pathogen : penicillium marneffei dimorphic fungus yeast like with cross septum
TRANSCRIPT
Pathogen : Pathogen : Penicillium marneffeiPenicillium marneffei dimorphic fungus dimorphic fungus yeast like with cross septum yeast like with cross septum
Mode of transmissionMode of transmission
: respiratory infection: respiratory infection
disseminateddisseminated
: Wright stain or Giemsa stain : Wright stain or Giemsa stain yeast like with cross septum 3 yeast like with cross septum 3 µm µm ( ( uusually in macrophage sually in macrophage ))
Penicillium other than P.marneffeiPenicillium other than P.marneffei
organorgan numbernumberLungLung
Prosthetic endocarditicProsthetic endocarditic
Infected CAPDInfected CAPD
EndophthalmitisEndophthalmitis
SepticemiaSepticemia
EsophagitisEsophagitis
Upper respiratory infectionUpper respiratory infection
Brain infectionBrain infection
1212
44
66
55
11
11
11
11
( Lyratzopaelos G , etal J infect 2002 ; 45 :184 – 207 )
Hypersensitivity pneumonitisHypersensitivity pneumonitis
Cheese – worker lungCheese – worker lung
Peat moss worker’ lungPeat moss worker’ lung
Salami worker’s lungSalami worker’s lung
Malt worker ‘s lungMalt worker ‘s lung
Farmer ‘s lungFarmer ‘s lung
Vienman 1956Vienman 1956 : bamboo rat : bamboo rat (( Rhizomys Rhizomys sinesis sinesis ))
KhwaseKhwase 19861986 : Li , et al study 16 : Li , et al study 16 Rhizomys pruinosusRhizomys pruinosus
93.1 % identified P. Marneffei93.1 % identified P. Marneffei87.5 % culture from lung87.5 % culture from lung56.3 % culture from liver56.3 % culture from liver56.3 % culture from spleen56.3 % culture from spleen50 % culture from abdominal 50 % culture from abdominal lymph nodelymph node
PathologyPathology
1. Granulomatous reaction : 1. Granulomatous reaction : lymph modelymph mode
2. Suppurative form : microbuses2. Suppurative form : microbuses
3. Anergic and necrotizing lesion 3. Anergic and necrotizing lesion : focal necrosis : focal necrosis
Clinical manifestation of HIV infected patient withClinical manifestation of HIV infected patient with P.marneffei, Chiang mai university hospitalP.marneffei, Chiang mai university hospital
Sign and symptomSign and symptom Number Number ((%%))
Sign feverSign fever
skin lesionskin lesion
coughcough
diarrheadiarrhea
74 74 925( . )925( . )
5 45 4 (67.5)(67.5)5 55 5 (48.7)(48.7)25 25 (31.2)(31.2)
Sign and SymptomSign and Symptom Number Number ((%%))
Symptum : fever ≥ 38Symptum : fever ≥ 38°C°C
weight lossweight loss
anemiaanemia
jaundicejaundice
oral candidiosisoral candidiosis
hairy lenkoplakiahairy lenkoplakia
Patatal papulesPatatal papules
generalized generalized lymphadenopathylymphadenopathy
hepatomegalyhepatomegaly
splenomegalysplenomegaly
genital ular genital ular
79 79 95(95())
6161(76.2)(76.2)
62 62 777755
6 6 75( . )75( . )
7979 73 737. )7. )
6 6 75( . )75( . )
3337( . )37( . )
46 46 57575. )5. )
4141 51 512. )2. )
13 13 16162. )2. )
5562( . )62( . )
Renew of 155 reported case Renew of 155 reported case ( ( Duong TA .Clin Infect DIS 1996;23:Duong TA .Clin Infect DIS 1996;23:((25-3025-30))
Clinical sign and symptomClinical sign and symptom Number Number ( ( % % ))
feverfever
anemia anemia
weight lossweight loss
Skin lesion Skin lesion
HemocultureHemoculture
lymphadenopathylymphadenopathy
CoughCough
HepatomegalyHepatomegaly
DiarrheaDiarrhea
SplenomegalySplenomegaly
PericarditisPericarditis
Osteolytic lesionsOsteolytic lesions
arthritisarthritis
152152 98( )98( )
116 116 (74.8)(74.8)111 111 716( . )716( . )
108 108 697( . )697( . )
84 84 (54.2)(54.2)81 81 523( . )523( . )
77 77 497( . )497( . )
68 68 439( . )439( . )
3636 232( . )232( . )
21 21 135( . )135( . )
7 7 45( . )45( . )
6 6 39( . )39( . )
6639( . )39( . )
Diagnostic smearDiagnostic smear
Skin scraping Skin scraping ( ( skin biopsy touch skin biopsy touch smear , bone marrow , lymph node smear , bone marrow , lymph node biopsy touch smear biopsy touch smear
Wright’s stainWright’s stain Oral yeast , 3-5 micronOral yeast , 3-5 micron With septum With septum ( ( binary fission binary fission ))
80 Patients from Chiang Mai university hospital80 Patients from Chiang Mai university hospital
specimenspecimen numbernumber positivepositive %positive%positive
Blood cultureBlood culture
Skin cultureSkin culture
Bone marrow cultureBone marrow culture
Sputum cultureSputum culture
Lymph node cultureLymph node culture
CSFCSF
Palatal papule Palatal papule scrapingscraping
Liver biopsy cultureLiver biopsy culture
Pleural fluid culturePleural fluid culture
Pharyngeal ular Pharyngeal ular scrapingscraping
7878
5252
2626
4141
99
2020
--------
5959
4747
2626
1414
99
33
33
11
11
11
75.675.6
90.490.4
100100
34.134.1
100100
1515
--------
30 Sample from CMU , 199330 Sample from CMU , 1993antifungalantifungal numbernumber MICMIC ( ( µg/mlµg/ml))
Geometric Geometric mean mean
rangerange
FluconazoleFluconazole
ItraconazoleItraconazole
KetoconazoleKetoconazole
MiconazoleMiconazole
Amphotericin BAmphotericin B
5-Flucytosine5-Flucytosine
3030
2828
2929
2929
2929
2929
7.9377.937
0.0090.009
0.0270.027
0.0010.001
0.9760.976
0.2480.248
0.313-20.00.313-20.0
<0.002-<0.002-0.190.19
<0.002-<0.002-0.0780.078
<0.002-<0.002-0.1560.156
0.25-4.00.25-4.0
<0.015-<0.015-0.460.46
TreatmentTreatment
Severe case : Amphotericin B 0.6 Severe case : Amphotericin B 0.6 mg /kg/day for 2 weeks Itraconazole mg /kg/day for 2 weeks Itraconazole 200 mg bid for 10 weeks. 200 mg bid for 10 weeks.
Mild case : Itraconazole 200 mg bid Mild case : Itraconazole 200 mg bid for 10 weekfor 10 week
Amphotericin BAmphotericin B
1.1. Amphotericin B DeoxycholateAmphotericin B Deoxycholate
- drip with 5 % dextrose in water- drip with 5 % dextrose in water
2.2. Lipid-complexed Amphotericin BLipid-complexed Amphotericin B
- Ampho B colloidal dispersion - Ampho B colloidal dispersion ( ( Amphotec Amphotec ))
- - Ampho B lipid complex Ampho B lipid complex ( ( Abelect Abelect ))
- - Liposomal Ampho B Liposomal Ampho B ( ( Ambisome Ambisome ))
Side effect of Amphotericin BSide effect of Amphotericin B
: Acute infusion – related : Acute infusion – related reactionreaction
- Fever , chill , tachypnea- Fever , chill , tachypnea
- not anaphylaxis- not anaphylaxis
Side effect of Amphotericin BSide effect of Amphotericin B
: Nephrotoxicity: Nephrotoxicity- dose dependent- dose dependent- loss K , Mg , bicarbonate- loss K , Mg , bicarbonate- risk : combine with other nephrotoxic - risk : combine with other nephrotoxic drug drug
hypotensionhypotensiondehydrationdehydrationkidney diseasekidney disease
Side effect of Amphotericin BSide effect of Amphotericin B
: : other side effectother side effectnausea , vomitingnausea , vomitingthrombophlebitisthrombophlebitisanemia ,thrombocytopenia , anemia ,thrombocytopenia , leucopenialeucopenia