title: First observation in a non-endemic country (Togo) of Penicillium marneffei infection in a human immunodeficiency virus-infected patient: a case report.
abstract: BACKGROUND
  Infection 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).
  
  
  METHODS
  A 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.
  
  
  CONCLUSIONS
  We 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.
authors.forename: Akouda Akessiwe
authors.initials: AA
authors.lastname: Patassi
authors.forename: Bayaki
authors.initials: B
authors.lastname: Saka
authors.affiliation: Division de l'Epidémiologie, Ministère de la Santé, BP: 1396 Lomé, Togo. mlandoh@yahoo.fr.
authors.forename: Dadja Essoya
authors.initials: DE
authors.lastname: Landoh
authors.forename: Awerou
authors.initials: A
authors.lastname: Kotosso
authors.forename: Koudjo
authors.initials: K
authors.lastname: Mawu
authors.forename: Wemboo Afiwa
authors.initials: WA
authors.lastname: Halatoko
authors.forename: Majesté Ihou
authors.initials: MI
authors.lastname: Wateba
authors.forename: Komi
authors.initials: K
authors.lastname: Adjoh
authors.forename: Osseni
authors.initials: O
authors.lastname: Tidjani
authors.forename: Dominique
authors.initials: D
authors.lastname: Salmon
authors.forename: Palokinam
authors.initials: P
authors.lastname: Pitché
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009181:Mycoses / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D010407:Penicillium / Q000302:isolation & purification*; D014037:Togo / Q000453:epidemiology