A 12-Case Series of Penicillium marneffei Pneumonia
Athavudh Deesomchok MD*, Surat Tanprawate MD*
Affiliation : * Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai
Background : Penicillium marneffei, an endemic fungus in Southeast Asia and southern China, is the cause of
opportunistic infection in HIV-infected patients who may present with symptoms and signs of the lungs, and
abnormal chest radiographs. However, only a few cases of pulmonary infection from this organism have been
reported.
Objective : To study the clinical manifestations of patients with Penicillium marneffei pneumonia diagnosed by
sputum or bronchoalveolar lavage (BAL) fluid culture
Materials and Methods : Retrospective descriptive study of patients who were diagnosed with Penicillium
marneffei pneumonia at Maharaj Nakorn Chiang Mai Hospital from September 1999 to July 2004.
Results : Twelve patients (eight males, four females) were included with mean age of 36.1 years. Nine cases
were HIV-infected. Their presenting symptoms included fever, cough, dyspnea and weight loss. Skin lesions,
hepatomegaly and lymphadenopathy were extrapulmonary signs. Chest radiographs revealed diffuse
reticulonodular, diffuse reticular, localized alveolar, localized reticular infiltration, and cavitary lesion. The
diagnosis was made by cultures from the sputum in five cases and BAL fluid in the others. Co-infections with
Streptococcus pneumoniae, Klebsiella pneumoniae, Mycobacterium tuberculosis, Cryptococcus neoformans,
and Strongyloides stercoralis were found. Most of them were treated by intravenous amphotericin B followed
by oral itraconazole, or oral itraconazole.
Conclusion : Penicillium marneffei pneumonia has non-specific clinical manifestations, it cannot be excluded
from other infections and may have co-infections. Physicians should include this infection in their differential
diagnosis especially in immunocompromised patients.
Keywords : Penicillium marneffei, Pneumonia, Chest radiography
