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Author: A/Prof Felix Boon-Bin Yap, Dermatologist, University Tunku Abdul Rahman and Sunway Medical Centre, Selangor, Malaysia. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. June 2020.
Penicilliosis is a systemic fungal infection caused by the fungus Penicillium marneffei.
Penicilliosis is mainly seen among individuals with a compromised immune system due to human immunodeficiency virus (HIV) infection. It can sometimes be seen in individuals with other causes of immunosuppression, such as kidney transplant recipients, and very rarely in individuals with a normal immune system .
Penicilliosis is common in tropical countries and is occasionally seen elsewhere in returning travellers .
An individual presenting with penicilliosis most commonly presents with fever, weight loss, and skin lesions. Other features may include:
Penicilliosis most commonly affects the face and neck, but may also arise on the arms, legs, trunk, and oral mucosa.
It typically presents as papules or nodules with central necrotic umbilication or ulceration. Subcutaneous nodules, abscesses, and verrucous (warty) skin lesions may also occur . Successful treatment is followed by postinflammatory hyperpigmentation and scarring.
Penicilliosis is a serious systemic infection which, if left untreated, will lead to death.
Penicilliosis can be diagnosed presumptively by finding intracellular or extracellular yeasts in a Wright-stained touch smear of a necrotic or ulcerated skin lesion.
Histopathological examination of a skin biopsy may reveal 2–4 µm, intracellular or extracellular fungal elements.
Culture of a sample taken from the skin lesion or another affected organ (eg, bone marrow, lymph node, or pleural fluid) may reveal Penicillium marneffei, confirming the diagnosis .
The differential diagnosis depends on the type of penicilliosis lesion.
Intracellular fungi seen on the histopathological examination might be confused with Histoplasma capsulatum infection. A ‘safety pin’ appearance (ie, cross-wall divisions) indicates penicilliosis .
Early diagnosis and treatment are essential to cure penicilliosis. Treatment consists of the administration of systemic antifungal treatment.
Detected early and with early treatment, the prognosis of penicilliosis is good with full recovery.
The recurrence rate is 4–50%.
The mortality rate ranges between 2.7% and 11.4%. Late diagnosis and treatment lead to higher mortality .
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