Sirisanthana T
Department of Medicine, Faculty of Medicine, Chiang Mai University, Thailand.
Ann Acad Med Singap. 1997 Sep;26(5):701-4.
Penicillium marneffei is endemic in Southeast Asia, the Guangxi province of China, and Hong Kong. Cases of patients infected with P. marneffei have been very rare, but the incidence has increased markedly during the past several years. This increase is exclusively due to infection among patients infected with human immunodeficiency virus (HIV). The patients usually presented with symptoms and signs similar to other patients with late HIV diseases. These included fever (99% of the patients), anaemia (78%), pronounced weight loss (76%), generalised lymphadenopathy (58%) and hepatomegaly (51%). Skin lesions were seen in 71% of our patients. These lesions were most commonly papules with central necrotic umbilication. It was easy to culture P. marneffei from various clinical specimens. Bone marrow culture was the most sensitive (100%), followed by culture of the specimen obtained from skin biopsy (90%) and blood culture (76%). The fungus was sensitive to amphotericin B, itraconazole, and ketoconazole. Our regimen is to give amphotericin B for 2 weeks, followed by itraconazole 400 mg/day orally for the next 10 weeks. After the initial treatment, the patient is given itraconazole 200 mg/day as secondary prophylaxis for life.
马尔尼菲青霉在东南亚、中国广西省和香港地区呈地方性流行。感染马尔尼菲青霉的患者病例曾非常罕见，但在过去几年中发病率显著上升。这种上升完全归因于人类免疫缺陷病毒（HIV）感染患者中的感染情况。这些患者通常表现出与其他晚期HIV疾病患者相似的症状和体征。这些症状包括发热（99%的患者）、贫血（78%）、明显体重减轻（76%）、全身淋巴结肿大（58%）和肝肿大（51%）。71%的患者出现皮肤病变。这些病变最常见的是中央有坏死性脐凹的丘疹。从各种临床标本中很容易培养出马尔尼菲青霉。骨髓培养最敏感（100%），其次是皮肤活检标本培养（90%）和血培养（76%）。该真菌对两性霉素B、伊曲康唑和酮康唑敏感。我们的治疗方案是给予两性霉素B治疗2周，随后在接下来的10周内口服伊曲康唑400毫克/天。初始治疗后，给予患者伊曲康唑200毫克/天作为终身二级预防。
