Presentation
We describe a unique presentation of systemic P. marneffei infection in an immunocompetent host presenting with an endobronchial tumour-like lesion and post-obstructive pneumonia. [erj.ersjournals.com]
Here we present a very rarely reported case of Talaromyces marneffei infection in an apparent non-immunosuppressed patient presenting decades later in a non-endemic setting (United States). [ncbi.nlm.nih.gov]
Extensive investigation revealedP marneffei as the sole cause of his presenting symptoms and signs. [thorax.bmj.com]
Fever, malaise, and anaemia were the commonest presentations. Most diagnoses were obtained from blood cultures (83%) and lymph node biopsies (34%). [hkmj.org]
Fever and weight loss are the most common first clinical manifestations, present in up to 95% of cases. Sometimes, prolonged fever is the only presenting symptom. [scielo.br]
Immune System
- Splenomegaly
Presentation is usually with fever, chills, lymphadenopathy, hepatomegaly, and splenomegaly, with skin lesions—most commonly papules with central necrotic umbilication—in two-thirds of cases. [oxfordmedicine.com]
Subcutaneous and mucosal lesions, diarrhea, colonic lesions, hepatomegaly with or without splenomegaly, hemoptysis, osteoarticular lesions, and pericarditis have also been described. [medcraveonline.com]
Symptom P (%) Hemoptysis 4 Neutropenia 12 Abdominal pain 15 Diarrhea 15 Arthritis 16 Splenomegaly 19 Hepatomegaly 23 Dyspnea 33 Weight loss 34 Fungemia 43 Anemia 47 Malaise 48 Cough 50 Lymphadenopathy 50 Cutaneous or subcutaneous lesions 53 Thrombocytosis [ncbi.nlm.nih.gov]
The average duration of symptoms prior to presentation is 4 weeks.(1,2) Other common manifestations include skin lesions, anemia, lymphadenopathy, and hepatomegaly with or without splenomegaly. [hivinsite.ucsf.edu]
Thailand, Sirisanthana et al. reported that 96 percent of patients presented with both fever and weight loss, 85 percent with skin lesions, 84 percent with generalized lymphadenopathy, 65 percent with hepatomegaly, 31 percent with cough, 23 percent with splenomegaly [escholarship.org]
- Generalized Lymphadenopathy
Other clinical manifestations are less specific, i.e., fever, weight loss, nonproductive cough, hepatosplenomegaly and generalized lymphadenopathy. [ijidonline.com]
Fungemia, generalized lymphadenopathy and cough are also reported in many of patients. [medcraveonline.com]
lymphadenopathy, and 22 percent with diarrhea [3]. [escholarship.org]
The average duration of symptoms prior to presentation is 4 weeks.(1,2) Other common manifestations include skin lesions, anemia, lymphadenopathy, and hepatomegaly with or without splenomegaly. [hivinsite.ucsf.edu]
Generalized lymphadenopathy and hepatomegaly were present in more than 60 to 80% of cases20. In both HIV-positive and HIV-negative patients the respiratory system is the most common organ affected at presentation5,19. [scielo.br]
- Mediastinal Lymphadenopathy
Computed tomography demonstrated resolution of cervical lymphadenopathy but interval development of pulmonary infiltrates and mediastinal lymphadenopathy (fig. 1). [erj.ersjournals.com]
[…] infiltrates and mediastinal lymphadenopathy Fiberoptic bronchoscopy; histopathological analysis and culture First, he was treated empirically with TMP sulfamethoxazole. [ncbi.nlm.nih.gov]
- Cervical Lymphadenopathy
Computed tomography demonstrated resolution of cervical lymphadenopathy but interval development of pulmonary infiltrates and mediastinal lymphadenopathy (fig. 1). [erj.ersjournals.com]
Entire Body System
- Fever
He eventually re-presented with dry cough, recurrent fevers and left sided pleuritic chest pain. [erj.ersjournals.com]
A 43-year-old man from Assam presented with low-grade fever, weight loss and skin lesions. He had not previously been tested for HIV antibody or virus. [jpgmonline.com]
Abstract A 35 year old HIV positive patient from Hong Kong presented with a fever, cough and a skin rash in association with a lung mass, all of which were due to disseminated Penicillium marneffeiinfection. [thorax.bmj.com]
The presence of fever, pulmonary infiltrates, and the characteristic skin lesions would make the diagnosis very likely. [aids.gov.hk]
Presentation is usually with fever, chills, lymphadenopathy, hepatomegaly, and splenomegaly, with skin lesions—most commonly papules with central necrotic umbilication—in two-thirds of cases. [oxfordmedicine.com]
- Lymphadenopathy
Computed tomography demonstrated resolution of cervical lymphadenopathy but interval development of pulmonary infiltrates and mediastinal lymphadenopathy (fig. 1). [erj.ersjournals.com]
Chronic lymphadenopathy caused by Penicillium marneffei: a condition mimicking tuberculous lymphadenopathy. Br J Surg 1986; 73: 1007-1008. Google Scholar | Crossref | Medline | ISI Deng Z. et al. [journals.sagepub.com]
Presentation is usually with fever, chills, lymphadenopathy, hepatomegaly, and splenomegaly, with skin lesions—most commonly papules with central necrotic umbilication—in two-thirds of cases. [oxfordmedicine.com]
[…] infiltrates and mediastinal lymphadenopathy Fiberoptic bronchoscopy; histopathological analysis and culture First, he was treated empirically with TMP sulfamethoxazole. [ncbi.nlm.nih.gov]
The most common specific symptoms were sore throat, pharyngeal and laryngeal lump, hoarseness, mucosal ulceration and multiple cervical and armpit lymphadenopathies. [journal.chestnet.org]
- Weight Loss
A 43-year-old man from Assam presented with low-grade fever, weight loss and skin lesions. He had not previously been tested for HIV antibody or virus. [jpgmonline.com]
The most common presenting symptoms and signs were fever (92%), anaemia (77%), weight loss (76%), and skin lesions (71%). 87% of patients presenting with skin lesions had generalised papules with central umbilication. [thelancet.com]
RESULTS: The most common nonspecific symptoms were fever, malaise, weight loss and anemia. [journal.chestnet.org]
Other clinical manifestations are less specific, i.e., fever, weight loss, nonproductive cough, hepatosplenomegaly and generalized lymphadenopathy. [ijidonline.com]
The clinical presentation usually involves the respiratory system and the skin, besides general symptoms like fever and weight loss. [scielo.br]
- Anemia
RESULTS: The most common nonspecific symptoms were fever, malaise, weight loss and anemia. [journal.chestnet.org]
The average duration of symptoms prior to presentation is 4 weeks.(1,2) Other common manifestations include skin lesions, anemia, lymphadenopathy, and hepatomegaly with or without splenomegaly. [hivinsite.ucsf.edu]
The most common clinical features include fever, weight loss, and anemia. The organism has been isolated most commonly from skin, blood, and bone marrow. [pubmed.ncbi.nlm.nih.gov]
Ten months after trip to Vietnam: several weeks’ history of wheezing, reduce exercise tolerance, headache, fever, weight loss, anemia, leukopenia • Chest x-ray: mild peri-bronchial thickening in the retrocardiac area BAL, blood cultures, and lymph node [ncbi.nlm.nih.gov]
- Malaise
After transient improvement, there was recurrence of productive cough, night sweats, malaise, and new hemoptysis. [ncbi.nlm.nih.gov]
Fever, malaise, and anaemia were the commonest presentations. Most diagnoses were obtained from blood cultures (83%) and lymph node biopsies (34%). [hkmj.org]
RESULTS: The most common nonspecific symptoms were fever, malaise, weight loss and anemia. [journal.chestnet.org]
Other characteristics are malaise, anemia and leukocytosis. Fungemia, generalized lymphadenopathy and cough are also reported in many of patients. [medcraveonline.com]
However, in Hong Kong, although fever and malaise were seen in more than 90 percent of their 47 patients with Penicillium marneffei infection, only 28 percent presented with skin lesions [6]. [escholarship.org]
Respiratoric
- Cough
After transient improvement, there was recurrence of productive cough, night sweats, malaise, and new hemoptysis. [ncbi.nlm.nih.gov]
He eventually re-presented with dry cough, recurrent fevers and left sided pleuritic chest pain. [erj.ersjournals.com]
Abstract A 35 year old HIV positive patient from Hong Kong presented with a fever, cough and a skin rash in association with a lung mass, all of which were due to disseminated Penicillium marneffeiinfection. [thorax.bmj.com]
We noted disappearance of cough and fever. The chest X-ray showed a decrease of pulmonary lesions. [bmcresnotes.biomedcentral.com]
A 36‑year‑old patient attended our hospital as a result of intermittent fever, cough, shortness of breath and multiple soft lesions located on the face, arms, neck and trunk. [spandidos-publications.com]
- Pleural Effusion
During this course of in-patient treatment, the patient developed both pericardial and pleural effusions. These were drained percutaneously, were inflammatory in nature and did not demonstrate Penicillium on culture. [erj.ersjournals.com]
A second chest CT showed increase in the size of the LLL cavitary infiltrate, a new small necrotizing lesion in the left lung, and a new small left pleural effusion. [ncbi.nlm.nih.gov]
A single case of a pleural effusion due toP marneffei has also been reported. Ours is the first description of a solid lung mass and an endotracheal lesion in this condition. [thorax.bmj.com]
Radiographic appearance of the lungs is variable, ranging from diffuse or localised reticular, reticulonodular, alveolar infiltration, cavitary lesion, interstitial pneumonia, lung nodules, and pleural effusion. [aids.gov.hk]
Lancet. 1997; 349: 1598 Scopus (13) PubMed Abstract Full Text Full Text PDF Google Scholar Fenech F Pleural effusion caused by Penicillium lilanicum. [journalofinfection.com]
- Dry Cough
He eventually re-presented with dry cough, recurrent fevers and left sided pleuritic chest pain. [erj.ersjournals.com]
Gastrointestinal
- Diarrhea
The bumps usually appear on the face and neck but can also appear in other places on the body. 2,3 Other symptoms include: 3,5,6 Fever General discomfort Weight loss Cough Swollen lymph nodes Difficulty breathing Swelling of the liver and spleen Diarrhea [cdc.gov]
Hart [6] Six weeks later: he presented with a 3-week history of abdominal pain and diarrhea, with 2 days acute severe lower abdominal pain which progressed to septic shock Laparotomy: perforated sigmoid colon diverticulum and intraperitoneal pus. [ncbi.nlm.nih.gov]
A 42-year-old male patient visited the emergency room of our hospital in November 2013 with fever, sore throat, and diarrhea. He was a known seropositive patient for HIV and syphilis and a frequent traveler to Guangxi, China, and Hong Kong. [jcytol.org]
Subcutaneous and mucosal lesions, diarrhea, colonic lesions, hepatomegaly with or without splenomegaly, hemoptysis, osteoarticular lesions, and pericarditis have also been described. [medcraveonline.com]
[…] that 96 percent of patients presented with both fever and weight loss, 85 percent with skin lesions, 84 percent with generalized lymphadenopathy, 65 percent with hepatomegaly, 31 percent with cough, 23 percent with splenomegaly, and 15 percent with diarrhea [escholarship.org]
- Abdominal Pain
Hart [6] Six weeks later: he presented with a 3-week history of abdominal pain and diarrhea, with 2 days acute severe lower abdominal pain which progressed to septic shock Laparotomy: perforated sigmoid colon diverticulum and intraperitoneal pus. [ncbi.nlm.nih.gov]
pain Talaromycosis may affect people living with HIV differently than people who do not have HIV. [cdc.gov]
Cardiovascular
- Chest Pain
He eventually re-presented with dry cough, recurrent fevers and left sided pleuritic chest pain. [erj.ersjournals.com]
Marneffei Treatment Outcome Reference 1 Male/45 Australia Laos, Vietnam (recent travel; not specified how long ago before initial symptoms None Fever, lymphadenopathy, night sweats, cough, left sided pleuritic chest pain (4-month history) CT: pulmonary [ncbi.nlm.nih.gov]
They noted that patients without HIV have longer disease duration, higher misdiagnosis rate, more underlying diseases, and a higher rate of generalized lympadenopathy, body aches, and chest pain. [escholarship.org]
Liver, Gall & Pancreas
- Hepatosplenomegaly
A patient who presented with autoimmune haemolytic anaemia and hepatosplenomegaly, and was subsequently found to be suffering from disseminated Penicillium marneffei infection, is reported. [experts.mcmaster.ca]
Hepatosplenomegaly, lung and bone involvement are other features of disseminated penicilliosis. Diagnosis is confirmed by fungal culture or histopathology. [jpgmonline.com]
Other clinical manifestations are less specific, i.e., fever, weight loss, nonproductive cough, hepatosplenomegaly and generalized lymphadenopathy. [ijidonline.com]
It is recognised as an emerging infection among HIV-infected patients in South East Asia, where it typically presents as cutaneous lesions, fever, lymphadenopathy and hepatosplenomegaly [2]. [erj.ersjournals.com]
Fever, weight loss, anemia, lymphadenopathy, hepatosplenomegaly, respiratory signs and skin lesions were the common clinical manifestations of P. marneffei infections. [pubmed.ncbi.nlm.nih.gov]
- Hepatomegaly
Presentation is usually with fever, chills, lymphadenopathy, hepatomegaly, and splenomegaly, with skin lesions—most commonly papules with central necrotic umbilication—in two-thirds of cases. [oxfordmedicine.com]
The average duration of symptoms prior to presentation is 4 weeks.(1,2) Other common manifestations include skin lesions, anemia, lymphadenopathy, and hepatomegaly with or without splenomegaly. [hivinsite.ucsf.edu]
Subcutaneous and mucosal lesions, diarrhea, colonic lesions, hepatomegaly with or without splenomegaly, hemoptysis, osteoarticular lesions, and pericarditis have also been described. [medcraveonline.com]
Symptom P (%) Hemoptysis 4 Neutropenia 12 Abdominal pain 15 Diarrhea 15 Arthritis 16 Splenomegaly 19 Hepatomegaly 23 Dyspnea 33 Weight loss 34 Fungemia 43 Anemia 47 Malaise 48 Cough 50 Lymphadenopathy 50 Cutaneous or subcutaneous lesions 53 Thrombocytosis [ncbi.nlm.nih.gov]
Generalized lymphadenopathy and hepatomegaly were present in more than 60 to 80% of cases20. In both HIV-positive and HIV-negative patients the respiratory system is the most common organ affected at presentation5,19. [scielo.br]
Musculoskeletal
- Arthritis
Symptom P (%) Hemoptysis 4 Neutropenia 12 Abdominal pain 15 Diarrhea 15 Arthritis 16 Splenomegaly 19 Hepatomegaly 23 Dyspnea 33 Weight loss 34 Fungemia 43 Anemia 47 Malaise 48 Cough 50 Lymphadenopathy 50 Cutaneous or subcutaneous lesions 53 Thrombocytosis [ncbi.nlm.nih.gov]
Skin
- Skin Lesion
The presence of skin lesions may sometimes be suggestive of the diagnosis. [aids.gov.hk]
A high index of suspicion in the presence of typical skin lesions can lead to early diagnosis. A 43-year-old man from Assam presented with low-grade fever, weight loss and skin lesions. He had not previously been tested for HIV antibody or virus. [jpgmonline.com]
lesions on multiple sites. [ijpmonline.org]
His skin lesions began to regress and his chest symptoms resolved within a week of starting treatment. Six months later his skin was clear and the chest radiograph was normal except for a small residual right upper lobe opacity. [thorax.bmj.com]
The most common presenting symptoms and signs were fever (92%), anaemia (77%), weight loss (76%), and skin lesions (71%). 87% of patients presenting with skin lesions had generalised papules with central umbilication. [thelancet.com]
- Sweating
After transient improvement, there was recurrence of productive cough, night sweats, malaise, and new hemoptysis. [ncbi.nlm.nih.gov]
The patient described a 4-month history of intermittent drenching night sweats, cough and posterior cervical lymphadenopathy against a background of a recent bicycle tour of Laos and Vietnam. [erj.ersjournals.com]
- Night Sweats
After transient improvement, there was recurrence of productive cough, night sweats, malaise, and new hemoptysis. [ncbi.nlm.nih.gov]
The patient described a 4-month history of intermittent drenching night sweats, cough and posterior cervical lymphadenopathy against a background of a recent bicycle tour of Laos and Vietnam. [erj.ersjournals.com]
Workup
An extensive workup for an immunosuppressive state was nondiagnostic; HIV testing was repeatedly negative, including HIV viral load. [ncbi.nlm.nih.gov]
X-Ray
- Pulmonary Infiltrate
A 45-yr-old, previously well male was referred to our hospital for further investigation of fevers, lymphadenopathy and pulmonary infiltrates. [erj.ersjournals.com]
The presence of fever, pulmonary infiltrates, and the characteristic skin lesions would make the diagnosis very likely. [aids.gov.hk]
Typically, penicilliosis presents as a subacute febrile illness with pulmonary infiltration and characteristic umbilicated skin lesions resembling those of molluscum contagiosum, as in the presently described case. [3] The tissue reaction observed in [ijpmonline.org]
[…] the pulmonary lesion. [ncbi.nlm.nih.gov]
Microbiology
- Penicillium
Thus, the patient was diagnosed with AIDS combined with Penicillium marneffei infection, which, to the best of our knowledge, is the first report of Penicillium marneffei infection in Shaanxi Province, China. [jidc.org]
The necropsy and final microbiologic analyses disclosed infection by Penicillium sp. There are thousands of fungal species of the Penicillium genera. [scielo.br]
Infection caused by Penicillium marneffei: description of first natural infection in man. Am J Clin Pathol 1973; 60:259-63. 18. Deng ZL, Connor DH. Progressive disseminated penicilliosis caused by Penicillium marneffei. [hivinsite.ucsf.edu]
Disseminated Penicillium marneffei infection among HIV-infected patients in Manipur state India. J Infect 2002;45:268-71. 2. Cooper CR Jr, McGinnis MR. Pathology of Penicillium marneffei. [jpgmonline.com]
A case report of Penicillium marneffei infection [in Chinese]. Chinese Journal of Nosocomiology. 2004; 14(2): 229–231. [29] Lu Zhaohui, Liu Hongrui, Xie Xiuli, Wang Aixia, Liu Honghua. Penicillium marneffei infection [in Chinese]. [link.springer.com]
Pleura
- Pleural Effusion
During this course of in-patient treatment, the patient developed both pericardial and pleural effusions. These were drained percutaneously, were inflammatory in nature and did not demonstrate Penicillium on culture. [erj.ersjournals.com]
A second chest CT showed increase in the size of the LLL cavitary infiltrate, a new small necrotizing lesion in the left lung, and a new small left pleural effusion. [ncbi.nlm.nih.gov]
A single case of a pleural effusion due toP marneffei has also been reported. Ours is the first description of a solid lung mass and an endotracheal lesion in this condition. [thorax.bmj.com]
Radiographic appearance of the lungs is variable, ranging from diffuse or localised reticular, reticulonodular, alveolar infiltration, cavitary lesion, interstitial pneumonia, lung nodules, and pleural effusion. [aids.gov.hk]
Lancet. 1997; 349: 1598 Scopus (13) PubMed Abstract Full Text Full Text PDF Google Scholar Fenech F Pleural effusion caused by Penicillium lilanicum. [journalofinfection.com]
Treatment
To date, no cases of P. marneffei infection relapse following treatment have been reported. [spandidos-publications.com]
[…] for treatment and for the prevention of relapse. [nejm.org]
(2) Even with treatment, mortality is approximately 20%. [hivinsite.ucsf.edu]
This regimen has been widely used in the treatment of HIV-infected patients and, in our case, led to significant clinical improvement. Cases of penicilliosis in non-HIV-infected patients are rare. [erj.ersjournals.com]
All surviving human immunodeficiency virus–infected patients took highly active antiretroviral treatment and oral itraconazole as secondary prophylaxis after treatment of penicilliosis. [hkmj.org]
Prognosis
The prognosis appeared satisfactory with early diagnosis and administration of appropriate antifungal therapy. Relapse ensued in two (4%) of the patients only. CONCLUSION. [hkmj.org]
We analyzed epidemiological and clinical features, laboratory findings, reaction to therapy and prognosis of the disease. [pubmed.ncbi.nlm.nih.gov]
When patients with penicilliosis/AIDS were diagnosed early and treated with standardized antifungal therapy and combined antiretroviral therapy, their prognosis improved. [journals.plos.org]
[…] most common presentation is a disseminated infection manifested by fever, skin lesions, anemia, generalized lymphadenopathy, and hepatomegaly.(2) Localized infection such as pneumonia also has been reported.(7) Patients with penicilliosis have a poor prognosis [hivinsite.ucsf.edu]
[…] without treatment.2 Although treatment with antifungal agents has improved the prognosis, the mortality rate from disseminated P. marneffei infection in patients with AIDS is still about 20 percent.16 In a study from Chiang Mai, the rate of relapse of [nejm.org]
Etiology
2010/53/2/361/64350 Penicillium marneffei, the only dimorphic species of the genus Penicillium is the etiological agent of a potentially life-threatening opportunistic fungal infection in human immunodeficiency virus (HIV)-infected and other immunocompromised [ijpmonline.org]
Human population may be adversely affected due to environmental contamination and these fungi traditionally have not been considered as very pathogenic and rarely are they implicated as etiological agent in a healthy human. [medcraveonline.com]
Bronchoscopy with bronchoalveolar lavage (BAL) yielded no specific etiology and he was treated symptomatically. After transient improvement, there was recurrence of productive cough, night sweats, malaise, and new hemoptysis. [ncbi.nlm.nih.gov]
Am J Ophthalmol. 1985; 100: 408-410 Scopus (14) PubMed Abstract Full Text PDF Google Scholar Theodore FH Etiology and diagnosis of fungal postoperative endophthalmitis. [journalofinfection.com]
Epidemiology
Public Health and Epidemiology Bulletin 2002;11:41-9. Sirisanthana T, Supparatpinyo K. Epidemiology and management of penicilliosis in human immunodeficiency virus-infected patients. Int J Infect Dis 1998;3:48-53. [aids.gov.hk]
An epidemiologic link to an area of endemicity of the two fungi can also help in the diagnosis. [jcytol.org]
Epidemiology and management of penicilliosis in human immunodeficiency virus-infected patients. Int J Infect Dis 1998;3:48-53. [PUBMED] 2. Vanittanakom N, Cooper CR Jr, Fisher MC, Sirisanthana T. [ijpmonline.org]
JP Latgé presented his first medical research theme, focused on the study of invasive aspergillosis (diagnosis, epidemiology and pathophysiology). [normalesup.org]
This change in epidemiology poses a diagnostic challenge. As a result, there may be delays initiating therapy which may result in disease progression and poor outcomes [[7], [8]]. [ncbi.nlm.nih.gov]
Pathophysiology
JP Latgé presented his first medical research theme, focused on the study of invasive aspergillosis (diagnosis, epidemiology and pathophysiology). [normalesup.org]
Prevention
Dongli Liu Institute of Pathogenic Microorganisms, Shaanxi Provincial Center for Disease Control and Prevention, Xi’an, China Lin Ma Institute of Pathogenic Microorganisms, Shaanxi Provincial Center for Disease Control and Prevention, Xi’an, China Lingfeng [jidc.org]
A healthcare provider might prescribe medicine to prevent talaromycosis for people who have a condition that weakens their immune system and who live in places where the fungus is present. 3 Itraconazole is the most commonly used medicine to prevent talaromycosis [cdc.gov]
Primary prophylaxis can prevent the occurrence of penicilliosis. [hivinsite.ucsf.edu]
We therefore believe that prevention of relapse is a better strategy than treatment of patients after relapse has been detected. In addition, itraconazole was well tolerated. [nejm.org]
Immunocompromised patients who have been successfully treated should receive oral itraconazole as a maintenance therapy to prevent relapse. [hkmj.org]