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April 2002
 Penicilliosis
Penicillium marneffei, a dimorphic fungus that is endemic in AIDS patients in southeast Asia, causes a disseminated infection that has become the third leading AIDS-defining illness in certain parts of Thailand. The first HIV-associated case was reported in 1988. Three-quarters of affected individuals develop dermatologic manifestations. Some of the cutaneous findings include umbilicated papules that may be confused with molluscum contagiosum (see case #1 from April, 2000). Abscesses, papules, pustules, and ulcers commonly occur on the face, extremities, and trunk. Cough, malaise, generalized lymphadenopathy, fever, and weight loss, along with the skin lesions, are presenting symptoms. Other commonly affected organs include the lungs (infiltrates or cavities), lymph nodes, liver, spleen, and bone. The diagnosis is established by culture and skin biopsy. The organism has been isolated from bamboo rats and is found in soil. Although the mechanism of transmission of the disease is still unclear, it is likely that infection occurs through the inhalation of conidia from the soil. The incidence of the disease appears to rise during the rainy season. Immunocompromised persons traveling to southeast Asia should be warned about the manifestations of this fungus as one visitor to an endemic region acquired the disease 10 years after leaving the area. Amphotericin B treatment appears to be most successful. Secondary prophylaxis with itraconazole appears wise as relapse is often reported.
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