Here we present a very rarely reported case of Talaromyces marneffei infection in an apparent non-immunosuppressed patient presenting decades later in a non-endemic setting (United States). [ncbi.nlm.nih.gov]

Extensive investigation revealedP marneffei as the sole cause of his presenting symptoms and signs. [thorax.bmj.com]

We describe a unique presentation of systemic P. marneffei infection in an immunocompetent host presenting with an endobronchial tumour-like lesion and post-obstructive pneumonia. [erj.ersjournals.com]

Fever, malaise, and anaemia were the commonest presentations. Most diagnoses were obtained from blood cultures (83%) and lymph node biopsies (34%). [hkmj.org]

In February 2016, the present patient presented with abscesses of the head, neck and left breast. A culture of blood and cyst fluid revealed infection with P. marneffei once again. [spandidos-publications.com]

• Splenomegaly

  Presentation is usually with fever, chills, lymphadenopathy, hepatomegaly, and splenomegaly, with skin lesions—most commonly papules with central necrotic umbilication—in two-thirds of cases. [oxfordmedicine.com]

  Subcutaneous and mucosal lesions, diarrhea, colonic lesions, hepatomegaly with or without splenomegaly, hemoptysis, osteoarticular lesions, and pericarditis have also been described. [medcraveonline.com]

  Symptom P (%) Hemoptysis 4 Neutropenia 12 Abdominal pain 15 Diarrhea 15 Arthritis 16 Splenomegaly 19 Hepatomegaly 23 Dyspnea 33 Weight loss 34 Fungemia 43 Anemia 47 Malaise 48 Cough 50 Lymphadenopathy 50 Cutaneous or subcutaneous lesions 53 Thrombocytosis [ncbi.nlm.nih.gov]

  The average duration of symptoms prior to presentation is 4 weeks.(1,2) Other common manifestations include skin lesions, anemia, lymphadenopathy, and hepatomegaly with or without splenomegaly. [hivinsite.ucsf.edu]

  Thailand, Sirisanthana et al. reported that 96 percent of patients presented with both fever and weight loss, 85 percent with skin lesions, 84 percent with generalized lymphadenopathy, 65 percent with hepatomegaly, 31 percent with cough, 23 percent with splenomegaly [escholarship.org]

• Generalized Lymphadenopathy

  Other clinical manifestations are less specific, i.e., fever, weight loss, nonproductive cough, hepatosplenomegaly and generalized lymphadenopathy. [ijidonline.com]

  Fungemia, generalized lymphadenopathy and cough are also reported in many of patients. [medcraveonline.com]

  lymphadenopathy, and 22 percent with diarrhea [3]. [escholarship.org]

  Generalized lymphadenopathy and hepatomegaly were present in more than 60 to 80% of cases20. In both HIV-positive and HIV-negative patients the respiratory system is the most common organ affected at presentation5,19. [scielo.br]

  The average duration of symptoms prior to presentation is 4 weeks.(1,2) Other common manifestations include skin lesions, anemia, lymphadenopathy, and hepatomegaly with or without splenomegaly. [hivinsite.ucsf.edu]

• Mediastinal Lymphadenopathy

  Computed tomography demonstrated resolution of cervical lymphadenopathy but interval development of pulmonary infiltrates and mediastinal lymphadenopathy (fig. 1). [erj.ersjournals.com]

  […] infiltrates and mediastinal lymphadenopathy Fiberoptic bronchoscopy; histopathological analysis and culture First, he was treated empirically with TMP sulfamethoxazole. [ncbi.nlm.nih.gov]

• Fever

  Abstract A 35 year old HIV positive patient from Hong Kong presented with a fever, cough and a skin rash in association with a lung mass, all of which were due to disseminated Penicillium marneffeiinfection. [thorax.bmj.com]

  He eventually re-presented with dry cough, recurrent fevers and left sided pleuritic chest pain. [erj.ersjournals.com]

  The bumps usually appear on the face and neck but can also appear in other places on the body. 2,3 Other symptoms include: 3,5,6 Fever General discomfort Weight loss Cough Swollen lymph nodes Difficulty breathing Swelling of the liver and spleen Diarrhea [cdc.gov]

  We noted disappearance of cough and fever. The chest X-ray showed a decrease of pulmonary lesions. [bmcresnotes.biomedcentral.com]

  Those without HIV tended to have intermittent fever compared to high persistent fever in patients with HIV. [escholarship.org]

• Lymphadenopathy

  Computed tomography demonstrated resolution of cervical lymphadenopathy but interval development of pulmonary infiltrates and mediastinal lymphadenopathy (fig. 1). [erj.ersjournals.com]

  […] infiltrates and mediastinal lymphadenopathy Fiberoptic bronchoscopy; histopathological analysis and culture First, he was treated empirically with TMP sulfamethoxazole. [ncbi.nlm.nih.gov]

  Other clinical manifestations are less specific, i.e., fever, weight loss, nonproductive cough, hepatosplenomegaly and generalized lymphadenopathy. [ijidonline.com]

  Chronic lymphadenopathy caused by Penicillium marneffei: a condition mimicking tuberculous lymphadenopathy. Br J Surg 1986; 73: 1007-1008. Google Scholar | Crossref | Medline | ISI Deng Z. et al. [journals.sagepub.com]

  Presentation is usually with fever, chills, lymphadenopathy, hepatomegaly, and splenomegaly, with skin lesions—most commonly papules with central necrotic umbilication—in two-thirds of cases. [oxfordmedicine.com]

• Weight Loss

  The most common presenting symptoms and signs were fever (92%), anaemia (77%), weight loss (76%), and skin lesions (71%). 87% of patients presenting with skin lesions had generalised papules with central umbilication. [thelancet.com]

  A 43-year-old man from Assam presented with low-grade fever, weight loss and skin lesions. He had not previously been tested for HIV antibody or virus. [jpgmonline.com]

  Other clinical manifestations are less specific, i.e., fever, weight loss, nonproductive cough, hepatosplenomegaly and generalized lymphadenopathy. [ijidonline.com]

  The bumps usually appear on the face and neck but can also appear in other places on the body. 2,3 Other symptoms include: 3,5,6 Fever General discomfort Weight loss Cough Swollen lymph nodes Difficulty breathing Swelling of the liver and spleen Diarrhea [cdc.gov]

  The clinical presentation usually involves the respiratory system and the skin, besides general symptoms like fever and weight loss. [scielo.br]

• Anemia

  Ten months after trip to Vietnam: several weeks’ history of wheezing, reduce exercise tolerance, headache, fever, weight loss, anemia, leukopenia • Chest x-ray: mild peri-bronchial thickening in the retrocardiac area BAL, blood cultures, and lymph node [ncbi.nlm.nih.gov]

  Fever, weight loss, anemia, lymphadenopathy, hepatosplenomegaly, respiratory signs and skin lesions were the common clinical manifestations of P. marneffei infections. [pubmed.ncbi.nlm.nih.gov]

  The average duration of symptoms prior to presentation is 4 weeks.(1,2) Other common manifestations include skin lesions, anemia, lymphadenopathy, and hepatomegaly with or without splenomegaly. [hivinsite.ucsf.edu]

  Moreover, weight loss, anemia, severe hypoproteinemia, and even multiple organ failure have been reported [4–6]. [bmcinfectdis.biomedcentral.com]

• Malaise

  After transient improvement, there was recurrence of productive cough, night sweats, malaise, and new hemoptysis. [ncbi.nlm.nih.gov]

  Fever, malaise, and anaemia were the commonest presentations. Most diagnoses were obtained from blood cultures (83%) and lymph node biopsies (34%). [hkmj.org]

  Other characteristics are malaise, anemia and leukocytosis. Fungemia, generalized lymphadenopathy and cough are also reported in many of patients. [medcraveonline.com]

  However, in Hong Kong, although fever and malaise were seen in more than 90 percent of their 47 patients with Penicillium marneffei infection, only 28 percent presented with skin lesions [6]. [escholarship.org]

  RESULTS: The most common nonspecific symptoms were fever, malaise, weight loss and anemia. [journal.chestnet.org]

• Cough

  After transient improvement, there was recurrence of productive cough, night sweats, malaise, and new hemoptysis. [ncbi.nlm.nih.gov]

  Abstract A 35 year old HIV positive patient from Hong Kong presented with a fever, cough and a skin rash in association with a lung mass, all of which were due to disseminated Penicillium marneffeiinfection. [thorax.bmj.com]

  He eventually re-presented with dry cough, recurrent fevers and left sided pleuritic chest pain. [erj.ersjournals.com]

  We noted disappearance of cough and fever. The chest X-ray showed a decrease of pulmonary lesions. [bmcresnotes.biomedcentral.com]

  A 36‑year‑old patient attended our hospital as a result of intermittent fever, cough, shortness of breath and multiple soft lesions located on the face, arms, neck and trunk. [spandidos-publications.com]

• Pleural Effusion

  During this course of in-patient treatment, the patient developed both pericardial and pleural effusions. These were drained percutaneously, were inflammatory in nature and did not demonstrate Penicillium on culture. [erj.ersjournals.com]

  A second chest CT showed increase in the size of the LLL cavitary infiltrate, a new small necrotizing lesion in the left lung, and a new small left pleural effusion. [ncbi.nlm.nih.gov]

  A single case of a pleural effusion due toP marneffei has also been reported. Ours is the first description of a solid lung mass and an endotracheal lesion in this condition. [thorax.bmj.com]

  Radiographic appearance of the lungs is variable, ranging from diffuse or localised reticular, reticulonodular, alveolar infiltration, cavitary lesion, interstitial pneumonia, lung nodules, and pleural effusion. [aids.gov.hk]

  Dermatomyositis complicated with Penicillium marneffeion pleural: a case report [in Chinese]. Chinese Journal of Dermatovenerology. 1992; 6(1): 35–36. [3] Zhang Xiliu, Liu Meizhen. Febrile, cough, thoracalgia and pleural effusion [in Chinese]. [link.springer.com]

• Purulent Sputum

  Initial evaluation revealed a man with a severe cough, hemoptysis, and purulent sputum. Sputum samples were obtained for culture. Voriconazole was continued but only for short time because of side effects. The initial BAL grew a mold. [ncbi.nlm.nih.gov]

• Diarrhea

  The bumps usually appear on the face and neck but can also appear in other places on the body. 2,3 Other symptoms include: 3,5,6 Fever General discomfort Weight loss Cough Swollen lymph nodes Difficulty breathing Swelling of the liver and spleen Diarrhea [cdc.gov]

  Hart [6] Six weeks later: he presented with a 3-week history of abdominal pain and diarrhea, with 2 days acute severe lower abdominal pain which progressed to septic shock Laparotomy: perforated sigmoid colon diverticulum and intraperitoneal pus. [ncbi.nlm.nih.gov]

  Subcutaneous and mucosal lesions, diarrhea, colonic lesions, hepatomegaly with or without splenomegaly, hemoptysis, osteoarticular lesions, and pericarditis have also been described. [medcraveonline.com]

  […] that 96 percent of patients presented with both fever and weight loss, 85 percent with skin lesions, 84 percent with generalized lymphadenopathy, 65 percent with hepatomegaly, 31 percent with cough, 23 percent with splenomegaly, and 15 percent with diarrhea [escholarship.org]

  A 42-year-old male patient visited the emergency room of our hospital in November 2013 with fever, sore throat, and diarrhea. He was a known seropositive patient for HIV and syphilis and a frequent traveler to Guangxi, China, and Hong Kong. [jcytol.org]

• Abdominal Pain

  Hart [6] Six weeks later: he presented with a 3-week history of abdominal pain and diarrhea, with 2 days acute severe lower abdominal pain which progressed to septic shock Laparotomy: perforated sigmoid colon diverticulum and intraperitoneal pus. [ncbi.nlm.nih.gov]

  pain Talaromycosis may affect people living with HIV differently than people who do not have HIV. [cdc.gov]

• Lower Abdominal Pain

  Hart [6] Six weeks later: he presented with a 3-week history of abdominal pain and diarrhea, with 2 days acute severe lower abdominal pain which progressed to septic shock Laparotomy: perforated sigmoid colon diverticulum and intraperitoneal pus. [ncbi.nlm.nih.gov]

• Hepatomegaly

  Presentation is usually with fever, chills, lymphadenopathy, hepatomegaly, and splenomegaly, with skin lesions—most commonly papules with central necrotic umbilication—in two-thirds of cases. [oxfordmedicine.com]

  The average duration of symptoms prior to presentation is 4 weeks.(1,2) Other common manifestations include skin lesions, anemia, lymphadenopathy, and hepatomegaly with or without splenomegaly. [hivinsite.ucsf.edu]

  Subcutaneous and mucosal lesions, diarrhea, colonic lesions, hepatomegaly with or without splenomegaly, hemoptysis, osteoarticular lesions, and pericarditis have also been described. [medcraveonline.com]

  Symptom P (%) Hemoptysis 4 Neutropenia 12 Abdominal pain 15 Diarrhea 15 Arthritis 16 Splenomegaly 19 Hepatomegaly 23 Dyspnea 33 Weight loss 34 Fungemia 43 Anemia 47 Malaise 48 Cough 50 Lymphadenopathy 50 Cutaneous or subcutaneous lesions 53 Thrombocytosis [ncbi.nlm.nih.gov]

  Generalized lymphadenopathy and hepatomegaly were present in more than 60 to 80% of cases20. In both HIV-positive and HIV-negative patients the respiratory system is the most common organ affected at presentation5,19. [scielo.br]

• Arthritis

  Symptom P (%) Hemoptysis 4 Neutropenia 12 Abdominal pain 15 Diarrhea 15 Arthritis 16 Splenomegaly 19 Hepatomegaly 23 Dyspnea 33 Weight loss 34 Fungemia 43 Anemia 47 Malaise 48 Cough 50 Lymphadenopathy 50 Cutaneous or subcutaneous lesions 53 Thrombocytosis [ncbi.nlm.nih.gov]

• Skin Lesion

  lesions on multiple sites. [ijpmonline.org]

  His skin lesions began to regress and his chest symptoms resolved within a week of starting treatment. Six months later his skin was clear and the chest radiograph was normal except for a small residual right upper lobe opacity. [thorax.bmj.com]

  The most common presenting symptoms and signs were fever (92%), anaemia (77%), weight loss (76%), and skin lesions (71%). 87% of patients presenting with skin lesions had generalised papules with central umbilication. [thelancet.com]

  lesions making an early diagnosis difficult. [semanticscholar.org]

  A high index of suspicion in the presence of typical skin lesions can lead to early diagnosis. A 43-year-old man from Assam presented with low-grade fever, weight loss and skin lesions. He had not previously been tested for HIV antibody or virus. [jpgmonline.com]

• Night Sweats

  After transient improvement, there was recurrence of productive cough, night sweats, malaise, and new hemoptysis. [ncbi.nlm.nih.gov]

  The patient described a 4-month history of intermittent drenching night sweats, cough and posterior cervical lymphadenopathy against a background of a recent bicycle tour of Laos and Vietnam. [erj.ersjournals.com]

• Sweating

  After transient improvement, there was recurrence of productive cough, night sweats, malaise, and new hemoptysis. [ncbi.nlm.nih.gov]

  The patient described a 4-month history of intermittent drenching night sweats, cough and posterior cervical lymphadenopathy against a background of a recent bicycle tour of Laos and Vietnam. [erj.ersjournals.com]

• Headache

  Ten months after trip to Vietnam: several weeks’ history of wheezing, reduce exercise tolerance, headache, fever, weight loss, anemia, leukopenia • Chest x-ray: mild peri-bronchial thickening in the retrocardiac area BAL, blood cultures, and lymph node [ncbi.nlm.nih.gov]

An extensive workup for an immunosuppressive state was nondiagnostic; HIV testing was repeatedly negative, including HIV viral load. [ncbi.nlm.nih.gov]

• Left Pleural Effusion

  A second chest CT showed increase in the size of the LLL cavitary infiltrate, a new small necrotizing lesion in the left lung, and a new small left pleural effusion. [ncbi.nlm.nih.gov]

• Atelectasis

  Stathakis [3] 18 months post-transplant: Vietnam for 2 weeks • Chest CT: bulky mediastinal and left hilar lymphadenopathy with narrowing of her left lingular and left lower lobe airways, peri bronchial infiltrate, lingual consolidation, atelectasis and [ncbi.nlm.nih.gov]

• Thrombocytosis

  Symptom P (%) Hemoptysis 4 Neutropenia 12 Abdominal pain 15 Diarrhea 15 Arthritis 16 Splenomegaly 19 Hepatomegaly 23 Dyspnea 33 Weight loss 34 Fungemia 43 Anemia 47 Malaise 48 Cough 50 Lymphadenopathy 50 Cutaneous or subcutaneous lesions 53 Thrombocytosis [ncbi.nlm.nih.gov]

• Creatinine Increased

  Two weeks after his return from vacation, his serum creatinine increased (124 to 190) and renal biopsy showed recurrent vasculitis. Chest x-ray: no evidence of fungal disease Blood and peritoneal fluid cultures after 3 days of incubation grew TM. [ncbi.nlm.nih.gov]

• Colitis

  Histopathological analysis of resected colon revealed CMV colitis but no fungal elements were seen on periodic acid-Schiff or Grocott’s methenamine staining After a diagnosis of TM: IV liposomal amphotericin B for two weeks followed by itraconazole as [ncbi.nlm.nih.gov]

• Liver Biopsy

  The liver biopsy showed epithelioid cell granulomas only, and tuberculosis was initially considered the most likely diagnosis. [experts.mcmaster.ca]

  Bronchoalveolar lavage, pleural fluid, liver biopsies, cerebrospinal fluid, pharyngeal ulcer scrapings, palatal papule scrapings, urine and stool samples may be used as clinical sample.10 Microscopy Microscopic examination of clinical materials reveals [medcraveonline.com]

  The laboratory diagnosis is performed by identifying the fungus by microscopy and culture from a variety of specimens including blood, skin, bone marrow, lymph nodes, respiratory sources, liver biopsies, cerebrospinal fluid, urine, stool, kidney, pericardium [ncbi.nlm.nih.gov]

• Pleural Effusion

  During this course of in-patient treatment, the patient developed both pericardial and pleural effusions. These were drained percutaneously, were inflammatory in nature and did not demonstrate Penicillium on culture. [erj.ersjournals.com]

  A second chest CT showed increase in the size of the LLL cavitary infiltrate, a new small necrotizing lesion in the left lung, and a new small left pleural effusion. [ncbi.nlm.nih.gov]

  A single case of a pleural effusion due toP marneffei has also been reported. Ours is the first description of a solid lung mass and an endotracheal lesion in this condition. [thorax.bmj.com]

  Radiographic appearance of the lungs is variable, ranging from diffuse or localised reticular, reticulonodular, alveolar infiltration, cavitary lesion, interstitial pneumonia, lung nodules, and pleural effusion. [aids.gov.hk]

  Dermatomyositis complicated with Penicillium marneffeion pleural: a case report [in Chinese]. Chinese Journal of Dermatovenerology. 1992; 6(1): 35–36. [3] Zhang Xiliu, Liu Meizhen. Febrile, cough, thoracalgia and pleural effusion [in Chinese]. [link.springer.com]

To date, no cases of P. marneffei infection relapse following treatment have been reported. [spandidos-publications.com]

[…] for treatment and for the prevention of relapse. [nejm.org]

All surviving human immunodeficiency virus–infected patients took highly active antiretroviral treatment and oral itraconazole as secondary prophylaxis after treatment of penicilliosis. [hkmj.org]

A treatment with ketoconazole 600 mg per day was initiated. After two weeks of treatment, there was a decrease in the size and number of papules and nodules, without any new lesions. We noted disappearance of cough and fever. [bmcresnotes.biomedcentral.com]

This regimen has been widely used in the treatment of HIV-infected patients and, in our case, led to significant clinical improvement. Cases of penicilliosis in non-HIV-infected patients are rare. [erj.ersjournals.com]

The prognosis appeared satisfactory with early diagnosis and administration of appropriate antifungal therapy. Relapse ensued in two (4%) of the patients only. CONCLUSION. [hkmj.org]

We analyzed epidemiological and clinical features, laboratory findings, reaction to therapy and prognosis of the disease. [pubmed.ncbi.nlm.nih.gov]

When patients with penicilliosis/AIDS were diagnosed early and treated with standardized antifungal therapy and combined antiretroviral therapy, their prognosis improved. [journals.plos.org]

[…] without treatment.2 Although treatment with antifungal agents has improved the prognosis, the mortality rate from disseminated P. marneffei infection in patients with AIDS is still about 20 percent.16 In a study from Chiang Mai, the rate of relapse of [nejm.org]

[…] most common presentation is a disseminated infection manifested by fever, skin lesions, anemia, generalized lymphadenopathy, and hepatomegaly.(2) Localized infection such as pneumonia also has been reported.(7) Patients with penicilliosis have a poor prognosis [hivinsite.ucsf.edu]

2010/53/2/361/64350 Penicillium marneffei, the only dimorphic species of the genus Penicillium is the etiological agent of a potentially life-threatening opportunistic fungal infection in human immunodeficiency virus (HIV)-infected and other immunocompromised [ijpmonline.org]

Human population may be adversely affected due to environmental contamination and these fungi traditionally have not been considered as very pathogenic and rarely are they implicated as etiological agent in a healthy human. [medcraveonline.com]

Bronchoscopy with bronchoalveolar lavage (BAL) yielded no specific etiology and he was treated symptomatically. After transient improvement, there was recurrence of productive cough, night sweats, malaise, and new hemoptysis. [ncbi.nlm.nih.gov]

1013-1018 PubMed Google Scholar Swan SK Wagner RA Myers JP Cinelli AB Mycotic endophthalmitis caused by Penicillium sp. after parenteral drug abuse.Am J Ophthalmol. 1985; 100: 408-410 Scopus (14) PubMed Abstract Full Text PDF Google Scholar Theodore FH Etiology [journalofinfection.com]

Epidemiology and management of penicilliosis in human immunodeficiency virus-infected patients. Int J Infect Dis 1998;3:48-53. [PUBMED] 2. Vanittanakom N, Cooper CR Jr, Fisher MC, Sirisanthana T. [ijpmonline.org]

This change in epidemiology poses a diagnostic challenge. As a result, there may be delays initiating therapy which may result in disease progression and poor outcomes [[7], [8]]. [ncbi.nlm.nih.gov]

Public Health and Epidemiology Bulletin 2002;11:41-9. Sirisanthana T, Supparatpinyo K. Epidemiology and management of penicilliosis in human immunodeficiency virus-infected patients. Int J Infect Dis 1998;3:48-53. [aids.gov.hk]

An epidemiologic link to an area of endemicity of the two fungi can also help in the diagnosis. [jcytol.org]

JP Latgé presented his first medical research theme, focused on the study of invasive aspergillosis (diagnosis, epidemiology and pathophysiology). [normalesup.org]

JP Latgé presented his first medical research theme, focused on the study of invasive aspergillosis (diagnosis, epidemiology and pathophysiology). [normalesup.org]

Dongli Liu Institute of Pathogenic Microorganisms, Shaanxi Provincial Center for Disease Control and Prevention, Xi’an, China Lin Ma Institute of Pathogenic Microorganisms, Shaanxi Provincial Center for Disease Control and Prevention, Xi’an, China Lingfeng [jidc.org]

A healthcare provider might prescribe medicine to prevent talaromycosis for people who have a condition that weakens their immune system and who live in places where the fungus is present. 3 Itraconazole is the most commonly used medicine to prevent talaromycosis [cdc.gov]

We therefore believe that prevention of relapse is a better strategy than treatment of patients after relapse has been detected. In addition, itraconazole was well tolerated. [nejm.org]

Immunocompromised patients who have been successfully treated should receive oral itraconazole as a maintenance therapy to prevent relapse. [hkmj.org]

Primary prophylaxis can prevent the occurrence of penicilliosis. [hivinsite.ucsf.edu]