Clinical presentations and outcomes of Penicillium marneffei infections: a series from 1994 to 2004.
OBJECTIVE
To describe the clinical presentation, management, and outcomes of patients with Penicillium marneffei infections in a regional hospital in Hong Kong.


METHODS
Retrospective study.


METHODS
A regional and tertiary human immunodeficiency virus-referral hospital in Hong Kong.


METHODS
Those who had penicilliosis during the inclusive period January 1994 to February 2004.


RESULTS
Forty-seven immunocompromised patients (44 being human immunodeficiency virus-positive) with penicilliosis were retrospectively studied. Fever, malaise, and anaemia were the commonest presentations. Most diagnoses were obtained from blood cultures (83%) and lymph node biopsies (34%). Five (11%) died, death being attributable to penicilliosis; four (9%) of them had received no specific antifungal treatment due to late presentation and late diagnosis. The CD4 count of human immunodeficiency virus-infected patients upon diagnosis of penicilliosis was low (median, 20.0 cells/mm3). Most (70%) patients received amphotericin B as an induction treatment, followed by oral itraconazole, although a smaller proportion (21%) received oral itraconazole only. All surviving human immunodeficiency virus-infected patients took highly active antiretroviral treatment and oral itraconazole as secondary prophylaxis after treatment of penicilliosis. The prognosis appeared satisfactory with early diagnosis and administration of appropriate antifungal therapy. Relapse ensued in two (4%) of the patients only.


CONCLUSIONS
Penicillium marneffei infection in immunocompromised patients is a serious disease with significant mortality if not diagnosed early and treated with appropriate antifungal drugs. Simple investigations like blood culture enable the diagnosis in the majority of cases. Immunocompromised patients who have been successfully treated should receive oral itraconazole as a maintenance therapy to prevent relapse.
Wu
T C
TC
Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong. tcwuqeh@hotmail.com
Chan
Johnny W M
JW
Ng
C K
CK
Tsang
Dominic N C
DN
Lee
M P
MP
Li
Patrick C K
PC
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D000284:Administration, Oral; D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D023241:Antiretroviral Therapy, Highly Active; D003881:Dermatomycoses / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D016469:Fungemia / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D006723:Hong Kong; D006801:Humans; D007262:Infusions, Intravenous; D017964:Itraconazole / Q000008:administration & dosage; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D010407:Penicillium; D012189:Retrospective Studies; D015996:Survival Rate
D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B