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Penicillium marneffei infection

Penicillium marneffei infection. in AIDS patients. Pathogen : Penicillium marneffei dimorphic fungus yeast like with cross septum. Mode of transmission : respiratory infection disseminated

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Penicillium marneffei infection

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  1. Penicillium marneffei infection in AIDS patients

  2. Pathogen : Penicillium marneffei dimorphic fungus yeast like with cross septum

  3. Mode of transmission : respiratory infection disseminated : Wright stain or Giemsa stain yeast like with cross septum 3 µm ( usually in macrophage )

  4. Penicillium other than P.marneffei ( Lyratzopaelos G , etal J infect 2002 ; 45 :184 – 207 )

  5. Hypersensitivity pneumonitis Cheese – worker lung Peat moss worker’ lung Salami worker’s lung Malt worker ‘s lung Farmer ‘s lung

  6. Vienman 1956 : bamboo rat ( Rhizomys sinesis ) Khwase1986 : Li , et al study 16 Rhizomys pruinosus 93.1 % identified P. Marneffei 87.5 % culture from lung 56.3 % culture from liver 56.3 % culture from spleen 50 % culture from abdominal lymph node

  7. Mode of Transmission • Respiratory • Skin ?? • GI??

  8. Pathology 1. Granulomatous reaction : lymph mode 2. Suppurative form : microbuses 3. Anergic and necrotizing lesion : focal necrosis

  9. Clinical manifestation of HIV infected patient with P.marneffei, Chiang mai university hospital

  10. Renew of 155 reported case ( Duong TA .Clin Infect DIS 1996;23:(25-30)

  11. Diagnostic smear • Skin scraping ( skin biopsy touch smear , bone marrow , lymph node biopsy touch smear • Wright’s stain • Oral yeast , 3-5 micron • With septum ( binary fission )

  12. 80 Patients from Chiang Mai university hospital

  13. 30 Sample from CMU , 1993

  14. Treatment • Severe case : Amphotericin B 0.6 mg /kg/day for 2 weeks Itraconazole 200 mg bid for 10 weeks. • Mild case : Itraconazole 200 mg bid for 10 week

  15. Amphotericin B • Amphotericin B Deoxycholate - drip with 5 % dextrose in water • Lipid-complexed Amphotericin B - Ampho B colloidal dispersion ( Amphotec ) - Ampho B lipid complex ( Abelect ) - Liposomal Ampho B ( Ambisome )

  16. Side effect of Amphotericin B : Acute infusion – related reaction - Fever , chill , tachypnea - not anaphylaxis

  17. Side effect of Amphotericin B : Nephrotoxicity - dose dependent - loss K , Mg , bicarbonate - risk : combine with other nephrotoxic drug hypotension dehydration kidney disease

  18. Side effect of Amphotericin B : other side effect nausea , vomiting thrombophlebitis anemia ,thrombocytopenia , leucopenia

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