HIV - Penicillium marneffei - Late clinical manifestations

In Southeast Asia infection with Penicillium marneffei should be included in the differential diagnosis of skin lesions. This fungus causes high fever (95%), hepatomegaly (40-90%), lymphadenopathy (50-90%), cough (50%), anaemia (40-80%), emaciation or weight loss (75%), splenomegaly (15-60%) and skin lesions (70%). The skin shows several papules with central umbilication. The chest X-ray can resemble tuberculosis. The organisms can be demonstrated in a smear from the skin, lymph nodes, sputum and/or from the bone marrow (a bone marrow analysis is the most sensitive). The white blood cell count varies greatly. The fungus is sometimes found in neutrophils in peripheral blood. Culture is also possible. The fungus is sensitive to amphotericin B and itraconazole. Do not confuse the yeast cells with other fungi or leishmania amastigotes.

The natural reservoir of Penicillium marneffei is still poorly known, though a connection with certain rodents (so-called bamboo rats such as Rhizomys sp. and Cannomys sp.) is thought to be likely. The organism was first isolated from the liver of a bamboo rat in 1956. It is named after Dr. Marneffe, a former director of the Pasteur Institute in Indochina. The first naturally infected human case was described in 1973. The mode of transmission has not yet been fully elucidated.