First observation in a non-endemic country (Togo) of Penicillium marneffei infection in a human immunodeficiency virus-infected patient: a case report

Abstract

BackgroundInfection with Penicillium marneffei is a common opportunistic infection in Southeast Asia where it is endemic. We report a case of Penicillium marneffei infection with fatal outcome in a Togolese woman infected with Human Immunodeficiency Virus (HIV).Case presentationA 45-years-old patient, infected with Human Immunodeficiency Virus had consulted for ongoing febrile pneumonia since two weeks. Clinical examination revealed fever of 38.5°C, dyspnea, pulmonary syndrome condensation and papulo-nodular of “molluscum contagiosum” like lesions located on the face, arms, neck and trunk. Sputum smear was negative for tuberculosis. The chest radiograph showed reticulonodular opacities in the right upper and middle lobes and two caves in the right hilar region. The CD4 count was 6 cells/mm3 after a year of antiretroviral treatment (Zidovudine-Lamivudine-Efavirenz). She was treated as smear negative pulmonary tuberculosis after a lack of gentamicin and amoxicillin plus clavulanic acid response. Culture of skin samples and sputum had revealed the presence of P. marneffei. A treatment with ketoconazole 600 mg per day was initiated. After two weeks of treatment, there was a decrease in the size and number of papules and nodules, without any new lesions. We noted disappearance of cough and fever. The chest X-ray showed a decrease of pulmonary lesions. There was no reactivation of P. marneffei infection but the patient died from AIDS after two years of follow up.ConclusionWe report a case of P. marneffei infection in a HIV-infected patient in a non-endemic country. Clinicians should think of P. marneffei infection in all HIV-infected patients with “molluscum contagiosum” like lesions.

Disseminated Penicillium marneffei infection recurrence in a non-acquired immune deficiency syndrome patient: A case report

“…Treatment options were intravenous amphotericin B (daily 0.6 mg/kg) for 2 weeks of treatment, followed by oral itraconazole (400 mg/day) maintenance therapy. To date, this patient with recurrent disease has not exhibited any recurrence (8).…”

Imported Talaromycosis in Oman in Advanced HIV: A Diagnostic Challenge Outside the Endemic Areas

“…Among HIV-infected patients with low CD4 counts, talaromycosis is an AIDS-defining diagnosis [20]. Additional cutaneous manifestations of translucent papular lesions, umbilicated with a central necrotic depression at the face and extremities characterizing talaromycosis [21], were also presented in our patient. Such lesions are similar to those observed in other fungal infections, particularly cryptococcosis and histoplasmosis, and were recently also reported from Emergomyces africanus infections [22, 23].…”

Re-drawing the Maps for Endemic Mycoses

“…Talaromycosis is a common, AIDS-defining opportunistic infection in South and Southeast Asia [ 265 – 273 ]. Talaromyces marneffei (formerly Penicillium marneffei ) is a soil dwelling fungus that causes disease in humans via inhalation or inoculation of conidia [ 270 ].…”

“…T. marneffei is endemic in southwest China (particularly Guangxi province) but seems to be increasing in much of mainland China with 668 cases reported between 1984 and 2009 [ 268 – 270 , 273 , 276 , 277 ]. Thailand, Hong Kong, northeastern India (particularly Assam and Manipur states), Taiwan, Laos, Cambodia, Malaysia, Myanmar, Indonesia and Vietnam are other endemic areas based on autochthonous case reports [ 266 , 268 – 271 , 273 , 278 – 287 ] (Table 4 ). In China, 8% of T. marneffei cases occur in healthy individuals; additionally, talaromycosis is an important presentation of adult-onset immunodeficiency syndrome, which is more common in Southeast Asia [ 288 ].…”