Penicillium marneffei infection (PM) is an important
disease among HIV-infected persons in Southeast Asia.
Discovered in 1956 from the bamboo rat, Rhizomys sinensis,
in Vietnam (1), PM was first identified in HIV-infected
persons in 1988 (2). The disease has now been reported among
HIV-infected persons in Thailand, Myanmar (Burma),
Vietnam, Cambodia, Malaysia, northeastern India, Hong
Kong, Taiwan, and southern China (3). Cases of PM also have
been reported among HIV-infected persons from the United
States, the United Kingdom, The Netherlands, Italy, France,
Germany, Switzerland, Sweden, Australia, and Japan after
they visited the PM-endemic region (3).
PM occurs late in the course of HIV infection. Our study
found that the CD4+ cell count at the time of the diagnosis of
PM was consistently less than 50 cells/ml. Clinical
presentation included fever (in 99% of the patients), anemia
(78%), pronounced weight loss (76%), generalized lymphadenopathy
(58%), and hepatomegaly (51%). However, these
conditions were not specific for PM and could be caused by
HIV or other HIV-related opportunistic infections. A more
specific finding was skin lesions, most commonly papules
with central necrotic umbilication (4), which were seen in 71%
of the patients.
In 63% of the patients with PM, a presumptive diagnosis
could be made several days before the results of fungal culture
were available. This was done by microscopic examination of
a Wright-stained sample of bone marrow aspirate, touch
smears of a skin biopsy specimen, or a lymph node biopsy
specimen. It was easy to culture P. marneffei from various
clinical specimens. Bone marrow culture was the most
sensitive (100%), followed by culture of the specimen obtained
from skin biopsy (90%) and blood culture (76%)(4).