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This fungal infection is caused by the fungus Penicillium Marneffei. This is a dimorphic fungus which exhibits thermal dimorphism. At 37oC it grows as a yeast-like fungus and at 30oC or lower temperatures it grows as a mould. It exits in nature as mycelium but in tissues it forms round or oval cells which divide by fission.

The mycelia/spores are thought to be found in soil and bamboo rats. They are asymptomatic carriers of the fungus. It can infect a normal host, as well as immune-suppressed patients. But in normal hosts, most of the time it is focal infection, and in immune suppressed patients the infection is disseminated. It is a major and most frequent opportunistic pathogen.

It occurs along with chronic lung diseases like tuberculosis, emphysema, bronchiectasis, immune suppression i.e. HIV, corticosteroid therapy, diabetes etc.

Clinical symptoms
The infection presents as a chronic progressive disease. Like other fungal infections, starting from lungs in the initial stages, the symptoms are very mild and may be like flu. Later non-specific symptoms of fever, malaise, loss of weight and appetite, anemia appear. The patient's presentation is similar to tuberculosis, showing lung and lymph-nodes involvement with cavity, consolidation and abscess formation.

From the lungs, through the blood, the infection spreads to other organs of the body like skin, gut, kidney, bones, joints and the reticuloendothelial system. The presentation of symptoms depends on the organ, system or the part involved. The patients present with liver and spleen enlargement, thrombocytopinea, generalized lymphadinopathy, anaemia etc.. Many patients present with multiple papular lesions on skin with central necrotic umbilication.

The illness can be fatal if it is not treated properly and aggressively.

Penicillium marneffei is easily seen by direct microscopy and in the culture of infected tissues by staining it with Giemsa staine.

Treatment -
This infection is treatable, but antifungal agents have to be started as soon as the infection is suspected.

The drug of choice is FUNGISOME the Liposomal Amphotericin B.

In less serious cases where patients can take oral medication - FUNGITRACE® (Itraconazole) should be given. Fluconazole is found to be less effective than Itraconazole. Maintenance dose of 200mg daily of Itraconazole have to be continued for long duration to prevent relapse in AIDS patients.


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