title: Penicilliosis in children without HIV infection--are they immunodeficient?
abstract: BACKGROUND
  Penicillium marneffei infection is indigenous to Southeast Asia. Majority of penicilliosis occurs in patients with AIDS, and less commonly with secondary immunodeficiencies. Penicilliosis is rare in otherwise healthy persons, but information on their immunological status is often lacking.
  
  
  METHODS
  From 1996 to 2009, we diagnosed penicilliosis in 5 children. Their clinical features, immunological findings, and genetic studies were analyzed. A systematic review of the English and Chinese literature was performed. Case reports/series on patients <18 years with penicilliosis were included, and patients stated to be human immunodeficiency virus (HIV)-positive excluded.
  
  
  RESULTS
  All of our 5 patients were HIV negative. Presentations included fungemia (n = 2), multifocal lymphadenopathy (n = 2), and necrotizing pneumonia (n = 1). Four patients had recurrent mucocutaneous candidiasis. Hyperimmunoglobin E syndrome was diagnosed in 1 patient, while another had functional defect in interleukin-12/interferon-γ axis. Three patients were lymphopenic with low natural killer cell counts, but a specific immune defect was not identified. Systematic review of 509 reports on human penicilliosis identified 32 patients aged 3 months to 16 years with no known HIV infection. Twenty-four patients (75%) had disseminated disease, and 55% died of penicilliosis. Eight patients had primary immunodeficiencies or blood disorders, while 4 others had abnormal immune functions. Immune evaluations of the remaining patients were unstated.
  
  
  CONCLUSIONS
  Penicilliosis is a severe disease causing high mortality in children. As an AIDS-defining illness, penicilliosis should be regarded as an indicator for underlying immunodeficiency in HIV-negative individuals. Immunological investigations should be performed, especially in those with recurrent infections. Multicentered collaborative studies are needed to collect information on long-term prognosis and define immune defects underlying penicilliosis.
authors: Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong.
authors: Pamela P W
authors: PP
authors: Lee
authors: Koon-Wing
authors: KW
authors: Chan
authors: Tsz-Leung
authors: TL
authors: Lee
authors: Marco Hok-Kung
authors: MH
authors: Ho
authors: Xiang-Yuan
authors: XY
authors: Chen
authors: Chak-Ho
authors: CH
authors: Li
authors: Kit-Man
authors: KM
authors: Chu
authors: Hua-Song
authors: HS
authors: Zeng
authors: Yu-Lung
authors: YL
authors: Lau
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000276:immunology / Q000382:microbiology*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017809:Fatal Outcome; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000382:microbiology*; D006801:Humans; D007121:Immunocompetence; D016867:Immunocompromised Host; D008206:Lymphatic Diseases / Q000382:microbiology / Q000821:virology; D009181:Mycoses / Q000276:immunology / Q000821:virology*; D010407:Penicillium / Q000302:isolation & purification*; D011014:Pneumonia / Q000382:microbiology