An Update on Penicillium Marneffei Infection and Advances in Laboratory Diagnosisb (original) (raw)

Journal of Bacteriology & Mycology: Open Access

Penicilliosis marneffei. 1,2 This is an opportunistic fungal disease endemic in south East Asia. 3 Pandemic of AIDS has virtually acted as trigger to rapid spread of penicilliosis marneffei as opportunistic infection or secondary infection. It is also known as AIDS defining illness among patients who have either lived or visited endemic areas regardless of time period since exposure. 3 P. marneffei infection is endemic in various part of world including countries of southeast Asia and other region of tropical countries. 4 The importance of P. marneffei most of time are related to HIV pandemic. Movement of people from one part to another part of world from endemic to non endemic increases its spread. 5 It was found to be the third most frequent opportunistic pathogen after tuberculosis and cryptococcosis among immunosuppressed in endemic areas. 1 Clinical picture: Low-grade fever, weight loss, and skin lesions are common. Other characteristics are malaise, anemia and leukocytosis. Fungemia, generalized lymphadenopathy, and cough are also reported in many of patients. Subcutaneous and mucosal lesions, diarrhea, colonic lesions, hepatomegaly with or without splenomegaly, hemoptysis, osteoarticular lesions, and pericarditis have also been described. Skin lesions commonly occur on the face, upper trunk, and extremities. They may occur as papules, pustules, nodules, ulcers, or abscesses. In HIV-infected individuals, lesions commonly become umbilicated and resemble those of molluscum contagiosum. Pharyngeal and palatal lesions are also more commonly seen in HIVinfected patients. Lung lesions can appear as reticulonodular, nodular, or diffuse alveolar infiltrates, but on occasion they are cavitary and cause hemoptysis. Autopsy studies have revealed involvement of lymph nodes, liver, spleen, lung, kidney, skin, bone, bone marrow, adrenal, tonsil, bowel, and meninges. Patients who do not receive the appropriate antifungal treatment have a poor prognosis; however, primary treatment with amphotericin B and secondary prophylaxis with Itraconazole are effective. Laboratory diagnoses of P. marneffei infection need demonstration of intracellular P. marneffei yeast cells in the infected tissue. Cultivating the fungus from clinical specimens is another means. In microscopy P. marneffei appears as a unicellular organism with round to oval cells or cross wall formation within macrophages, or form extracellular elongated cells. 6 The determination of the P. marneffei may be carried out by molecular techniques and such analyses will helps to understand the molecular mechanism of fungal morphogenesis, pathogenesis and host-fungus interactions. 7