Epidemiology and clinical manifestations of Penicillium (Talaromyces) marneffei infection
- Khuanchai Supparatpinyo, MD
Khuanchai Supparatpinyo, MD
- Professor of Medicine
- Chiang Mai University
- Thira Sirisanthana, MD
Thira Sirisanthana, MD
- Professor of Medicine
- Chiang Mai University
Talaromyces marneffei (formerly Penicillium marneffei) causes a systemic fungal infection referred to as penicilliosis. Penicilliosis was commonly diagnosed in HIV-infected individuals from endemic areas prior to the era of potent antiretroviral therapy (ART), and was an important cause of morbidity and mortality. The widespread use of ART has led to a significant decline in T. marneffei infections among HIV-infected patients in these areas . However, penicilliosis continues to be seen in patients with AIDS (eg, those who are unaware of their HIV infection, who do not have access to ART, or who have suboptimal treatment responses to ART), as well as other immunocompromised individuals.
The mycology, epidemiology, and clinical manifestations of T. marneffei will be reviewed here. The diagnosis and treatment of this infection are discussed elsewhere. (See "Diagnosis and treatment of Penicillium (Talaromyces) marneffei infection".)
T. marneffei (formerly P. marneffei) was first isolated from the bamboo rat (Rhizomys sinensis) in Vietnam in 1956 . The first human case was reported in an American missionary with Hodgkin disease who had been living in Southeast Asia . Thereafter, rare cases of T. marneffei infection were reported, mostly from Southeast Asia and Southern China [4,5]. The first case of penicilliosis in an HIV-infected patient was reported in 1989 from Bangkok, coinciding with the beginning of the AIDS epidemic in the region . P. marneffei was renamed T. marneffei in 2015; however, the disease is still referred to as penicilliosis.
●T. marneffei grows as a mold at 25ºC on Sabouraud dextrose agar; over time, colonies produce a soluble red pigment that diffuses into the agar . Microscopically, the mycelia show septate hyphae with lateral and terminal conidiophores (picture 1).
- Le T, Wolbers M, Chi NH, et al. Epidemiology, seasonality, and predictors of outcome of AIDS-associated Penicillium marneffei infection in Ho Chi Minh City, Viet Nam. Clin Infect Dis 2011; 52:945.
- CAPPONI M, SEGRETAIN G, SUREAU P. [Penicillosis from Rhizomys sinensis]. Bull Soc Pathol Exot Filiales 1956; 49:418.
- DiSalvo AF, Fickling AM, Ajello L. Infection caused by Penicillium marneffei: description of first natural infection in man. Am J Clin Pathol 1973; 60:259.
- Jayanetra P, Nitiyanant P, Ajello L, et al. Penicilliosis marneffei in Thailand: report of five human cases. Am J Trop Med Hyg 1984; 33:637.
- Deng ZL, Yun M, Ajello L. Human penicilliosis marneffei and its relation to the bamboo rat (Rhizomys pruinosus). J Med Vet Mycol 1986; 24:383.
- Sathapatayavongs B, Damrongkitchaiporn S, Saengditha P, et al. Disseminated penicilliosis associated with HIV infection. J Infect 1989; 19:84.
- Woo PC, Zhen H, Cai JJ, et al. The mitochondrial genome of the thermal dimorphic fungus Penicillium marneffei is more closely related to those of molds than yeasts. FEBS Lett 2003; 555:469.
- Vanittanakom N, Vanittanakom P, Hay RJ. Rapid identification of Penicillium marneffei by PCR-based detection of specific sequences on the rRNA gene. J Clin Microbiol 2002; 40:1739.
- Supparatpinyo K, Khamwan C, Baosoung V, et al. Disseminated Penicillium marneffei infection in southeast Asia. Lancet 1994; 344:110.
- Walsh TJ, Groll A, Hiemenz J, et al. Infections due to emerging and uncommon medically important fungal pathogens. Clin Microbiol Infect 2004; 10 Suppl 1:48.
- Chan YH, Wong KM, Lee KC, et al. Pneumonia and mesenteric lymphadenopathy caused by disseminated Penicillium marneffei infection in a cadaveric renal transplant recipient. Transpl Infect Dis 2004; 6:28.
- Wong SS, Wong KH, Hui WT, et al. Differences in clinical and laboratory diagnostic characteristics of penicilliosis marneffei in human immunodeficiency virus (HIV)- and non-HIV-infected patients. J Clin Microbiol 2001; 39:4535.
- Clezy K, Sirisanthana T, Sirisanthana V, et al. Late manifestations of HIV in Asia and the Pacific. AIDS 1994; 8 Suppl 2:S35.
- Tsang DN, Chan JK, Lau YT, et al. Penicillium marneffei infection: an underdiagnosed disease? Histopathology 1988; 13:311.
- Chariyalertsak S, Supparatpinyo K, Sirisanthana T, Nelson KE. A controlled trial of itraconazole as primary prophylaxis for systemic fungal infections in patients with advanced human immunodeficiency virus infection in Thailand. Clin Infect Dis 2002; 34:277.
- Kawila R, Chaiwarith R, Supparatpinyo K. Clinical and laboratory characteristics of penicilliosis marneffei among patients with and without HIV infection in Northern Thailand: a retrospective study. BMC Infect Dis 2013; 13:464.
- Browne SK, Burbelo PD, Chetchotisakd P, et al. Adult-onset immunodeficiency in Thailand and Taiwan. N Engl J Med 2012; 367:725.
- Deng Z, Ribas JL, Gibson DW, Connor DH. Infections caused by Penicillium marneffei in China and Southeast Asia: review of eighteen published cases and report of four more Chinese cases. Rev Infect Dis 1988; 10:640.
- Duong TA. Infection due to Penicillium marneffei, an emerging pathogen: review of 155 reported cases. Clin Infect Dis 1996; 23:125.
- Singh PN, Ranjana K, Singh YI, et al. Indigenous disseminated Penicillium marneffei infection in the state of Manipur, India: report of four autochthonous cases. J Clin Microbiol 1999; 37:2699.
- Louthrenoo W, Thamprasert K, Sirisanthana T. Osteoarticular penicilliosis marneffei. A report of eight cases and review of the literature. Br J Rheumatol 1994; 33:1145.
- Ranjana KH, Priyokumar K, Singh TJ, et al. Disseminated Penicillium marneffei infection among HIV-infected patients in Manipur state, India. J Infect 2002; 45:268.
- Vanittanakom N, Sirisanthana T. Penicillium marneffei infection in patients infected with human immunodeficiency virus. Curr Top Med Mycol 1997; 8:35.
- Chariyalertsak S, Sirisanthana T, Saengwonloey O, Nelson KE. Clinical presentation and risk behaviors of patients with acquired immunodeficiency syndrome in Thailand, 1994--1998: regional variation and temporal trends. Clin Infect Dis 2001; 32:955.
- Huynh TX, Nguyen HC, Dinh Nguyen HM, et al. [Penicillium marneffei infection and AIDS. A review of 12 cases reported in the Tropical Diseases Centre, Ho Chi Minh City (Vietnam)]. Sante 2003; 13:149.
- Gugnani H, Fisher MC, Paliwal-Johsi A, et al. Role of Cannomys badius as a natural animal host of Penicillium marneffei in India. J Clin Microbiol 2004; 42:5070.
- Corbet GB, Hill JE. Subfamily Rhizomyinae: bamboo rats. In: The Mammals of the Indo Malaya Region: A Systematic Review, Oxford University Press, Oxford, UK 1992. p.404.
- Chariyalertsak S, Sirisanthana T, Supparatpinyo K, Nelson KE. Seasonal variation of disseminated Penicillium marneffei infections in northern Thailand: a clue to the reservoir? J Infect Dis 1996; 173:1490.
- Chariyalertsak S, Sirisanthana T, Supparatpinyo K, et al. Case-control study of risk factors for Penicillium marneffei infection in human immunodeficiency virus-infected patients in northern Thailand. Clin Infect Dis 1997; 24:1080.
- Chariyalertsak S, Vanittanakom P, Nelson KE, et al. Rhizomys sumatrensis and Cannomys badius, new natural animal hosts of Penicillium marneffei. J Med Vet Mycol 1996; 34:105.
- Hilmarsdottir I, Coutellier A, Elbaz J, et al. A French case of laboratory-acquired disseminated Penicillium marneffei infection in a patient with AIDS. Clin Infect Dis 1994; 19:357.
- SEGRETAIN G. [Penicillium marneffei n.sp., agent of a mycosis of the reticuloendothelial system]. Mycopathol Mycol Appl 1959; 11:327.
- Vanittanakom N, Mekaprateep M, Sittisombut N, et al. Western immunoblot analysis of protein antigens of Penicillium marneffei. J Med Vet Mycol 1997; 35:123.
- Jones PD, See J. Penicillium marneffei infection in patients infected with human immunodeficiency virus: late presentation in an area of nonendemicity. Clin Infect Dis 1992; 15:744.
- Sirisanthana V, Sirisanthana T. Disseminated Penicillium marneffei infection in human immunodeficiency virus-infected children. Pediatr Infect Dis J 1995; 14:935.
- Kantipong P, Panich V, Pongsurachet V, Watt G. Hepatic penicilliosis in patients without skin lesions. Clin Infect Dis 1998; 26:1215.
- Ukarapol N, Sirisanthana V, Wongsawasdi L. Penicillium marneffei mesenteric lymphadenitis in human immunodeficiency virus-infected children. J Med Assoc Thai 1998; 81:637.
- McShane H, Tang CM, Conlon CP. Disseminated Penicillium marneffei infection presenting as a right upper lobe mass in an HIV positive patient. Thorax 1998; 53:905.
- Cheng NC, Wong WW, Fung CP, Liu CY. Unusual pulmonary manifestations of disseminated Penicillium marneffei infection in three AIDS patients. Med Mycol 1998; 36:429.
- Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf (Accessed on September 21, 2016).
- Tong AC, Wong M, Smith NJ. Penicillium marneffei infection presenting as oral ulcerations in a patient infected with human immunodeficiency virus. J Oral Maxillofac Surg 2001; 59:953.
- Kronauer CM, Schär G, Barben M, Bühler H. [HIV-associated Penicillium marneffei infection]. Schweiz Med Wochenschr 1993; 123:385.
- Leung R, Sung JY, Chow J, Lai CK. Unusual cause of fever and diarrhea in a patient with AIDS. Penicillium marneffei infection. Dig Dis Sci 1996; 41:1212.
- Le T, Huu Chi N, Kim Cuc NT, et al. AIDS-associated Penicillium marneffei infection of the central nervous system. Clin Infect Dis 2010; 51:1458.