Penicillium marneffei infection

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Penicillium marneffei infection
in AIDS patients
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Pathogen Penicillium marneffei
dimorphic fungus yeast like with cross
septum
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• Mode of transmission
• respiratory infection
• disseminated
• Wright stain or Giemsa stain yeast like
  with cross septum 3 µm ( usually in macrophage
  )

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Penicillium other than P.marneffei
( Lyratzopaelos G , etal J infect 2002 45 184
207 )
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Hypersensitivity pneumonitis

• Cheese worker lung
• Peat moss worker lung
• Salami workers lung
• Malt worker s lung
• Farmer s lung

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• Vienman 1956 bamboo rat ( Rhizomys sinesis )
• Khwase 1986 Li , et al study 16
  Rhizomys pruinosus
• 93.1 identified P. Marneffei
• 87.5 culture from lung
• 56.3 culture from liver
• 56.3 culture from spleen
• 50 culture from abdominal
• lymph node

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Mode of Transmission

• Respiratory
• Skin ??
• GI??

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Pathology

• 1. Granulomatous reaction lymph mode
• 2. Suppurative form microbuses
• 3. Anergic and necrotizing lesion focal
  necrosis

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Clinical manifestation of HIV infected patient
with P.marneffei, Chiang mai university
hospital
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Renew of 155 reported case ( Duong TA .Clin
Infect DIS 199623(25-30)
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Diagnostic smear

• Skin scraping ( skin biopsy touch smear , bone
  marrow , lymph node biopsy touch smear
• Wrights stain
• Oral yeast , 3-5 micron
• With septum ( binary fission )

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80 Patients from Chiang Mai university hospital
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30 Sample from CMU , 1993
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Treatment

• Severe case Amphotericin B 0.6 mg /kg/day for
  2 weeks Itraconazole 200 mg bid for 10
  weeks.
• Mild case Itraconazole 200 mg bid for 10
  week

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Amphotericin B

• Amphotericin B Deoxycholate
• - drip with 5 dextrose in water
• Lipid-complexed Amphotericin B
• - Ampho B colloidal dispersion
  ( Amphotec )
• - Ampho B lipid complex ( Abelect )
• - Liposomal Ampho B ( Ambisome )

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Side effect of Amphotericin B

• Acute infusion related reaction
• - Fever , chill , tachypnea
• - not anaphylaxis

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Side effect of Amphotericin B

• Nephrotoxicity
• - dose dependent
• - loss K , Mg , bicarbonate
• - risk combine with other nephrotoxic
  drug
• hypotension
• dehydration
• kidney disease

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Side effect of Amphotericin B

• other side effect
• nausea , vomiting
• thrombophlebitis
• anemia ,thrombocytopenia , leucopenia

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