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M94A0654.TXT
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1994-10-21
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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).