1. KCP 814
서울아산병원
임상강사 추현희

2. Clinical findings 중국, 홍콩 41/M Fever, sore throat, diarrhea (O: 1mon)
Past history
On admission
WBC: 9600/μL (Neutrophil 8764/μL, lymphocyte 470/μL)
Hb: 7.0g/dL
Platelet: 86K/μL
CD4 + T cell: 25 cells/μL
2000년 ~ 2013년 9월
중국, 홍콩
유학생활 및 사업 귀국
Fever
10월
11월
Transfer
HIV
Syphilis

4. Rt. bronchi - RUL bronchus에서 multiple polypoid lesion 관찰되어 RUL bronchus에서 bronchial washing 및 biopsy(#6) 시행함.

5. Bronchial washing cytology 슬라이드입니다.

8. Lung, ( right upper lobe bronchus ), bronchoscopic biopsy

9. Lymph node, ( right supraclavicular ), needle biopsy

10. Lymph node, ( right supraclavicular ), needle biopsy:
- Intracellular small yeast form fungi, suggestive of Histoplasmosis.

11. Penicillium marneffei
Culture
Mold form
 Dimorphic fungus ?
AIDS
Histoplasma capsulatum
Pneumocystis jirovecii
Penicillium marneffei
China &
Hong kong
- Endemic area ?

12. Penicillium marneffei
Final diagnosis
Bronchial washing, Liquid-based cytology :
Penicillium marneffei

13. Penicillium marneffei infection in AIDS
Epidemiology: endemic among HIV-positive patients in many areas in Southeast Asia, including Thailand (M/C), Vietnam, Hong Kong, Southern China, Taiwan, India, and Laos.
Penicilliosis is the 3rd commonest AIDS indication disease among HIV positive patients in endemic area.
Mycology: the only dimorphic fungus in the genus of Penicillium;
Mycelial form at 25◦C but yeast form at 37◦C.
Granular colony of P. marneffei with a characteristic red diffusible pigment on Sabouraud’s dextrose agar after 7 days
incubation at 25◦C.
Yeast-like colony of P. marneffei without red diffusible pigment on Sabouranud’s dextrose agar after 7 days of incubation
at 35◦C
25◦C
37◦C
Pathol Res Int Feb 10;2011

14. Previously reported case in Korea
Sex
Age
Clinical backgound
Tavel history in endemic area
Symptoms and sings
Initial diagnosis
Fever
Diarrhea
Anemia
Skin lesion
Other
대한신장학회지
2002; 21:680-5 M 43
Paraplegia, ESRD, CAPD No
Yes
Abdominal
pain
Peritonitis
Korean J Lab Med ; 30:400-5 52
Hepatitis B Liver cirrhosis LT from China Immunosuppressive therapy
Yes (China)
Chest
Discomport,
Dyspnea
Pneumonia
J Korean Med Sci ;27: 39
AIDS
Yes (Laos)
Cough
Pneumocystis jirovecii pneumonia
Present case 42
Yes (China
-Guangzhou,
Hong Kong)
Hepato splenomegaly,
Lymphadenopathy
Histoplasmosis

15. Differential diagnosis
Clustered small round pathogens phagocytized by macrophages
Protozoal infections
Leishmaniasis
Toxoplasmosis
Fungal infections
Histoplasmosis
Pneumocystosis
Penicilliosis
Bacterial infections

16. Yeast – like fungi in AIDS patients
Central transvers septum
Budding instead of
septated yeast cells
Round cysts containing
single or paired comma
shaped argyrophilic foci
in walls
Yeast cell with simiar stained positive for GMS

17. KCP 814