Penicilliosis is a less common fungal infection caused by Penicillium, mostly secondary to primary immunodeficiency, AIDS, neutropenia, diabetes, long-term use of adrenal cortex hormones, antineoplastics, antibiotics, and artificial valve prosthesis. Skin infections can cause ulcers, predominantly in the groin, genitals, and buttocks.
Penicillium marneffei is biphasic and can cause primary fungal diseases, and most of other Penicillium only result in secondary infections.
Figure 1 Penicillium marneffei colony
Figure 2 Penicillium marneffei in microscopy
The pathogens include Penicillium citrinum, Penicillium chrysogenum, Penicillium expansum, Penicillium decumbens, and Penicillium puberulum also known as Penicillium commune.
Signs and Symptoms
Pulmonary infections are non-specific, and are characterized by fever, emaciation, cough, expectoration, hemoptysis, and dyspnea. Focal pulmonary inflammatory infiltration or cavities, or soap bubble appearance can be seen in X-ray examination. There may be various symptoms of allergic bronchitis. Brain infections are manifested by headache, nausea, vomiting, blurred vision, epilepsy, and coma. Renal and urinary infections are characterized by fever, renal colic, hematuria, and fungal discharge. Various symptoms of endocarditis or pericarditis may be present. Penicillium keratitis and fungal endophthalmitis can have various ocular symptoms. Onychomycosis or fungemia may occur.
If patients have cough, hemoptysis, expectoration, dyspnea, fever, anorexia, emaciation, and systemic failure, penicillosis should be suspected. Definitive diagnosis is based on the results of X-ray examination, and branched, septate hyphae or spores found in histopathology or microscopy.
Primary diseases should be treated.
Systemic antifungal treatment, such as potassium iodide, amphotericin B, flucytosine, miconazole, and itraconazole, and be administered.
The lesion on the infected cardiac valve should be excised in endocarditis, and amphotericin B can be used. Keratomycosis can be treated with systemic or local antifungals after withdrawal of antibiotics and adrenal cortex hormones.