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1 Natl Med J China March Vol 82 No (1) HIV ; (2) ; (3) ; ;25 ; ; ; B ; Disseminated Penicillium marneffei infection associated with AIDS report of a case LIAO Xiaomei RAN Yuping CHEN Huijiao Meng Wentong XIANG Bing KANG Mei XIONG Zhiyu ZHUANG Jie PENG Xuemei DENG Chengqi LI Gandi LIU Weiping. First University Hospital of West China University of Medical Sciences. Chengdu China Abstract Objective To explore the clinical and laboratory features of disseminated Penicillium marneffei infection in patients with AIDS. Methods The HIV antibody in serum was assayed by both enzyme immunoassay ( EIA) and Western immunoblot (WIB) methods. Morphology of the pathogenic fungus in smear and biopsy specimens of bone marrow was observed. The fungus was isolated from the patient s skin lesion and inoculated into the abdominal cavities of 2 rats and 2 mice. Twenty days later the rats and mice were killed and their viscera were taken out. Blood from the organs were cultured in Sabourand glucose agar at 25and 37. The colonies were observed. The morphology of the fungus was observed by microscopy and scanning electron microscopy. Results The most common clinical manifestations of Penicilium marneffei infection were fever weight loss anemia papular skin lesion hepatosplenomegaly and lymphadenectasis. Yeast2like cells were found in the culture at 37 or in tissues. The fungi outside the host cells were elongated often curved sausage2like and with clear central septi. When cultured at 25 the fungus was mycelia2like and produced a characteristic red pigment diffusing into the medium. Conclusion Disseminated Penicilliosis marneffei is one of the most important opportunistic infections in patients with AIDS in Southeast Asia and the southern part of China. Since there is no specific clinical manifestation for Penicillium marneffei infection it is often misdiagnosed. Definite diagnosis requires culture of the pathogenic fungus from clinical specimens. The fungus is thermally dimorphic produces red pigment and is sausage - form with clear central septum outside the host cell. Amphotericin B and itraconazole are effective in treating Penicilliosis marneffei. Key words Acquired immunodeficiency syndrome ; Penicillium (penicilliosis marneffei) ( penicillium marneffei) : ( ) ( ) ( ) ( ) ( )

2 Natl Med J China March Vol 82 No. 5 ( 38 ) 2 1. : ; 10 % ( PAS ) 65 kg 47 kg 3 2. : (1) HIV : 3817 ( HIV / 120 / min 24 / min 105/ 75 mm Hg(1 mm Hg = kpa) ( HIV Blot2. 2 Genelabs 0. Diagnostics ) (2) ( 3 cm0. 8 cm (1) ELISA ) (3) (Dipstick rr39 K. P. Chang ) 3. : (1) 10 ml cm (2) : 3. 0 cm 4. 0 cm (4 % 1 % 2 % : / L 53 g/ L / L mol/ L mol/ L 73 U/ L ( AMRAY g/ L g/ L 10002B ) : ( + ) ( ) ( + ) ( Grocott ) ) ) : (1) 7 SD g g( ) (2) : h CFU/ ml (3) : 0. 5 ml 0. 5 ml : / 18m(2) 2. : PAS (3a) Grocott (3b) HE

3 Natl Med J China March Vol 82 No a. PAS 700 ;b. Grocott cm 2 a. ;B. 12 HE m ;37 (4) (3) (5a) ;37 23m (5b) (4) 25 ( 6a) ;37 (6b) ( penicillium marneffei) 5. : 0. 2 cm 0. 2 cm 0. 1 cm : (1) HIV 4 : ( 25 ) 6. : HIV21 ; (2) ; (3) () ;37 4. : (1) () B 6125 mg/ (2) : 25 5 a ;b. 37 HE 1 000

4 Natl Med J China March Vol 82 No. 5 6 a. 25 ;b d mg/ d 25 mg/ d 50 mg/ d 2 d 50 mg/ d [ d ] : ( 0. 2 g 3 / d) 3 : (1) (2) (3) : [ Capponi ] [1 ] 1973 DiSalvo [ ] : [2 ] 10 [325 ] [6 7 ] : : (1) HIV Piehl [8 ] ; (2) ; (3) 1988 ; (4) HIV [ ] HIV/ AIDS : [1 7 9 ] [ ] : ( ) [ ] [ ] : (1) 37 : 25 (chlamydospore) 1 :31 :4 [12 16 ] (2) 25 : B

5 Natl Med J China March Vol 82 No [9 15 ] : B 0. 6 mg kg - 1 d mg d % [ ] 200 mg d - 1 [ ] Duong TA. Infection due to Penicillium marneffei an emerging : pathogen : review of 155 reported cases. Clin Infect Dis : : DiSalvo AF Fickling AM Ajello L. Infection caused by Penicillium 14. marneffei: description of first natural infection in man. Am J Clin : Pathol : Sirisanthana T. Infection due to Penicillium marneffei. Ann Acad Med 3 Deng ZL Connor DH. Progressive disseminated penicilliosis caused by Sigapore : Penicillium marneffei : report of eight cases and differentiation of the 16.. :.. causative organism from Histoplasma capsulatum. Am J Clin Pathol 1. : Blackwell Science : Sirisanthana T Supparatpinyo K Perriens J et al. Amphotericin B and 4.. itraconazole for treatment of disseminated Penicillium marneffei infection : in human immunodeficiency virus2infected patients. Clin Infect Dis 5 So SY Chau PY Jones BM et al. A case of invasive penicilliosis in : Hong Kong with immunologic evaluation. Am Rev Respir Dis :. 131 : : Blackwell Science :.. 19 Supparatpinyo K Perriens J Nelson KE et al. A controlled trial of : itraconazole to prevent relapse of Penicillium marneffei infection in 7 Deng ZL Ribas JL Gibson DW et al. Infections caused by Penicillium patients infected with the human immunodeficiency virus. N Engl J Med marneffei in China and Southeast Asia : review of eighteen published : cases and report of four more Chinese cases. Rev Infect Dis : Piehl MR Kaplan RL Haber MH. Disseminated penicilliosis in a patient with acquired immunodeficiency syndrome. Arch Pathol Lab Med : Sirisanthana T Supparatpinyo K. Epidemiology and management of penicilliosis in human immunodeficiency virus2infected patients. Int J Infect Dis : Supparatpinyo K Khamwan C Baosoung V et al. Disseminated Penicillium marneffei infection in Southeast Asia. Lancet : Jayanetra P Nityanant P Ajello L et al. Penicilliosis marneffei in Thailand : report of five human cases. Am J Trop Med Hyg : ( : ) ( : ) ( ) ; ( ) ; ( ) ;111 ( ) ;121 ( ) ;131 ( ) ;141 : ( ) ;151 ( 11 ( ) ;21 ) ;161 ( ) ;31 ( ) ( ) ; ( ) ; ( ) ;61 ( 12 ) ;71 ( ) ;81