Ranjana K H, Priyokumar K, Singh Th J, Gupta Ch C, Sharmila L, Singh P N, Chakrabarti A
Department of Microbiology, J. N. Medical Hospital, Imphal 795001, Manipur, India.
J Infect. 2002 Nov;45(4):268-71. doi: 10.1053/jinf.2002.1062.
To further describe the clinical and epidemiological characteristics of Penicillium marneffei infection in human immunodeficiency virus (HIV) infected patients in India.
In continuation of our earlier report of four autochthonous cases of P. marneffei infection in HIV infected patients from Manipur, a northeastern state of India, we studied additional 46 cases of penicilliosis marneffei from the same area over a period of 19 months (April 1998-October 1999). Clinical, microbiological features, and therapeutic responses were analyzed in 36 of the 46 patients as ten patients were lost to follow-up.
Of the 198 HIV positive patients attending the J. N. Medical Hospital, Imphal, Manipur state during the period mentioned, 46 (25%) had P. marneffei disseminated infection. Of the 36 patients analyzed 31 (86%) were intravenous drug abusers, 1 had multiple sex partners, and 3 females acquired HIV infection from their respective spouses. A 9-year-old child acquired HIV infection by vertical transmission. The common clinical symptoms included fever (97%), weight loss (100%), weakness (86%), anemia (86%), and characteristic skin lesions (81%). Presumptive diagnosis was made by microscopic examination of Wright's-stained smears of fine needle aspirated material from skin lesions and lymph nodes showing numerous intracellular and extracellular, oval, elongated, yeast-like cells dividing by fission. The etiologic agent P. marneffei was isolated in culture from clinical materials in 10 cases when isolation was attempted. All patients were treated with oral itraconazole. All, except one patient, responded favorably to treatment within 7 days.
Thus, the present cases further confirm the endemicity of penicilliosis marneffei in Manipur and resemble the epidemiology and clinical course of patients from other parts of south-east Asia.
进一步描述印度人类免疫缺陷病毒（HIV）感染患者马尔尼菲青霉感染的临床和流行病学特征。
继我们之前报道的来自印度东北部曼尼普尔邦4例HIV感染患者的马尔尼菲青霉本土感染病例后，我们在19个月期间（1998年4月至1999年10月）对同一地区另外46例马尔尼菲青霉病病例进行了研究。由于10例患者失访，因此对46例患者中的36例进行了临床、微生物学特征及治疗反应分析。
在上述期间到曼尼普尔邦英帕尔市J.N.医学院医院就诊的198例HIV阳性患者中，46例（25%）发生了马尔尼菲青霉播散性感染。在分析的36例患者中，31例（86%）为静脉吸毒者，1例有多个性伴侣，3例女性从各自配偶处感染HIV。一名9岁儿童通过垂直传播感染HIV。常见临床症状包括发热（97%）、体重减轻（100%）、乏力（86%）、贫血（86%）及特征性皮肤损害（81%）。通过对皮肤损害和淋巴结细针穿刺吸取物的瑞氏染色涂片进行显微镜检查做出初步诊断，涂片显示有大量细胞内和细胞外、椭圆形、细长形、酵母样细胞通过分裂进行增殖。在尝试进行培养的10例患者中，从临床材料中分离出病原体马尔尼菲青霉。所有患者均接受口服伊曲康唑治疗。除1例患者外，所有患者在7天内对治疗反应良好。
因此，目前这些病例进一步证实了马尔尼菲青霉病在曼尼普尔邦的地方性流行，并且与东南亚其他地区患者的流行病学及临床病程相似。
