2011.2-1.Penicillium

PENICILLIUM MARNEFFEI – AIDS DEFINING ILLNESS

Anaparthy Usharani, Bharathi M.

Corresponding author: Dr. Anaparthy Usharani    e-mail: usharani.anaparthy@gmail.com

How to cite an article: Anaparthy U, Bharathi M. Penicillium marneffei – AIDS defining illness. Our Dermatol Online 2011; 2(2): 58-60.

Abstract

Background: Penicillium marneffei infection is the emerging fungal infection in the present day global scenario of HIV pandemic. P. marneffei is a dimorphic fungi with mycelial growth at 37oC. Suspicion of P.marneffei infection arises when a immunocompromised individuals especially HIV positive persons present with Molluscum contagiosum like skin lesions. But pulmonary manifestations are not characteristic of P.marneffei infection unless we test the sputum for fungal growth in individuals with low CD4 counts ,we may miss P.marneffei respiratory infection. Material and methods: 100 sputum samples from HIV patients with cough were examined for fungal pathogens by inoculating the samples on SDA and incubated at 28oC. The samples with greenish yellow mycelial growth with diffusible red pigment were inoculated on blood agar and SDA and incubates at 37oC for conversion to yeast. Results: We isolated two cases of P.marneffei out of 100 samples. The CD4 counts of the cases were 33 and 84. Conclusions: Early diagnosis and treatment reduces the mortality P.marneffei HIV patients.

 

Key words:  infection; dimorphic; fungi; low CD4 counts

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Introduction

Penicillium marneffei is known to be endemic in S E Asia. It causes infections of RE system in humans in immunocompetent & more often in immunocompromised individuals especially in AIDS patients. As a result of recent increase of HIV infection P.marneffei has become one of the principal new emerging fungal pathogens. First human infection was reported in 1959 and caused by accidental puncture of finger by a needle used to inoculate hamsters in Segretain who had given the name P. marneffei. First spontaneous infection in humans was reported in 1973 in a splenic abscess case. Second case was reported in 1984 as a focal pulmonary infection. During the period of 1988-89 disseminated P. marneffei infection began to be observed in AIDS patients [1] and it is also included as an AIDS defining illness among patients who have lived or visited endemic areas. At present it is considered to be the third most frequent opportunistic pathogen after tuberculosis and cryptococcosis in endemic areas [2] .

 

Material and methods

Two consecutive sputum samples at an interval of 3 days were collected from HIV positive patients, whose CD4 cell counts are less than 500 /cumm, as shown in Table no. 1, with complaint of cough and fever for more than one week, in a sterile wide mouthed container. Patients were asked to wash their oral cavity with distilled water before collecting sputum in order to avoid contamination of sputum with commensal flora from oral cavity. Sputum was inoculated on two sets of Sabouraud’s dextrose agar (SDA with antibiotic gentamicin alone and SDA with gentamicin and cycloheximide) and incubated at 25oC +or – 2oC in BOD for 4 weeks. SDA bottles were examined for growth once in two days during 1st week and twice a week thereafter up to 4 weeks. SDA medium with growth was processed by standard methods. LPCB mount was done for filamentous growth. Growth was identified by arrangement of conidia. Slide cultures were done to demonstrate hyphal and conidial arrangement. When two samples yielded the same fungal isolates, then only they were considered as pathogenic. 

 

 

CD4 Count	Males	Females
< 100	6	0
101-200	13	2
201-300	15	13
301-400	20	7
401-500	13	11
	67	33

Table I. Showing CD4 counts

 

Results

P. marneffei is a dimorphic fungi. At 25oC on SDA grows as a mycelial fungus producing,rapidly growing greenish yellow sporulating colony with a red centre and dark green edges with diffusible brick red pigment (Fig.1). At 37oC on SDA it produces smooth glabrous off white yeast like growth with little pigment (fig. 2). Microscopically the fruiting heads sometimes have terminal conidia larger than the ones beneath them called Corda’s phenomenon, characteristic of P. marneffei (fig. 3). 

 

Figure 1. Growth of P.marneffei on SDA at 370 C glabrous off white yeast like growth

Figure 2. Growth of P.marneffei on SDA at 370 C glabrous off white yeast like growth

Figure 3. Photomicrograph of P.marneffei showing Corda’s phenomenon

 

Discussion

Clinical picture includes fever, lymphadenopathy. hepatosplenomegaly. leucocytosis, anaemia, persistent cough, molluscum contagiosum like lesions and disseminated infection. Pulmonary manifestations like cough, dyspnoea, occasionally chest pain .haemaptysis associated with pneumonia, pulmonary abscess or pulmonary infiltrates are seen. We isolated two cases of P.marneffei from HIV positive individuals with cough of more than one week duration who attended the ART centre, KGH,Visakhapatnam. The CD4 counts of the two individuals are 33 and 84 respectively. We got permission from Local Ethics Committee, Andhra Medical College, Visakhapatnam to conduct the study Annexure–I. Penicillium marneffei was isolated for the first time in and around Visakhapatnam. Bhagyabati Devi S. et al. isolated P.marneffei from sputum of HIV positive individuals whose CD4 counts were less than 100 (21.4% positivity) in Imphal [3]. P. marneffei is a potentially fatal disease in the absence of treatment as documented by a case fatality rate of 91.3% in immunocompetent individuals and 100% in AIDS patients. As Penicillosis is highly susceptible to Iatrakonazole, it can be used in the treatment as well as in secondary prophylaxis and also in primary prophylaxis [1].

 

Conclusions

So early diagnosis and timely treatment reduces the mortality from P. marneffei.

 

REFERENCES

1. Topley & Wilson’s. Medical Microbiology and Microbial Infections-Medical Mycology. 10th ed. Published by Hodder Arnold; 2005, 29: 561-72.

2. Jagdish Chander. Text book of Medical Mycology .3rd ed. Published by Mehtha publications; 2009, 23: 329.

3. Devi SB, Devi TS, Ningshen R, Devi KhR, Singh TB, Singh NB: Penicillium morneffei, an emerging AIDSrelated pathogen–a RIMS study. J Indian Med Assoc. 2009; 107: 208-210.