title: 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/microliter 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 lymph nodes. Fine needle aspirates of cervical and retroperitoneal lymph nodes, 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 lymph nodes gradually decreased in the CT scans, and the initial abdominal and back pain vanished.
authors.affiliation: Hygiene-Institut, Heidelberg, Germany. dagmar_rimek@med.uni-heidelberg.de
authors.forename: D
authors.initials: D
authors.lastname: Rimek
authors.forename: T
authors.initials: T
authors.lastname: Zimmermann
authors.forename: M
authors.initials: M
authors.lastname: Hartmann
authors.forename: C
authors.initials: C
authors.lastname: Prariyachatigul
authors.forename: R
authors.initials: R
authors.lastname: Kappe
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D003429:Cross Reactions; D004359:Drug Therapy, Combination; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D005437:Flucytosine / Q000627:therapeutic use; D005858:Germany; D006679:HIV Seropositivity / Q000150:complications*; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D009181:Mycoses / Q000209:etiology*; D010407:Penicillium; D013785:Thailand / Q000208:ethnology; D014195:Travel
chemical_list: D019380:Anti-HIV Agents; D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B; D015725:Fluconazole; D005437:Flucytosine