       Document 0654
 DOCN  M94A0654
 TI    Disseminated Penicillium marneffei: presenting illness of advanced HIV
       infection in a Burmese immigrant. Successful treatment with early
       recognition.
 DT    9412
 AU    Heath T; Patel A; Fisher D; Currie B; Royal Darwin Hospital, Casuarina
       NT.
 SO    Annu Conf Australas Soc HIV Med. 1993 Oct 28-30;5:56 (abstract no.
       FCP4). Unique Identifier : AIDSLINE ASHM5/94349001
 AB    Penicillium marneffei is a dimorphic fungus occasionally causing
       infection in immunocompetent individuals, but more frequently infecting
       patients with impaired T-cell immunity, particularly in association with
       HIV. Infection appears to be confined to residents of, or travellers to,
       south-east Asia, especially northern Thailand and Guangxi province in
       China. An interesting fungal ecology is recognised involving bamboo rats
       and their habitat, but the link to human infection is poorly understood
       and an independent environmental acquisition is more likely. This
       patient had lived in northern Thailand for years before migration to
       Australia. HIV infection and P. marneffei colonisation were presumably
       acquired in Asia. He presented for the first time in Darwin 5 years
       after immigration with disseminated P. marneffei infection involving
       skin, blood and reticuloendothelial system, and with profound
       lymphopenia (CD4 = 0/cu mm). Typical umbilicated skin lesions were
       recognised on admission, biopsies and touch smears (Wright's stained)
       facilitating rapid diagnosis. Amphotericin B therapy was instituted with
       dramatic clinical response. Full clinical recovery occurred and
       successful maintenance therapy was instituted with oral itraconazole. No
       co-existent opportunistic infection was identified. P. marneffei is
       distinguishable by characteristic skin lesions, pathology and
       travel/ethnicity history. It needs to be differentiated from
       tuberculosis, histoplasmosis, leishmaniasis and molluscum contagiosum,
       all of which it can clinically and histologically mimic. P. marneffei
       has unique and easily identifiable mycological characteristics. As
       regional neighbours we should anticipate further imported penicilliosis
       from Asia. Consideration should be given for its inclusion as an AIDS
       'indicator disease' in HIV patients.
 DE    Adult  Amphotericin B/ADMINISTRATION & DOSAGE  Australia  AIDS-Related
       Opportunistic Infections/*DIAGNOSIS/DRUG THERAPY/  MICROBIOLOGY  Case
       Report  Dermatomycoses/*DIAGNOSIS/DRUG THERAPY/MICROBIOLOGY  Diagnosis,
       Differential  Drug Therapy, Combination  *Emigration and Immigration
       Human  Itraconazole/ADMINISTRATION & DOSAGE  Male  *Penicillium/DRUG
       EFFECTS  Thailand/ETHNOLOGY  MEETING ABSTRACT

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

