Journal of The Academy of Clinical Microbiologists

CASE REPORT
Year
: 2018  |  Volume : 20  |  Issue : 1  |  Page : 49--51

Case of Talaromyces marneffei skin infection in an immunocompetent adult


O Sasikumari, Thara Ann Jose, S Anupama 
 Department of Microbiology, Government Medical College, Thiruvananthapuram, Kerala, India

Correspondence Address:
Dr. O Sasikumari
Department of Microbiology, Government Medical College, Thiruvananthapuram, Kerala
India

Abstract

Talaromyces marneffei, earlier called Penicillium marneffei, is a fungus which causes infection mostly in immunocompromised patients. Here, we report a case of T. marneffei causing chronic skin infection in a farmer who has no history of immune deficiency. Antifungal treatment was started, but the patient expired due to complications of deep vein thrombosis.



How to cite this article:
Sasikumari O, Jose TA, Anupama S. Case of Talaromyces marneffei skin infection in an immunocompetent adult.J Acad Clin Microbiol 2018;20:49-51


How to cite this URL:
Sasikumari O, Jose TA, Anupama S. Case of Talaromyces marneffei skin infection in an immunocompetent adult. J Acad Clin Microbiol [serial online] 2018 [cited 2019 Jun 19 ];20:49-51
Available from: http://www.jacmjournal.org/text.asp?2018/20/1/49/235927


Full Text

 Introduction



Talaromyces marneffei is a unique pathogenic dimorphic fungus which has a mycelial form at 24°C and an yeast-like phase at 37°C. The yeast-like form is entirely different from other dimorphic fungi as it divides by fission with formation of transverse septum and not by budding. This fungus is endemic in South East Asia and usually causes infection in immunocompromised individuals. It is also included as an AIDS-defining illness.[1]

It causes systemic infection involving multiple organ systems mainly blood, bone marrow, skin, lungs and the reticuloendothelial system. The fungus is most often isolated in culture from specimens such as bone marrow, blood, lymph node and skin. It has been suggested that the organism is acquired mainly via inhalation and rarely through inoculation.[2]

 Case Report



A 52-year-old farmer presented in the dermatology department with complaints of a raised lesion in the right foot of three months duration. The lesion started as a small papule which eroded and started itching and increased in size. It was a single well-defined erythematous plaque with verrucous surface [Figure 1].{Figure 1}

There was no history of trauma, tuberculosis, diabetes mellitus, HIV, hepatitis B or HCV infections. Differential diagnosis of chromoblastomycosis, tuberculosis verrucosa cutis and lupus vulgaris were considered.

Skin biopsy was sent to the Central Microbiology Laboratory of Medical College Thiruvananthapuram for culture. The tissue was inoculated on Sabouraud's dextrose agar (SDA) at 37°C and 22°C.

After eight days of incubation, SDA at 37°C showed no growth but SDA at 22°C showed yellowish green velvety colonies with brick red-coloured pigment on the reverse [Figure 2], [Figure 3], [Figure 4].{Figure 2}{Figure 3}{Figure 4}

Wet mount with Lacto phenol cotton blue showed hyaline septate hyphae. Conidiophores were at right angles to the hyphae. At the tip of the conidiophores, there were branching metula. On each metula, whorls of flask-shaped phialides were arranged. On each phialide, there were chains of round conidia. From these morphological features, the fungus was identified as Penicillium species [Figure 6].

Subculture was done to demonstrate dimorphism. The fungus was inoculated on to Sabouraud's dextrose agar plate at 22°C and to brain–heart infusion agar at 37°C. Mycelial forms were seen at 22°C and yeast forms were seen at 37°C [Figure 5], [Figure 6], [Figure 7].{Figure 5}{Figure 6}{Figure 7}{Figure 8}

The isolate was identified as T. marneffei. The patient was started on Itraconazole 200 mg twice daily.

The patient was brought to the casualty of Medical College Thiruvananthapuram after five days of treatment. He had severe dyspnoea and expired. The cause of death was pulmonary embolism following deep vein thrombosis of the leg.

 Discussion



T. marneffei was first discovered in 1959 by G. Segretain at Pasteur Institute in Paris. Human and bamboo rats are the only known animal hosts of T. marneffei.[3]

T. marneffei infection is endemic among HIV-positive patients in many areas in Southeast Asia. Although most patients with T. marneffei infection are immunocompromised, the infection has been described in immunocompetent individuals also.[4]

Immunocompromised patients have a greater chance of having disseminated T. marneffei infection. Without early diagnosis and proper treatment, the disease is associated with a high mortality rate. The incidence of this disease in individuals without HIV infection is recently increasing and hence awareness is necessary for early diagnosis and timely treatment and can lead to a better outcome.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Benj CR. Talaromyces. Mycologia 1955;47:681.
2Jayanetra P, Nitiyanant P, Ajello L, Padhye AA, Lolekha S, Atichartakarn V, et al. Penicilliosis marneffei in Thailand: Report of five human cases. Am J Trop Med Hyg 1984;33:637-44.
3Deng Z, Ribas JL, Gibson DW, Connor DH. Infections caused by Penicillium marneffei in China and Southeast Asia: Review of eighteen published cases and report of four more Chinese cases. Rev Infect Dis 1988;10:640-52.
4Hilmarsdottir I, Meynard JL, Rogeaux O, Guermonprez G, Datry A, Katlama C, et al. Disseminated Penicillium marneffei infection associated with human immunodeficiency virus: A report of two cases and a review of 35 published cases. J Acquir Immune Defic Syndr 1993;6:466-71.