Penicillium marnefii is a common cause of opportunistic infection in HIV-infected patients in Southeast Asia and Southern China in late stage disease (CD4+ < 50 cells/m3). The exact route of infection in humans is not known. The organism proliferates in macrophages and is disseminated throughout the body, especially to the endothelial system.

The most common clinical presentations are fever, anaemia, and weight loss. Respiratory complaints (cough, shortness of breath) are also common. In these patients the chest radiograph shows diffuse nodular pulmonary infiltrates or cavity disease. Less commonly, local or generalized lymphadenopathy, hepatomegaly or splenomegaly also occur. Skin involvement occurs in patients with disseminated disease. The typical appearance is one of multiple papular lesions, often with a centralized umbilication or ulceration. The lesions are typically on the head and upper trunk.

The organism may be seen by microscopic examination of skin scrapings, or bone marrow or lymph node aspirates, and has been described as being evident on direct smears of peripheral blood in some patients. The diagnosis is confirmed by culturing the fungus from clinical specimens.

Treatment

Initial treatment should be with amphotericin B (for one or two weeks) followed by itraconazole; in mild cases itraconazole can be used throughout.

Long-term suppressive therapy with itraconazole should be given to prevent relapse.