2011.2-1.Penicillium

                                                                                                                            article in PDF  
N Dermatol Online. 2011; 2(2): 58-60
Conflicts of interest: None
 

PENICILLIUM MARNEFFEI – AIDS DEFINING ILLNESS

PENICILLIUM MARNEFFEI – AIDS, DEFINICJA CHOROBY

Anaparthy Usharani, Bharathi M.

Dept. of Microbiology, Andhra Medical College, VisaKhapatnam-2, Andhra Pradesh, India
 

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


 

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.
 
Streszczenie
Wstęp: Infekcja Penicillium marneffei jest pojawiającym się zaka?eniem grzybiczym w obecnym, globalnym scenariuszu pandemii HIV. P. marneffei jest dymorficznym grzybem ze wzrostem grzybni w 37oC. Podejrzenie zaka?enia P.marneffei powstaje, gdy u osób z obni?oną odpornością, zwłaszcza HIV stwierdzimy obecność mięczaka zakaźnego, jako zmiany skórnej. Płucne objawy nie są charakterystyczne dla infekcji P.marneffei chyba, ?e test plwociny jest dodatni (dla wzrostu grzybów) u pacjentów z niskim mianem CD4; mo?emy przeoczyć wówczas infekcję P.marneffei w układzie oddechowym. Materiał i Metody: Zbadano 100 próbek plwociny od pacjentów zaka?onych HIV z towarzyszącym kaszlem; zbadano patogeny grzybicze poprzez zaszczepienie próbek na SDA i inkubację w temperaturze 28oC. Próbki z ?ółto-zielonkawym wzrostem grzybni z dyfuzyjnym, czerwonym barwnikiem zaszczepiono na krew, agar oraz SDA i inkubowano w temperaturze 37oC do konwersji na dro?d?ach. Wyniki: Stwierdziliśmy dwa przypadki izolowanych P. marneffei ze 100 próbek. Miano komórek CD4 w analizowanych przypadkach wynosiło 33 i 84. Wnioski: Wczesne rozpoznanie i leczenie zmniejsza śmiertelność z powodu infekcji P. marneffei u pacjentów z HIV.
 
Key words:  infection; dimorphic; fungi; low CD4 counts
Słowa klucze:  zaka?enia; dymorfizm; grzyby; niskie CD4 miano

 

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.


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