinyo K, Khamwan C, Baosoung V, et al. Disseminated Penicillium marneffei infection in southeast Asia. Lancet. 1994;344:110–3.Google Scholar
  4. 4.
    Duong TA. Infection due to Penicillium marneffei, an emerging pathogen: review of 155 reported cases. Clin Infect Dis. 1996;23:125–30.PubMedCrossRefGoogle Scholar
  5. 5.
    Imwidthaya P. Update of Penicillosis marneffei in Thailand. Review article. Mycopathologia. 1994;127:135–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Hu Y, Zhang J, Li X, Yang Y, Zhang Y Ma J, et al. Penicillium marneffei Infection: an emerging disease in Mainland China. Mycopathologia. 2012;1–11.Google Scholar
  7. 7.
    Stern M, Romaña CA, Chovin S, Drouhet E, Danel C, Pays JF. Pulmonary Penicillium marneffei penicilliosis in a patient with acquired immunodeficiency syndrome. Presse Med. 1989;18:2067.Google Scholar
  8. 8.
    Carey J, Hofflich H, Amre R, et al. Penicillium marneffei infection in an immunocompromised traveler: a case report and literature review. J Trav Med. 2005;12:291–4.CrossRefGoogle Scholar
  9. 9.
    Nelson KSK, Vanittanakom N. Penicilliosis. In: C.A. Kauffman ea, editor. Essentials of clinical mycology: Springer Science and Business Media; 2011. p. 4419–6640.Google Scholar
  10. 10.
    Chariyalertsak S, Sirisanthana T, Supparatpinyo K, et al. Case–control study of risk factors for Penicillium marneffei infection in human immunodeficiency virus-infected patients in northern Thailand. Clin Infect Dis. 1997;24:1080–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Hilmarsdottir I, Coutellier A, Elbaz J, et al. A French case of laboratory-acquired disseminated Penicillium marneffei infection in a patient with AIDS. Clin Infect Dis. 1994;19:357–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Ajello L, Padhye AA, Sukroongreung S, et al. Occurrence of Penicillium marneffei infections among wild bamboo rats in Thailand. Mycopathologia. 1995;131:1–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Chariyalertsak S, Sirisanthana T, Supparatpinyo K, et al. Seasonal variation of disseminated Penicillium marneffei infections in northern Thailand: a clue to the reservoir? J Infect Dis. 1996;173:1490–3.PubMedCrossRefGoogle Scholar
  14. 14.
    Chaiwun B, Vanittanakom N, Jiviriyawat Y, et al. Investigation of dogs as a reservoir of Penicillium marneffei in northern Thailand. Int J Infect Dis. 2011;15:e236–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Kudeken N, Kawakami K, Kusano N, et al. Cell-mediated immunity in host resistance against infection caused by Penicillium marneffei. J Med Vet Mycol. 1996;34:371–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Mootsikapun P, Srikulbutr S. Histoplasmosis and penicilliosis: comparison of clinical features, laboratory findings and outcome. Int J Infect Dis. 2006;10:66–71.PubMedCrossRefGoogle Scholar
  17. 17.
    Le T, Wolbers M, Chi NH, et al. Epidemiology, seasonality, and predictors of outcome of AIDS-associated Penicillium marneffei infection in Ho Chi Minh City, Vietnam. Clin Infect Dis. 2011;52:945–52.PubMedCrossRefGoogle Scholar
  18. 18.
    Ranjana KH, Priyokumar K, Singh TJ, et al. Disseminated Penicillium marneffei infection among HIV-infected patients in Manipur state, India. J Infect. 2002;45:268–71.PubMedCrossRefGoogle Scholar
  19. 19.
    Wu TC, Chan JW, Ng CK, et al. Clinical presentations and outcomes of Penicillium marneffei infections: a series from 1994 to 2004. Hong Kong Med J. 2008;14:103–9.PubMedGoogle Scholar
  20. 20.
    Lin WC, Dai YS, Tsai MJ, et al. Systemic Penicillium marneffei infection in a child with common variable immunodeficiency. J Formos Med Assoc. 1988;97:780–3.Google Scholar
  21. 21.
    Luo DQ, Chen MC, Liu JH, et al. Disseminated Penicillium marneffei infection in an SLE patient: a case report and literature review. Mycopathologia. 2011;171:191–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Lin JN, Lin HH, Lai CH, et al. Renal transplant recipient infected with Penicillium marneffei. Lancet Infect Dis. 2010;10:138.PubMedCrossRefGoogle Scholar
  23. 23.
    Lo CY, Chan DT, Yuen KY, et al. Penicillium marneffei infection in a patient with SLE. Lupus. 1995;4:229–31.PubMedCrossRefGoogle Scholar
  24. 24.
    Wang JL, Hung CC, Chang SC, et al. Disseminated Penicillium marneffei infection in a renal-transplant recipient successfully treated with liposomal amphotericin B. Transplantation. 2003;76:1136–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Chan YH, Wong KM, Lee KC, Kwok PC, Chak WL, Choi KS, et al. Pneumonia and mesenteric lymphadenopathy caused by disseminated Penicillium marneffei infection in a cadaveric renal transplant recipient. Transpl Infect Dis. 2004;6:28–32.PubMedCrossRefGoogle Scholar
  26. 26.
    Hart J, Dyer JR, Clark BM, et al. Travel-related disseminated Penicillium marneffei infection in a renal transplant patient. Transpl Infect Dis. 2012;14:434–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Seo JY, Ma YE, Lee JH, Lee ST, Ki CS, Lee NY. [A case of disseminated Penicillium marneffei infection in a liver transplant recipient]. Korean J Lab Med. 2010;30:400–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Woo PC, Lau SK, Lau CC, Chong KT, Hui WT, Wong SS, et al. Penicillium marneffei fungaemia in an allogeneic bone marrow transplant recipient. Bone Marrow Transplant. 2005;35:831–3.PubMedCrossRefGoogle Scholar
  29. 29.
    Larsson M, Nguyen LH, Wertheim HF, Dao TT, Taylor W, Horby P, et al. Clinical characteristics and outcome of Penicillium marneffei infection among HIV-infected patients in northern Vietnam. AIDS Res Ther. 2012;9:24.PubMedCrossRefGoogle Scholar
  30. 30.
    Ungpakorn R. Cutaneous manifestations of Penicillium marneffei infection. Curr Opin Infect Dis. 2000;13:129–34.PubMedCrossRefGoogle Scholar
  31. 31.
    Deesomchok A, Tanprawate S. A 12-case series of Penicillium marneffei pneumonia. J Med Assoc Thai. 2006;89:441–7.PubMedGoogle Scholar
  32. 32.
    Ma BH, Ng CS, Lam RK, Wan S, Wan IY, Lee TW, et al. Recurrent hemoptysis with Penicillium marneffei and Stenotrophomonas maltophilia in Job's syndrome. Can Respir J J Can Thorac Soc. 2009;16:e50–2.Google Scholar
  33. 33.
    Khongkunthian P, Isaratanan W, Samaranayake LP, Gelderblom HR, Reichart PA. Case report. Oro-facial manifestations of Penicillium marneffei infection in a Thai patient with AIDS. Mycoses. 2002;45(9–10):411–4.PubMedCrossRefGoogle Scholar
  34. 34.
    Hung HG, Lok KH. Intestinal Penicillium marneffei: an unusual cause of chronic diarrhea in an AIDS patient. J Digest Dis. 2010;11:189–91.CrossRefGoogle Scholar
  35. 35.
    George IA, Sudarsanam TD, Pulimood AB, Mathews MS. Acute abdomen: an unusual presentation of disseminated Penicillium marneffei infection. Indian J Med Microbiol. 2008;26:180–2.PubMedCrossRefGoogle Scholar
  36. 36.
    Othman N, Yip CW, Intan HI, Zainuddin Z, Amran F. An abdominal mass owing to Penicillium marneffei in an HIV-infected 7-year-old boy: case report. Ann Trop Paediatr Int Child Health. 2006;26:259–62.CrossRefGoogle Scholar
  37. 37.
    Cui Y, Jin C, Li X, Wu N. Penicillium marneffei infection presenting as vulva ulcer in an HIV-infected woman. Eur J Med Res. 2011;16:425–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Chan YF, Woo KC. Penicillium marneffei osteomyelitis. J Bone Joint Surg. 1990;72:500–3.Google Scholar
  39. 39.
    •• Le T, Huu Chi N, Kim Cuc NT, et al. AIDS-associated Penicillium marneffei infection of the central nervous system. Clin Infect Dis. 2010;51:1458–62. This is the first study described clinical characteristics of CNS infection of PM in AIDS patients.PubMedCrossRefGoogle Scholar
  40. 40.
    Noritomi DT, Bub GL, Beer I, et al. Multiple brain abscesses due to Penicillium spp infection. Rev Inst Med Trop Sao Paulo. 2005;47:167–70.PubMedCrossRefGoogle Scholar
  41. 41.
    Supparatpinyo K, Chiewchanvit S, Hirunsri P, et al. Penicillium marneffei infection in patients infected with human immunodeficiency virus. Clin Infect Dis. 1992;14:871–4.Google Scholar
  42. 42.
    Woo PC, Lau SK, Liu B, et al. Draft genome sequence of Penicillium marneffei strain PM1. Eukaryot Cell. 2011;10:1740–1.PubMedCrossRefGoogle Scholar
  43. 43.
    Sun J, Najafzadeh MJ, Zhang J, et al. Molecular identification of Penicillium marneffei using rolling circle amplification. Mycoses. 2011;54:e751–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Yuen KY, Woo PC, Lau SK. A multilocus sequence typing system for Penicillium marneffei: an international molecular cyber system for tracking its origin and transmission. Hong Kong Med J. 2010;16(5 Suppl 4):45–6.PubMedGoogle Scholar
  45. 45.
    Pornprasert S, Praparattanapan J, Khamwan C, et al. Development of TaqMan real-time polymerase chain reaction for the detection and identification of Penicillium marneffei. Mycoses. 2009;52:487–92.PubMedCrossRefGoogle Scholar
  46. 46.
    Bugeja HE, Boyce KJ, Weerasinghe H, et al. Tools for high efficiency genetic manipulation of the human pathogen Penicillium marneffei. Fungal Genet Biol. 2012;49:772–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Wang YF, Cai JP, Wang YD, et al. Immunoassays based on Penicillium marneffei Mp1p derived from Pichia pastoris expression system for diagnosis of penicilliosis. PLoS One. 2011;6:e28796.PubMedCrossRefGoogle Scholar
  48. 48.
    Sun J, Li X, Zeng H, et al. Development and evaluation of loop- mediated isothermal amplification (LAMP) for the rapid diagnosis of Penicillium marneffei in archived tissue samples. FEMS Immunol Med Microbiol. 2010;58:381–8.PubMedGoogle Scholar
  49. 49.
    Zhang JM, Sun JF, Feng PY, et al. Rapid identification and characterization of Penicillium marneffei using multiplex ligation-dependent probe amplification (MLPA) in paraffin-embedded tissue samples. J Microbiol Met. 2011;85:33–9.CrossRefGoogle Scholar
  50. 50.
    Singh N, Perfect JR. Immune reconstitution syndrome associated with opportunistic mycoses. Lancet Infect Dis. 2007;7:395–401.Google Scholar
  51. 51.
    Gupta S, Mathur P, Maskey D, et al. Immune restoration syndrome with disseminated Penicillium marneffei and cytomegalovirus co-infections in an AIDS patient. AIDS Res Ther. 2007;4:21.PubMedCrossRefGoogle Scholar
  52. 52.
    Saikia L, Nath R, Hazarika D, et al. Atypical cutaneous lesions of Penicillium marneffei infection as a manifestation of the immune reconstitution inflammatory syndrome after highly active antiretroviral therapy. Indian J Dermatol, Venereol Leprol. 2010;76:45–8.CrossRefGoogle Scholar
  53. 53.
    Sudjaritruk T, Sirisanthana T, Sirisanthana V. Immune reconstitution inflammatory syndrome from Penicillium marneffei in an HIV-infected child: a case report and review of literature. BMC Infect Dis. 2012;12:28.PubMedCrossRefGoogle Scholar
  54. 54.
    Ho A, Shankland GS, Seaton RA. Penicillium marneffei infection presenting as an immune reconstitution inflammatory syndrome in an HIV patient. Int J STD AIDS. 2010;21:780–2.PubMedCrossRefGoogle Scholar
  55. 55.
    Saikia L, Nath R, Biswanath P, et al. Penicillium marneffei infection in HIV infected patients in Nagaland & immune reconstitution after treatment. Indian J Med Res. 2009;129:333–4.PubMedGoogle Scholar
  56. 56.
    Manosuthi W, Chaovavanich A, Tansuphaswadikul S, et al. Incidence and risk factors of major opportunistic infections after initiation of antiretroviral therapy among advanced HIV-infected patients in a resource-limited setting. J Infec. 2007;55:464–9.CrossRefGoogle Scholar
  57. 57.
    Supparatpinyo K, Nelson KE, Merz WG, et al. Response to antifungal therapy by human immunodeficiency virus-infected patients with disseminated Penicillium marneffei infections and in vitro susceptibilities of isolates from clinical specimens. Antimicrob Agents Chemother. 1993;37:2407–11.Google Scholar
  58. 58.
    Ryder NS. Activity of terbinafine against serious fungal pathogens. Mycoses. 1999;42 Suppl 2:115–9.PubMedGoogle Scholar
  59. 59.
    Radford SA, Johnson EM, Warnock DW. In vitro studies of activity of voriconazole (UK-109,496), a new triazole antifungal agent, against emerging and less-common mold pathogens. Antimicrob Agents Chemother. 1997;41:841–3.PubMedGoogle Scholar
  60. 60.
    Cao C, Liu W, Li R, et al. In vitro interactions of micafungin with amphotericin B, itraconazole or fluconazole against the pathogenic phase of Penicillium marneffei. J Antimicrob Chemother. 2009;63:340–2.PubMedCrossRefGoogle Scholar
  61. 61.
    Odabasi Z, Paetznick VL, Rodriguez JR, et al. In vitro activity of anidulafungin against selected clinically important mold isolates. Antimicrob Agents Chemother. 2004;48:1912–5.PubMedCrossRefGoogle Scholar
  62. 62.
    Sirisanthana T, Supparatpinyo K, Perriens J, et al. Amphotericin B and itraconazole for treatment of disseminated Penicillium marneffei infection in human immunodeficiency virus-infected patients. Clin Infect Dis. 1998;26:1107–10.PubMedCrossRefGoogle Scholar
  63. 63.
    Supparatpinyo K, Chiewchanvit S, Hirunsri P, et al. An efficacy study of itraconazole in the treatment of Penicillium marneffei infection. J Med Assoc Thai. 1992;75:688–91.PubMedGoogle Scholar
  64. 64.
    Supparatpinyo K, Perriens J, Nelson KE, et al. A controlled trial of itraconazole to prevent relapse of Penicillium marneffei infection in patients infected with the human immunodeficiency virus. New Engl J Med. 1998;339:1739.Google Scholar
  65. 65.
    Chariyalertsak S, Supparatpinyo K, Sirisanthana T, et al. A controlled trial of Itraconazole as primary prophylaxis for systemic fungal infections in patients with advanced human immunodeficiency virus infection in Thailand. Clin Infect Dis. 2002;34:277–84.PubMedCrossRefGoogle Scholar
  66. 66.
    Chaiwarith R, Charoenyos N, Sirisanthana T, et al. Discontinuation of secondary prophylaxis against penicilliosis marneffei in AIDS patients after HAART. AIDS. 2007;21:365–7.PubMedCrossRefGoogle Scholar
  67. 67.
    • Chaiwarith R, Fakthongyoo A, Praparattanapan J, et al. Itraconazole vs fluconazole a primary prophylaxis for fungal infections in HIV-infected patients in Thailand. Currt HIV Res. 2011;9:334–8. This randomized trial demonstrated the efficacy of fluconazole compared to intraconazole.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  1. 1.Department of Medicine, Faculty of Medicine, Ramathibodi HospitalMahidol UniversityBangkokThailand
  2. 2.Department of Medicine, Faculty of MedicineChiang Mai UniversityChiang MaiThailand

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