Rare misdiagnosed case of penicilliosis marneffei in an immunocompetent patient

Background Penicilliosis marneffei is a rare disease caused by Talaromyces marneffei, which is endemic in Southeast Asian countries, and usually occurs in immunocompromised or immunodeficient hosts. We report an unusual misdiagnosed case of penicilliosis marneffei in an immunocompetent patient from a non-endemic area of China. Case presentation: A 59-year-old man presented to hospital with a cough and progressive hemoptysis for a 3-month period. Clinical characteristics, radiological abnormalities, and prognosis were analyzed. Detailed examinations, chest computed tomography, and bronchoscopy were performed. The patient was misdiagnosed as having lung cancer and provided anti-tumor treatment for 1 month in the early stage. Imaging and bronchoscopy showed a neoplasm in the basal segment in the left lung, but a tissue biopsy did not establish a diagnosis. He subsequently underwent lobectomy for the lesion. The final pathological diagnosis was penicilliosis marneffei based on immunohistochemical staining. He was then prescribed specific anti-fungal treatment of voriconazole 200 mg twice daily for 12 weeks. Conclusion Timely fungal culture and pathological examination of clinical specimens are critical for the diagnosis of penicilliosis marneffei, especially in non-endemic regions and immunocompetent patients.

Review article Epidemiology of Talaromycosis (Penicilliosis) Marneffei in India: An Update

Talaromycosis marneffei (Penicilliosis marneffei) caused by a thermally dimorphic fungus, Talaromyces (Penicillium) marneffei is emerging as an important systemic opportunistic mycosis in HIV infected patients in several countries in Southeast Asia and in northeast India. This study presents an update on epidemiological and clinical aspects of talaromycosis marneffiei in India. A thorough search of literature was done in Medline, PubMed, and Google Scholar, for accessing relevant data. Fifty-three cases of this disease have originated from the Manipur State. Several cases have been reported from Assam, a few are also known from Meghalaya, Mizoram, Nagaland, Sikkim, Delhi and Maharashtra. Clinical manifestations of disseminated infection in AIDS patients are fever, anemia, weight loss, weakness, lymphadenopathy, hepatosplenomegaly, respiratory signs, and characteristic skin lesions. The bamboo rat (Cannomys badius) has been found to be a natural host of Talaromyces (Penicillium) marneffei in Manipur. It is noteworthy that one of the ten T. marneffei isolates from bamboo rats shared the genotype with a human isolate from that area providing evidence for common source of infection for the rats and humans and host to host transmission. Natural reservoir of T. marneffei has not been established, though it has been demonstrated that the fungus can survive in sterile soil for several weeks, but only for a few days in unsterile soil. There is need for comprehensive investigation of T. marneffei infection in humans, and for occurrence of the fungus in bamboo rats and in soils of the rat burrows in India employing conventional and molecular techniques.