Disseminated infection with the fungal pathogen Penicillium marneffei is, after extrapulmonary tuberculosis and cryptococcal meningitis, the third most common opportunistic infection in HIV disease in northern Thailand. We report the clinical, microbiological, and therapeutic features of a large series of HIV-infected adults with disseminated P marneffei infection. From August, 1987, to June, 1992, 92 patients with P marneffei infection confirmed by culture were seen at Chiang Mai University Hospital, of whom 86 were also infected with HIV. Clinical information was available for 80 of these patients. The most common presenting symptoms and signs were fever (92%), anaemia (77%), weight loss (76%), and skin lesions (71%). 87% of patients presenting with skin lesions had generalised papules with central umbilication. Presumptive diagnosis was made in 50 patients by microscopic examination of Wright's-stained bone-marrow aspirate and/or touch smears of skin biopsy or lymph-node biopsy specimens. Most patients who were diagnosed responded initially to amphotericin or itraconazole, whereas most who were not diagnosed and treated died. 12 patients relapsed within 6 months of cessation of treatment. P marneffei has become an important pathogen of HIV-associated opportunistic infection in Thailand.
PIP: Penicillium marneffei (PM) is the only Penicillium species which is dimorphic and can cause systemic mycosis in human beings; it is endemic in southeast Asia and China. The prevalence of PM infection has increased substantially during the past few years, occurring exclusively among patients infected with HIV. After extrapulmonary tuberculosis and cryptococcal meningitis, disseminated infection with PM is the most common opportunistic infection of HIV disease in northern Thailand. The clinical, microbiological, and therapeutic features of a large series of well-documented cases have not, however, been reported. The authors describe the clinical and laboratory features of 80 HIV-infected adults with disseminated PM infection seen over the period August 1987 - June 1992 at Chiang Mai University Hospital, Thailand. Subjects were of mean age 32.4 years in a range of 18-63. 74 subjects were male and 76 acquired HIV via heterosexual relations. Fever was present in 92%, anemia in 77%, weight loss in 76%, and skin lesions in 71%, while 87% of patients presenting with skin lesions had generalized papules with central umbilication. Most patients who were diagnosed responded initially to amphotericin or itraconazole, while most who were not diagnosed and treated died. More precisely, 40 of the 68 patients treated responded to the therapy. Twelve patients relapsed within six months of cessation of treatment.