Pathogen Penicillium marneffei dimorphic fungus yeast like with

Pathogen : Penicillium marneffei dimorphic fungus yeast like with cross septum

Mode of transmission : respiratory infection disseminated : Wright stain or Giemsa stain yeast like with cross septum 3 µm )usually in macrophage (

Penicillium other than P. marneffei organ Lung Prosthetic endocarditic Infected CAPD Endophthalmitis Septicemia Esophagitis Upper respiratory infection Brain infection number 12 4 6 5 1 1 )Lyratzopaelos G , etal J infect 2002 ; 45 : 184 – 207 )

Hypersensitivity pneumonitis Cheese – worker lung Peat moss worker’ lung Salami worker’s lung Malt worker ‘s lung Farmer ‘s lung

Vienman 1956 : bamboo rat ( Rhizomys sinesis ) Khwase 1986 : Li , et al study 16 Rhizomys pruinosus 93. 1 % identified P. Marneffei 87. 5 % culture from lung 56. 3 % culture from liver 56. 3 % culture from spleen 50 % culture from abdominal lymph node

Mode of Transmission Respiratory - Skin ? ? - GI? ? -

Pathology 1. Granulomatous reaction : lymph mode 2. Suppurative form : microbuses 3. Anergic and necrotizing lesion : focal necrosis

Clinical manifestation of HIV infected patient with P. marneffei, Chiang mai university hospital Sign and symptom Sign fever skin lesion cough diarrhea Number (%) 74 (92. 5) 54 (67. 5) 39 (48. 7) 25 (31. 2)

Sign and Symptom Number (% ) : fever ≥ 38°C weight loss anemia jaundice oral candidiosis hairy lenkoplakia Patatal papules generalized lymphadenopathy hepatomegaly splenomegaly genital ular 79 (95) 61(76. 2 ) 62 (77. 5 ) 6 (7. 5) 79( 73. 7) 6 (7. 5) 3(3. 7) 46 (57. 5 Symptum

Renew of 155 reported case ( Duong TA. Clin Infect DIS 1996; 23: (25 -30) Clinical sign and symptom fever anemia weight loss Skin lesion Hemoculture lymphadenopathy Cough Hepatomegaly Diarrhea Splenomegaly Pericarditis Osteolytic lesions arthritis Number ( % ) 152(98) 116 (74. 8) 111 (71. 6) 108 (69. 7) 84 (54. 2) 81 (52. 3) 77 (49. 7) 68 (43. 9) 36(23. 2) 21 (13. 5) 7 (4. 5) 6 (3. 9) 6(3. 9)

Diagnostic smear u Skin scraping ( skin biopsy touch smear , bone marrow , lymph node biopsy touch smear u Wright’s stain u Oral yeast , 3 -5 micron u With septum ( binary fission )

80 Patients from Chiang Mai university hospital specimen Blood culture Skin culture Bone marrow culture Sputum culture Lymph node culture CSF Palatal papule scraping Liver biopsy culture Pleural fluid culture number 78 52 26 41 9 20 - positive %positive 59 47 26 14 9 3 3 1 1 1 75. 6 90. 4 100 34. 1 100 15 -

30 Sample from CMU , 1993 antifungal Fluconazole Itraconazole Ketoconazole Miconazole Amphotericin B 5 -Flucytosine number 30 28 29 29 MIC( µg/ml( Geometric mean 7. 937 0. 009 0. 027 0. 001 0. 976 0. 248 range 0. 313 -20. 0 <0. 0020. 19 <0. 0020. 078 <0. 0020. 156 0. 25 -4. 0 <0. 0150. 46

Treatment u Severe case : Amphotericin B 0. 6 mg /kg/day for 2 weeks Itraconazole 200 mg bid for 10 weeks. u Mild case : Itraconazole 200 mg bid for 10 week

Amphotericin B 1. 2. Amphotericin B Deoxycholate - drip with 5 % dextrose in water Lipid-complexed Amphotericin B - Ampho B colloidal dispersion ( Amphotec ) - Ampho B lipid complex ( Abelect ) - Liposomal Ampho B ( Ambisome )

Side effect of Amphotericin B : Acute infusion – related reaction - Fever , chill , tachypnea - not anaphylaxis

Side effect of Amphotericin B : Nephrotoxicity - dose dependent - loss K , Mg , bicarbonate - risk : combine with other nephrotoxic drug hypotension dehydration kidney disease

Side effect of Amphotericin B : other side effect nausea , vomiting thrombophlebitis anemia , thrombocytopenia , leucopenia