Disseminated Penicillium marneffei: presenting illness of advanced HIV infection; a clinicopathological review, illustrated by a case report

British Association for Sexual Health and HIV national guideline for the management of Genital Molluscum in adults (2021)

This guideline offers recommendations on diagnosis, treatment regimens and health promotion principles needed for the effective management of genital molluscum, including management of the initial presentation and recurrences. The Primary focus of the guideline is on infection which affects the genital area and has a sexual mode of transmission. This is an update to the guideline previously published in this journal in 2014.

Human Hyalohyphomycoses: A Review of Human Infections Due toAcremoniumspp.,Paecilomycesspp.,Penicilliumspp., andScopulariopsisspp

Human infections due to opportunistic molds are on the rise. This is due to recent advances in medical technology that have led to increased numbers of patients who are immunosuppressed, receiving broad-spectrum antibiotics, or have indwelling medical devices. In this article, human infections caused by four hyalohyphomycoses, Acremonium spp., Paecilomyces spp., Penicillium spp., and Scopulariopsis spp., will be reviewed. Specific areas of focus will include the epidemiology, mycology, clinical presentations, and treatment options for each of these four hyaline molds.

Endemic fungal infections in the Asia-Pacific region

Endemic mycoses are important fungal infections in their respective habitats. In the Asia-Pacific region, an accurate epidemiological picture of endemic mycoses is elusive; few epidemiological surveys have been performed, and limited laboratory facilities and experience with fungal infections have further hampered recognition of infection. However, pockets of endemicity do indeed exist, and endemic fungal infections can have a significant impact on public health. This article reviews the most common endemic mycoses in the Asia-Pacific region: histoplasmosis, penicilliosis, and sporotrichosis. Blastomycosis, which has been infrequently reported within the region, is also briefly discussed. Certain areas of the Asia-Pacific region are endemic for histoplasmosis; however, the ecologic niche for this infection remains unclear. Penicilliosis is restricted to Southeast and Eastern Asia, whereas sporotrichosis is encountered in tropical areas of the Asia-Pacific region linked to environmental reservoirs distinct from those seen in the Western world. Before the advent of acquired immune deficiency syndrome (AIDS), histoplasmosis and penicilliosis were only occasionally reported; however, the incidence of both mycoses has increased with the rise in the incidence of AIDS. Comprehensive studies are needed to fully assess the areas of endemicity and the impact of endemic mycoses in the Asia-Pacific region.

Disseminated Penicillium marneffei infection in an HIV-positive Italian patient and a review of cases reported outside endemic regions

We describe a case of disseminated Penicillium marneffei in a human immunodeficiency virus (HIV)-positive Italian man who stayed for 4 years in Chiang Ray province, northern Thailand. A review of the literature shows that penicilliosis, although unusual, may represent an emerging opportunistic infection among HIV-positive people traveling to endemic areas.

Penicillium marneffei infection and recent advances in the epidemiology and molecular biology aspects

Penicillium marneffei infection is an important emerging public health problem, especially among patients infected with human immunodeficiency virus in the areas of endemicity in southeast Asia, India, and China. Within these regions, P. marneffei infection is regarded as an AIDS-defining illness, and the severity of the disease depends on the immunological status of the infected individual. Early diagnosis by serologic and molecular assay-based methods have been developed and are proving to be important in diagnosing infection. The occurrence of natural reservoirs and the molecular epidemiology of P. marneffei have been studied; however, the natural history and mode of transmission of the organism remain unclear. Soil exposure, especially during the rainy season, has been suggested to be a critical risk factor. Using a highly discriminatory molecular technique, multilocus microsatellite typing, to characterize this fungus, several isolates from bamboo rats and humans were shown to share identical multilocus genotypes. These data suggest either that transmission of P. marneffei may occur from rodents to humans or that rodents and humans are coinfected from common environmental sources. These putative natural cycles of P. marneffei infection need further investigation. Studies on the fungal genetics of P. marneffei have been focused on the characterization of genetic determinants that may play important roles in asexual development, mycelial-to-yeast phase transition, and the expression of antigenic determinants. Molecular studies have identified several genes involved in germination, hyphal development, conidiogenesis, and yeast cell polarity. A number of functionally important genes, such as the malate synthase- and catalase-peroxidase protein-encoding genes, have been identified as being upregulated in the yeast phase. Future investigations pertaining to the roles of these genes in host-fungus interactions may provide the key knowledge to understanding the pathogenicity of P. marneffei.

Clinicopathologic Study of Hepatic Penicillium marneffei in Northern Thailand

Context.—Penicillium marneffei, an opportunistic fungus, is endemic in Southeast Asia, especially in human immunodeficiency virus–infected individuals living in northern Thailand.

Objective.—We present the results of a clinicopathologic study of hepatic penicilliosis among human immunodeficiency virus/acquired immunodeficiency syndrome patients.

Design.—A search of liver biopsies in one institution from 1998 to 1999 identified 30 cases of penicilliosis.

Results.—Histologically, hepatic lesions could be classified into 1 of 3 patterns: diffuse, granulomatous, and mixed. The diffuse pattern showed a diffuse infiltration of foamy macrophages that contained numerous P marneffei. The granulomatous pattern showed a formation of multiple granulomata with various degrees of inflammatory cell infiltration. The mixed pattern showed features intermediate between the diffuse and granulomatous patterns. Liver function tests of the 3 pathologic pattern groups were evaluated, but there were no statistically significant differences in aspartate aminotransferase, alanine aminotransferase, or alkaline phosphatase levels among the various histologic groups.

Conclusion.—To our knowledge, this is the largest series to date that documents the liver pathology that results from this pathogen. We hypothesize that the histologic patterns seen on biopsy reflect the level of the host's immunity. Hence, in addition to a diagnosis of penicilliosis, a liver biopsy may also provide an assessment of the host's immune status, whereas liver function tests do not.

Occurrence and Management of Opportunistic Infections Associated with HIV/AIDS in Asia

Illnesses, diseases and malignancies occur among HIV-infected individuals along a continuum. These are directly correlated with the degree of immune suppression and are caused by common patho gens and opportunistic infections. In decreasing order offrequency, frequent opportunistic infections and malignancies that occur in Asia are: Mycobacterium tuberculosis, Cryptococcus neoformans, Candida spp., Herpes simplex, Cryptosporidium parvum, Pneumocystis carinii, Toxoplasma gondii, non-Hodgkin's lymphoma and Kaposi's sarcoma. The association of morbidityand mortality due to co-infection with HIV and M.tuberculosis has become more evident in the region. Natural history studies conducted in Mumbai and Bangkok have reported incubation periods from infection to AIDS of eight and nine years respectively. Despite the advent of antiretroviral therapy (ART) and improved affordability of the generic drugs, only 30,000 (2 to 3 per cent) of the estimated 1.3 million eligible persons with AIDS in South Asia are presently on AR T. Apparently, the focus of the low-cost care in the region still continues to be of care and management of prevalent opportunistic infections. As care practices start to include ART over the next few years, there will be consequent change in the occurrence of opportunistic infections and need for their prophylaxis.

Role of superoxide anion in the fungicidal activity of murine peritoneal exudate macrophages against Penicillium marneffei

Penicillium marneffei is an important opportunistic fungal pathogen. The mechanisms of host defense against P. marneffei are not fully understood. In the present study, we, for the first time, investigated the role of superoxide anion (O2-) in the killing of two forms of P. marneffei, yeast cells and conidia, and the role of this killing mediator in the fungicidal activity of IFN-gamma-stimulated murine peritoneal macrophages. P. marneffei yeast cells were susceptible to the killing effect of activated macrophages and chemically generated O2, while conidia were not. These results suggested that O2- played some role in the fungicidal activity of macrophages. However, an oxygen radical scavenger, superoxide dismutase (SOD), did not suppress, but rather enhanced the fungicidal activity of IFN-gamma-stimulated macrophages against P. marneffei yeast cells. This inconsistency was explained by the release of insufficient concentrations of O2- by activated macrophages as compared with the amount of O2- necessary for the killing of yeast cells, which was predicted in a chemical generating system. On the other hand, SOD enhanced the production of nitric oxide (NO) by IFN-gamma-activated macrophages, and their increased fungicidal activity was significantly inhibited by N(G)-monomethyl-L-arginine (L-NMMA), a competitive inhibitor of NO synthase. Our results suggested that O2- does not function as the killing mediator of macrophages against P. marneffei, but rather plays an important role in the regulation of the NO-mediated killing system by suppressing NO production.

Epidemiology and management of penicilliosis in human immunodeficiency virus-infected patients

Penicillium marneffei is a dimorphic fungus that can cause systemic mycosis in humans. It is endemic in Southeast Asia, the Guangxi province of China, Hong Kong, and Taiwan. Prior to the epidemic of human immunodeficiency virus (HIV), penicilliosis was a rare event. The incidence of this fungal infection has increased markedly during the past few years, paralleling the incidence of HIV infection. The patients usually present with fever, anemia, weight loss, skin lesions, generalized lymphadenopathy, and hepatomegaly. The skin lesions are most commonly papules with central necrotic umbilication. The average number of CD4+ T lymphocytes at presentation is 64 cells/mm3. The fungus is usually sensitive to amphotericin B, itraconazole, and ketoconazole. The response to antifungal treatment is good if the treatment is started early. After the initial treatment the patient may need to take an antifungal drug as secondary prophylaxis for life. New tests for the laboratory diagnosis of penicilliosis have been reported. Further studies of these tests, as well as the epidemiology, natural history, and management of this potentially fatal systemic fungal infection are needed.

Different susceptibilities of yeasts and conidia of Penicillium marneffei to nitric oxide (NO)-mediated fungicidal activity of murine macrophages

Penicillium marneffei is an important opportunistic fungal pathogen. Host defence mechanisms against P. marneffei are not fully understood. We investigated the fungicidal activity of murine peritoneal macrophages against two forms of P. marneffei, conidia and yeast cells, and the involvement of the NO-mediated killing system. Peritoneal macrophages suppressed the intracellular growth of P. marneffei yeast cells and conidia. The number of live yeast cells within macrophages was significantly reduced by activation of macrophages by interferon-gamma (IFN-gamma), while a similar response was not observed with conidia. IFN-gamma-induced macrophage fungicidal activity against yeast cells was mediated by NO and was almost completely inhibited by N(G)-monomethyl-L-arginine (L-NMMA), a competitive inhibitor of NO synthesis, while N(G)-monomethyl-D-arginine (D-NMMA), an optical isomer of L-NMMA, did not show any influence. NO production by macrophages stimulated with IFN-gamma was significantly enhanced when these macrophages were cultured with P. marneffei yeast cells, while conidia did not enhance macrophage NO production. Furthermore, yeast cells were more susceptible to the killing effect of chemically generated NO than conidia. Our results indicate that the yeast form of P. marneffei is more sensitive to the fungicidal activity of IFN-gamma-stimulated macrophages than conidia, and suggest that the different effects of two forms of P. marneffei on macrophage NO production and their different susceptibilities to NO may be reasons for the present findings.

Deep-seated fungal diseases in the South Pacific, especially in New Caledonia

The main deep-seated fungal diseases and their encountered pathology in New Caledonia and other islands of the South Pacific are reviewed (1970-96). Cryptococcosis is encountered in all islands of the South Pacific, Australia and Papua New Guinea, with a predominance of variety gattii, which is associated with some species of Eucalyptus. Histoplasmosis is not uncommon, and there was an epidemic in New Caledonia in 1994 among people who had visited a bat-inhabited cave. Mycetomas, in particular presenting as pale granules in tissues, are encountered in New Caledonia, Vanuatu, Papua New Guinea, Fiji and French Polynesia. Other fungal infections, such as zygomycosis, sporotrichosis (three cases) and chromomycosis (six cases) are rarely observed in New Caledonia.