Clinical presentations and outcomes of Penicillium marneffei infections: a series from 1994 to 2004
Johnny WM Chan,
Dominic NC Tsang,
Patrick CK Li
Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne
Road, Kowloon, Hong Kong
OBJECTIVES. To describe the clinical presentation, management, and
outcomes of patients with Penicillium marneffei infections in a
regional hospital in Hong Kong.
DESIGN. Retrospective study.
SETTING. A regional and tertiary human immunodeficiency virus–referral
hospital in Hong Kong.
PATIENTS. Those who had penicilliosis during the inclusive period
January 1994 to February 2004.
RESULTS. Forty-seven immunocompromised patients (44 being human
immunodeficiency virus–positive) with penicilliosis were
retrospectively studied. Fever, malaise, and anaemia were the
commonest presentations. Most diagnoses were obtained from
blood cultures (83%) and lymph node biopsies (34%). Five
(11%) died, death being attributable to penicilliosis; four (9%)
of them had received no specific antifungal treatment due to
late presentation and late diagnosis. The CD4 count of human
immunodeficiency virus–infected patients upon diagnosis of
penicilliosis was low (median, 20.0 cells/mm3). Most (70%)
patients received amphotericin B as an induction treatment,
followed by oral itraconazole, although a smaller proportion
(21%) received oral itraconazole only. All surviving human
immunodeficiency virus–infected patients took highly active
antiretroviral treatment and oral itraconazole as secondary
prophylaxis after treatment of penicilliosis. The prognosis
appeared satisfactory with early diagnosis and administration of
appropriate antifungal therapy. Relapse ensued in two (4%) of
the patients only.
CONCLUSION. Penicillium marneffei infection in immunocompromised
patients is a serious disease with significant mortality if not
diagnosed early and treated with appropriate antifungal drugs.
Simple investigations like blood culture enable the diagnosis in
the majority of cases. Immunocompromised patients who have
been successfully treated should receive oral itraconazole as a
maintenance therapy to prevent relapse.
Hong Kong Med J 2008;14:103-9
Key words: AIDS-related opportunistic infections;
HIV infections; Immunocompromised
host; Itraconazole; Penicillium