European Journal of Epidemiology

, Volume 9, Issue 1, pp 79–85 | Cite as

Treatment and serological studies of an Italian case of penicilliosis marneffei contracted in Thailand by a drug addict infected with the human immunodeficiency virus

  • M. A. Viviani
  • A. M. Tortorano
  • G. Rizzardini
  • T. Quirino
  • L. Kaufman
  • A. A. Padhye
  • L. Ajello


A case of disseminated penicilliosis marneffei, the first to be diagnosed in Italy, is described in a male HIV-positive drug addict. The patient had visited Thailand several times in the two years prior to his hospitalization. The presenting signs were fever, productive cough, facial skin papules and pustules, nodules on both thumbs and oropharyngeal candidiasis.

Penicillium marneffei was isolated from a series of blood specimens with the lysis centrifugation procedure. Septate, yeast-like cells were observed in histological sections of the nodules and sputum smears.

The patient was treated for 6 weeks with amphotericin B (total dosage 1,400 mg) and flucytosine (150 mg/kg/die) for the first 3 weeks. Prompt clinical improvement and sterilization of all biological specimens were attained. Itraconazole was administered as maintenance therapy (400 mg/die for the first month and 200 mg afterward). During the follow-up period, no relapse was observed. The patient, however, did succumb to a variety of non-mycotic infections and died nine months after start of therapy. At autopsy, P. marneffei was not detected in his tissues.

Serological studies were performed with a micro-immunodiffusion procedure using a mycelial culture filtrate antigen of P. marneffei. Sera taken early in the course of the disease gave positive antibody reactions. Whereas sera taken 3–5 months following therapy were negative.

All known cases of penicilliosis marneffei in bamboo rats and in humans among the inhabitants and visitors to the endemic areas of P. marneffei in South East Asia and Indonesia are summarized.

Key words

Penicilliosis marneffei Drug addict AIDS Thailand Italy - Serology Therapy 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ajello L., Padhye A.A. and Sukroongreung S. Unpublished data.Google Scholar
  2. 2.
    Ancelle T., Dupouy-Carnet J., Pujol F., Nassif X., Ferradini L. and Lapierre J. (1988): Un cas de pénicilliose disseminée à Penicillium marneffei chez un malade atteint de SIDA -Bull. Soc. Fr. Mycol. Med. 17: 73–76.Google Scholar
  3. 3.
    Capponi M., Sureau P. and Segretain G. (1956): Pénicilliose de Rhizomys sinensis -Bull. Soc. Pathol. Exot. 49: 418–421.Google Scholar
  4. 4.
    Chan J.K.C., Tsang D.N.C. and Wong D.K.K. (1989): Penicillium marneffei in bronchoalveolar lavage fluid -Acta Cytol 33: 523–526.Google Scholar
  5. 5.
    Chan J.K.C. and Tsang D.N.C. (1989): Penicillium marneffei infection: an update -Am. J. Clin. Pathol. 92: 709.Google Scholar
  6. 6.
    Chan Y.F. and Chow T.C. (1990): Ultrastructural observations on Penicillium marneffei in natural human infection -Ultrastruct. Pathol. 14: 439–452.Google Scholar
  7. 7.
    Chan Y.F. and Woo K.C. (1990): Penicillium marneffei osteomyelitis -J. Bone and Joint Surg. 72: 500–503.Google Scholar
  8. 8.
    Chiewchanvit S., Mahanupab P., Hirunsri P. and Vanittanakom N. (1991): Cutaneous manifestations of disseminated Penicillium marneffei mycosis in five HIV-infected patients -Mycoses 34: 245–249.Google Scholar
  9. 9.
    Coen M., Viviani M.A., Rizzardini G., Tortorano A.M., Bonaccorso C. and Quirino T. (1989): Disseminated infection due to Penicillium marneffei in a HIV positive patient. Poster M.B.P. 94: In: V International Conference on AIDS. Montreal, Quebec, Canada, June 4–9, 1989.Google Scholar
  10. 10.
    Deng Z. and Connor D.H. (1985): Progressive disseminated penicilliosis caused by Penicillium marneffei: report of eight cases and differentiation of the causative organism from Histoplasma capsulatum -Am. J. Clin. Pathol. 84: 323–324Google Scholar
  11. 11.
    Deng Z, Yun M. and Ajello L. (1986): Human penicilliosis marneffei and its relation to the bamboo rat (Rhizomys pruinosus) -J. Med. and Vet. Mycol. 24: 383–389.Google Scholar
  12. 12.
    Deng Z., Ribas J.L., Gibson D.W. and Connor D.H. (1988): Infections caused by Penicillium marneffei in China and Southeast Asia: review of eighteen published cases and report of four more Chinese cases -Rev. Infect. Dis. 10: 640–652.Google Scholar
  13. 13.
    DiSalvo A.F., Fickling A.M. and Ajello L. (1973): Infection caused by Penicillium marneffei: Description of first natural infection in man -Am. J. Clin. Pathol. 60: 259–263.Google Scholar
  14. 14.
    DiSalvo A.F. (1989): Penicillium marneffei infection: a follow-up -Am. J. Clin. Pathol. 91: 507.Google Scholar
  15. 15.
    Goodwin S.D., Fiedler-Kelly J., Grasela T.H., Schell W.A. and Perfect J.R. (1992): A nationwide survey of clinical laboratory methodologies for fungal infections -J. Med. Vet. Mycol. 30: 153–160.Google Scholar
  16. 16.
    Hilmarsdottir L, Datry A., Meynard J.L., Rogeaux 0., Katlama C., Chalot M., Guermonprez G., Brucker G., Danis M. and Gentilini M. (1991): Infection disseminée à Penicillium marneffei observée chez deux patients infectes par le VIH — Réunion Soc. Fran. Mycol. Méd. Novembre 22–23, Abst. p. 62.Google Scholar
  17. 17.
    Hulshof C.M.J., Zanten R.A.A. van, Sluiters J.F., Ende M.E. van der, Samson R.S., Zondervan R.E. and Wagenvoort J.H.T. (1990): Penicillium marneffei infection in an AIDS patient -Eur. J. Clin. Microbiol. Infect. Dis. 9: 370.Google Scholar
  18. 18.
    Jayanetra P., Nitiyanant P., Ajello L., Padhye A.A., Lolekha S., Atichartakarn V., Vathesatogit P., Sathaphatayavongs B. and Prajaktam R. (1984): Penicilliosis marneffei in Thailand: Report of five human cases -Am. J. Trop. Med. Hyg. 33: 637–644.Google Scholar
  19. 19.
    Kok L, Boot H., Rietra P.G.J.M. and Weigel H.M. (1992): Successful treatment of Penicillium marneffei infection - SIDA 92. Paris, March 12–13 Abst. p. 180.Google Scholar
  20. 20.
    Li J.C., Pan L.Q. and Wu S.X. (1989): Mycologic investigation on Rhizomys pruinosus senex in Guangxi as natural carrier with Penicillium marneffei -Chinese Med. J. 102: 477–485.Google Scholar
  21. 21.
    Lü Y. C. (1990): Rare mycoses from Taiwan -Jpn. J. Med. Mycol. 31: 179–185.Google Scholar
  22. 22.
    Ma K.F., Tsui M.S. and Tsang D.N.C. (1991): Fine needle aspiration diagnosis of Penicillium marneffei infection -Acta Cytol. 35: 557–559.Google Scholar
  23. 23.
    Manion D.J., Auclair F. and Saginur R. (1991): Penicillium marneffei mycosis: the first Canadian case report. In: 59th Conjoint Meeting on Infectious Diseases. December 2–5, 1991 - Cand. Assoc. Clin. Microbiol. Infect. Dis. Quebec (Canada) Abst. C-3.Google Scholar
  24. 24.
    Pautler K.B., Padhye A.A. and Ajello L. (1984): Imported penicilliosis marneffei in the United States: report of a second human infection — Sabouraudia: J. Med. Vet. Mycol. 22: 433–438.Google Scholar
  25. 25.
    Peto T.E.A., Bull R., Millard P.R., Mackenzie D.W.R., Campbell C.K., Haines M.E. and Mitchell R.G. (1988): Systemic mycosis due to Penicillium marneffei in a patient with antibody to human immunodeficiency virus -J. Infect. 16: 285–290.Google Scholar
  26. 26.
    Piehl M.R., Kaplan R.L. and Haber M.H. (1988): Disseminated penicilliosis in a patient with acquired immunodeficiency syndrome -Arch. Pathol. Lab. Med. 112: 1262–1264.Google Scholar
  27. 27.
    Romaña C.A., Stern M., Chouin S., Drouhet E., and Pays J.F. (1989): Penicilliose pulmonaire à Penicillium marneffei chez un patient atteint d'une syndrome immunodéficitaire acquis. Deuxieme cas francais Bull. Soc. Fr. Mycol. Méd. 18: 311–316.Google Scholar
  28. 28.
    Sathapatayavongs B., Damrongkitchaiporn S., Saengditha P., Kiatboonsri S. and Jayanetra P. (1989): Disseminated penicilliosis associated with HIV infection -J. Infect. 19: 84–85.Google Scholar
  29. 29.
    Segretain G. (1959): Description d'une nouvelle espèce de Penicillium: Penicillium marneffei n. sp. -Bull. Soc. Mycol. Fr. 75: 412–416.Google Scholar
  30. 30.
    Segretain G. (1959): Penicillium marneffei n. sp., agent d'une mycose du système réticulo-endothèlial -Mycopathol. Mycol. Appl. 11: 327–353.Google Scholar
  31. 31.
    Sekhon A.S., Li J.S.K. and Garg A.K. (1982): Penicilliosis marneffei: serological and exoantigen studies -Mycopathologia 77: 51–57.Google Scholar
  32. 32.
    Sekhon A.S., Garg A.K., Padhye A.A., Standard P.G., Kaufman L. and Ajello L. (1989): Antigenic relationship of Penicillium marneffei to P. primulinum -J. Med. Vet. Mycol. 27: 105–112.Google Scholar
  33. 33.
    Sekhon A.S., Galbraith J., Mielke B. W., Black W.A., Gare AX, Sheehan G., Stein L., Glezes J.D. and Wong C. (1991): Esoteric mycoses: cerebral phaeohyphomycosis caused by Xylohypha bantiana and penicilliosis marneffei. In: Program and Abstracts, XI Congress of the Int. Soc. Human and Animal Mycology, June 24–28, Montreal (Canada) Abst. S13.4, p. 36.Google Scholar
  34. 34.
    So S.Y., Chau P.Y., Jones B.M., Wu P.C., Pun K.K., Lam W.K. and Lawton J.W.M. (1985): A case of invasive penicilliosis in Hong Kong with immunologic evaluation -Am. Rev. Respir. Dis. 131: 662–665.Google Scholar
  35. 35.
    Stern M., Romana C.A., Chovin S., Drouhet E., Danel C and Pays J.F. (1989): Pénicilliose pulmonaire à Penicillium marneffei chez un malade atteint d'un syndrome immunodeficitaire acquis. Presse Med. 18: 2087.Google Scholar
  36. 36.
    Supparatpinyo K., Chiewchanvit S., Hirunsri P., Uthammachai C., Nelson K.E. and Sirisanthana T. (1992): Penicillium marneffei infection in patients infected with human immunodeficiency virus -Clin. Infect. Dis. 14: 871–874.Google Scholar
  37. 37.
    Tanphaichitra D. and Srimuang S. (1984): Cellular immunity (T-cell subset using monoclonal antibody) in tuberculosis, melioidosis, pasteurellosis, penicilliosis; and role of levamisole and isoprinosine -Develop. Biol. Standard 57: 117–123.Google Scholar
  38. 38.
    Truchis P. De, Bounioux M.E, Roussi J., Paraire F., Nordmann P. and Dournon E. (1991): Septicemie à Penicillium marneffei au cours du SIDA. Réunion Interdisciplinaire de Chimioantibioticotherapie — Paris. December 5, Abstract 35/C4.Google Scholar
  39. 39.
    Tsang D.N.C., Chan J.K.C., Lau Y.T., Lim W., Tse C.H. and Chan N.K. (1988): Penicillium marneffei infection: an underdiagnosed disease? -Histopathology 13: 311–318.Google Scholar
  40. 40.
    Tsang D.N.C., Li P.C.K., Tsui M.S., Lau Y.T., Ma K.F. and Yeoh E.K. (1991): Penicillium marneffei: another pathogen to consider in patients infected with human immunodeficiency virus -Rev. Infect. Dis. 13: 766–767.Google Scholar
  41. 41.
    Tsui W.M.S., Ma K.F. and Tsang D.N.C. (1992): Disseminated Penicillium marneffei infection in HIV-infected subjects -Histopathology 20: 287–293.Google Scholar
  42. 42.
    Viviani M.A. and Tortorano A.M. (1990): Unusual mycoses in AIDS patients, pp. 147–153. In: Bosche H. Vanden et al. (Eds): Mycoses in AIDS patients. Plenum Press, New York.Google Scholar
  43. 43.
    Wang I.L., Yeh H.P., Chang S.C. and Chen J.S. (1989): Penicilliosis caused by Penicillium marneffei. A case report — Derm. Sinica. 7: 19–22.Google Scholar
  44. 44.
    Wei X.G., Zhou L.T., Zhang Q.S., Song S.Y. and Nong Q.G. (1985): Report of the first case of penicilliosis marneffei in China -Natl. Med. J. China 65: 533–534.Google Scholar
  45. 45.
    Yuen W.C., Chan Y.F., Loke S.L., Seto W.H., Poon G.P. and Wong K.K. (1986): Chronic lymphadenopathy caused by Penicillium marneffei: a condition mimicking tuberculous lymphadenopathy -Br. J. Surg. 73: 1007–1008.Google Scholar

Copyright information

© Gustav Fischer 1993

Authors and Affiliations

  • M. A. Viviani
    • 1
  • A. M. Tortorano
    • 1
  • G. Rizzardini
    • 2
  • T. Quirino
    • 2
  • L. Kaufman
    • 3
  • A. A. Padhye
    • 3
  • L. Ajello
    • 4
  1. 1.Istituto di Igiene e Medicina PreventivaUniversità degli Studi di MilanoMilanoItaly
  2. 2.1° Divisione di Malattie InfettiveOspedale L. SaccoMilanoItaly
  3. 3.Division of Bacterial and Mycotic Diseases - National Center for Infectious Diseases and PreventionCenters for Disease ControlAtlantaUSA
  4. 4.Department of OphthalmologyEmory University School of MedicineAtlantaUSA

Personalised recommendations