Penicilliosis is caused by a fungus called Penicillium marneffei. The fungus is widespread in south-east Asia and southern China, but was rarely reported to cause disease before the beginning of the AIDS epidemic in the region. The infection has also been seen in migrants from this region, and in HIV-positive travellers returning from the region.

In Thailand, penicilliosis is one of the most common AIDS-related opportunistic illnesses. There has been a recent case report of HIV-related penicilliosis in India.

Penicilliosis is seen more commonly during the rainy season in Asia, but the precise route of transmission is unknown.

Symptoms

The most common symptom of penicilliosis is a skin rash, which takes the form of small bumps on the skin, often with ulceration on the bump. The rash normally occurs on the upper part of the body, including the face and scalp.

The other common symptoms of penicilliosis are cough, fever, anaemia, weight loss and shortness of breath. A chest X-ray will reveal pulmonary infiltrates if the lungs are affected.

Penicilliosis rarely develops in individuals with CD4 cell counts above 50 cells/mm³, so it is a symptom of advanced immune suppression. It can be diagnosed by culture from blood or from a scraping taken from a skin lesion (if the rash is present). No antigen test is yet available.

Treatment

Antifungal therapy with amphotericin B at 0.6 - 1.0mg/kg per day for two weeks has been used successfully, but the side effects can be difficult to tolerate. Little research into treatment with alternative antifungals such as ketaconazole and itraconazole has been reported, although p. Marneffei has been shown to be sensitive to both drugs in the test tube. Generally, induction treatment with amphotericin will be followed by maintenance treatment with itraconazole (200mg per day). Suppressive treatment will be necessary for as long as the immune system remains severely impaired, but no guidelines currently exist for discontinuing suppressive treatment after immune reconstitution due to HAART.

The initiation of HAART without antifungal treatment is unlikely to be successful, since immune reconstitution may take many months, and in the meantime p. Marneffei may have caused respiratory failure (the most common cause of death associated with this fungal infection).

References

Hilmarsdottir I et al. Disseminated Penicillium marneffei infection associated with human immunodeficiency virus: a report of two cases and a review of 35 published cases. J Acquir Immune Defic Syndr 6: 466-471, 1993.

Li PC etal. Penicillium marneffei: indicator disease for AIDS in South East Asia. AIDS 6: 240-241, 1992.

Shah K et al. Disseminated penicilliosis: AIDS defining illness (report of an index case from Maharashtra province of India). Second International AIDS Society Conference on HIV Pathogenesis and Treatment, Paris, abstract 903, 2003.