Disseminated Penicillium marneffei infection in an HIV‐positive female from Thailand in Germany

Abstract

We report the case of a 33 year old Thai female, who was married in Germany for eight years and used to travel to Thailand every year for several weeks. She presented with abdominal and back pain, prolonged fever, generalized lymphadenopathy, and a recent history of oral thrush. She was diagnosed HIV positive with initial CD4 counts of 18/μl and an HI virus load of 59.000 copies/ml. Antiviral therapy was installed with zidovudin, lamivudin, and efavirenz. Abdominal CT scans revealed greatly enlarged abdominal lymphnodes. Fine needle aspirates of cervical and retroperitoneal lymphnodes, sputum samples, blood samples, and a bone marrow biopsy were microscopically positive for Penicillium marneffei and grew P. marneffei. The isolates were sensitive to amphotericin B, flucytosine, itraconazole, and fluconazole. Both universal and specific fungal polymerase chain reaction assays were positive in various samples. Serum Aspergillus galactomannan antigen, which is known to crossreact with P. marneffei, was elevated and subsequently used for monitoring of therapy. With antifungal treatment (intravenous amphotericin B 0.6 mg/kg/d for two weeks, oral itraconazole 400 mg/d for 10 weeks and 200 mg/d as maintenance therapy), the fever declined in 6 days, the size of the enlarged lymphnodes gradually decreased in the CT scans, and the initial abdominal and back pain vanished.

Transmission of Tropical and Geographically Restricted Infections during Solid-Organ Transplantation

“…Penicillium marneffei is a dimorphic fungus that is endemic in Southeast Asia, southern China, Taiwan, and Hong Kong and causes opportunistic infections. Isolated cases have been reported for patients who had traveled to areas of endemicity and returned home to Western countries (22,312,378). It has also been reported for patients with deficiencies in cellular immunity and HIV infection and for patients receiving steroids or other forms of immunosuppressive therapy (82,365,378,400).…”

Aspergillus Galactomannan Enzyme-Linked Immunosorbent Assay Cross-Reactivity Caused by Invasive Geotrichum capitatum

“…Culture supernatants of Trichophyton species, Botrytis species, Wallemia sebi, Cladosporium cladosporioides, Penicillium species, Paecilomyces variotii, Acremonium species, Alternaria species, and Fusarium species showed weak to strong reactivities with the sandwich ELISA (8,13,14), and very recently, Cryptococcus neoformans galactoxylomannan was also shown to be cross-reactive with Aspergillus galactomannan (4). On the other hand, only a few cases of non-Aspergillus fungal infections in whom the test for galactomannan was positive have been reported to date: two human immunodeficiency viruspositive patients, one with disseminated Penicillium marneffei infection and one with cryptococcosis (4,12), and one blood stem cell transplant patient with a Hickman intravenous line infection by Penicillium species (9).…”

“…The monoclonal antibody EB-A2, used both in the Pastorex Aspergillus latex agglutination test and in the Platelia Aspergillus assay, showed cross-reactivity with other fungi, bacteria, drugs, foods, and cotton swabs (3,8,(11)(12)(13)(14). The occurrence of false-positive results with the Aspergillus galactomannan detection test for patients receiving antibiotics, in particular piperacillin and amoxicillin either alone or combined with ␤-lactamase inhibitors, is a major drawback of this technique; as such, results may lead to a false diagnosis of probable or possible aspergillosis and unjustified antifungal therapy (3,11).…”

Positive Result of the Aspergillus Galactomannan Antigen Assay Using Bronchoalveolar Lavage Fluid from a Patient with an Invasive Infection Due to Lichtheimia ramosa

“…Positive galactomannan antigen (GM) test results with serum by the Platelia Aspergillus assay (Bio-Rad, Marnes-LaCoquette, France) have been reported to occur during invasive fungal infections caused by Penicillium marneffei (8), Cryptococcus neoformans (2), Geotrichum capitatum (3), or Histoplasma capsulatum (1,6,11). We report on a case of a positive GM result in bronchoalveolar lavage fluid (BAL fluid) in the clinical setting of a possibly invasive infection caused by Lichtheimia ramosa.…”