Objective To explore the clinical characters, diagnosis and treatment of Penicilliosis marneffei (PSM) in healthy hosts.
Methods The clinical data of three cases of PSM involving the lung, bronchus and pleura in healthy hosts were retrospectively analyzed, and the case reports of Penicillium marneffei (PM) infection in healthy hosts were summarized by searching database for related articles, with "Penicilliosis marneffei" as key word both in English and Chinese literatures.
Results The main clinical manifestations of three PSM patients included fever, cough, lymphadenopathy, and elevated white blood cell counts.Series of chest computed tomography of three cases demonstrated atypical and extensive lung lesions.The fiberoptic bronchoscopy of the 2nd case showed several irregular nodules on the bronchial wall.The thoracoscopy of the 3rd case showed much pleural adhesions and small nodules on visceral and parietal pleura.Final diagnosis of PSM was confirmed by the fungal culture, and all patients received antifungal treatment.The symptoms relieved on medication but reoccurred on discontinuation.Literature review identified 36 cases of PSM in healthy hosts.The main clinical features were fever, cough/expectoration, skin rash/skin abscess and elevated white blood cell counts.The most common used antifungal drug was amphotericin B alone or combined with traconazole.The thoracic radiological imaging showed that roughly half of them had clearly thoracic lesions (20/36, 55.65%), and the pulmonary inflammatory infiltrate shadow was most common.Seventeen cases (47.22%) were misdiagnosed as tuberculosis.
Conclusions Pulmonary involvement is common in healthy hosts with PSM and the thoracic radiological features are variable and unspecific, so PSM is easy to be misdiagnosed as tuberculosis.The PSM patients need a longer treatment than other fungal infections.
Citation：
DaiXiaoying, ChenHuan, LiMeihua, ZhangJianquan, BaiJing, DengJingmin, LiuGuangnan, ZhongXiaoning, LanXiuwan, HeZhiyi. Penicilliosis marneffei Involving the Lung in Healthy Hosts: Three Cases Report and Literature Review. Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(1): 12-16. doi: 10.7507/1671-6205.2016004
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Copyright © the editorial department of Chinese Journal of Respiratory and Critical Care Medicine of West China Medical Publisher. All rights reserved
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李云, 王惠萱, 夏正武, 等.马尔尼菲青霉与马尔尼菲青霉病.中国误诊学杂志, 2005, 5:2826-2827.
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- 1. 苏小芬, 张挪富, 刘春丽, 等.免疫健全者播散性马尔尼菲青霉菌病一例及文献复习.中国呼吸与危重监护杂志, 2013, 12:244-248.
- 2. Hu Y, Zhang J, Li X, et al. Penicillium marneffei infection:an emerging disease in mainland China. Mycopathologia, 2013, 175:57-67.
- 3. 邓卓霖, 马韵.马尔尼菲青霉穿通血管壁特性的研究.临床与实验病理学杂志, 1999, 15:30-1, 插页6.
- 4. Duong TA. Infection due to Penicillium marneffei, an emerging pathogen:review of 155 reported cases. Clin Infect Dis, 1996, 23:125-130.
- 5. 赵国庆, 冉玉平, 向耘.中国大陆马尔尼菲青霉病的临床表现及流行病学特征的系统评价.中国真菌学杂志, 2007, 2:68-72.
- 6. 庄晓晟, 梁伶, 黄绍标, 等.马尔尼菲青霉病93例临床分析.临床皮肤科杂志, 2009, 38:69-72.
- 7. 张建全, 钟小宁, 柳广南, 等.健康宿主合并马尔尼菲青霉病的临床特征及误诊原因分析.中华内科杂志, 2010, 49:700-701.
- 8. 余卫业, 陆普选, 朱文科, 等.艾滋病合并播散性马尔尼菲青霉菌感染的临床与影像学特点.中国临床医学影像杂志, 2007, 18:434-437.
- 9. Patassi AA, Saka B, Landoh DE, et al. First observation in a non-endemic country (Togo) of Penicillium marneffei infection in a human immunodeficiency virus-infected patient:a case report. BMC Res Notes, 2013, 6:506.
- 10. Cogliati M, Roverselli A, Boelaert JR, et al. Development of an in vitro macrophage system to assess Penicillium marneffei growth and susceptibility to nitric oxide. Infect Immun, 1997, 65:279-284.
- 11. Supparatpinyo K, Khamwan C, Baosoung V, et al. Disseminated Penicillium marneffei infection in southeast Asia. Lancet, 1994, 344:110-113.
- 12. 李云, 王惠萱, 夏正武, 等.马尔尼菲青霉与马尔尼菲青霉病.中国误诊学杂志, 2005, 5:2826-2827.
