Penicilliosis: Difference between revisions
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==Treatment== | ==Treatment== | ||
===Antimicrobial Regimen=== | ===Antimicrobial Regimen=== | ||
::*1. '''Mild disease''' | |||
:::* Preferred regimen: [[Itraconazole]] 200 mg PO bid for 8 to 12 weeks without amphotericin B induction therapy<ref name="pmid1339213">{{cite journal| author=Supparatpinyo K, Chiewchanvit S, Hirunsri P, Baosoung V, Uthammachai C, Chaimongkol B et al.| title=An efficacy study of itraconazole in the treatment of Penicillium marneffei infection. | journal=J Med Assoc Thai | year= 1992 | volume= 75 | issue= 12 | pages= 688-91 | pmid=1339213 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1339213 }} </ref> | |||
:::* Alternative regimen: [[Voriconazole]] 400 mg PO bid on day 1 {{then}} 200 mg PO bid for 12 weeks<ref name="pmid17690411">{{cite journal| author=Supparatpinyo K, Schlamm HT| title=Voriconazole as therapy for systemic Penicillium marneffei infections in AIDS patients. | journal=Am J Trop Med Hyg | year= 2007 | volume= 77 | issue= 2 | pages= 350-3 | pmid=17690411 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17690411 }} </ref> | |||
::*2. '''Moderate-severe disease''' | |||
:::* Preferred regimen: Liposomal [[Amphotericin B]] 3-5 mg/kg/day IV qd {{or}} [[Amphotericin B]] lipid complex 5 mg/kg/day IV qd for 2 weeks {{then}} [[Itraconazole]] 200 mg PO bid for 10 weeks<ref name="pmid9831676">{{cite journal| author=Sirisanthana T, Supparatpinyo K| title=Epidemiology and management of penicilliosis in human immunodeficiency virus-infected patients. | journal=Int J Infect Dis | year= 1998 | volume= 3 | issue= 1 | pages= 48-53 | pmid=9831676 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9831676 }} </ref> | |||
:::* Alternative regimen: [[Voriconazole]] 6 mg/kg IV q12h on day 1 {{then}} 4 mg/kg q12h for at least 3 days {{then}} [[Voriconazole]] 200 mg PO bid for a total of 12 weeks<ref name="pmid17690411">{{cite journal| author=Supparatpinyo K, Schlamm HT| title=Voriconazole as therapy for systemic Penicillium marneffei infections in AIDS patients. | journal=Am J Trop Med Hyg | year= 2007 | volume= 77 | issue= 2 | pages= 350-3 | pmid=17690411 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17690411 }} </ref> | |||
::*3. '''Maintenance therapy'''<ref name="pmid9845708">{{cite journal| author=Supparatpinyo K, Perriens J, Nelson KE, Sirisanthana T| title=A controlled trial of itraconazole to prevent relapse of Penicillium marneffei infection in patients infected with the human immunodeficiency virus. | journal=N Engl J Med | year= 1998 | volume= 339 | issue= 24 | pages= 1739-43 | pmid=9845708 | doi=10.1056/NEJM199812103392403 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9845708 }} </ref> | |||
:::* Preferred regimen [[Itraconazole]] 200 mg PO qd | |||
:::* Alternative regimen: [[Voriconazole]] 200 mg PO bid | |||
::* Note: [[Voriconazole]] and [[Itraconazole]] use require serum levels to be monitored to ensure adequate absorption. | |||
==References== | |||
{{reflist|2}} | |||
Revision as of 13:01, 10 August 2015
This page is about clinical aspects of the disease. For microbiologic aspects of the causative organism(s), see Penicillium marneffei.
For patient information click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Penicilliosis is an infection caused by Penicillium marneffei. Once considered rare, its occurrence has increased due to AIDS. It is now the third most common opportunistic infection (after extrapulmonary tuberculosis and cryptococcosis) in HIV-positive individuals within the endemic area of Southeast Asia.
Diagnosis is usually made by identification of the fungi from clinical specimens. Biopsies of skin lesions, lymph nodes, and bone marrow demonstrate the presence of organisms on histopathology.
The most common symptoms are fever, skin lesions, anemia, generalized lymphadenopathy, and hepatomegaly.
Penicillium marneffei demonstrates in vitro susceptibility to multiple antifungal agents including ketoconazole, itraconazole, miconazole, flucytosine, and amphotericin B. Without treatment patients have a poor prognosis.
Treatment
Antimicrobial Regimen
- 1. Mild disease
- Preferred regimen: Itraconazole 200 mg PO bid for 8 to 12 weeks without amphotericin B induction therapy[1]
- Alternative regimen: Voriconazole 400 mg PO bid on day 1 THEN 200 mg PO bid for 12 weeks[2]
- 2. Moderate-severe disease
- Preferred regimen: Liposomal Amphotericin B 3-5 mg/kg/day IV qd OR Amphotericin B lipid complex 5 mg/kg/day IV qd for 2 weeks THEN Itraconazole 200 mg PO bid for 10 weeks[3]
- Alternative regimen: Voriconazole 6 mg/kg IV q12h on day 1 THEN 4 mg/kg q12h for at least 3 days THEN Voriconazole 200 mg PO bid for a total of 12 weeks[2]
- 3. Maintenance therapy[4]
- Preferred regimen Itraconazole 200 mg PO qd
- Alternative regimen: Voriconazole 200 mg PO bid
- Note: Voriconazole and Itraconazole use require serum levels to be monitored to ensure adequate absorption.
References
- ↑ Supparatpinyo K, Chiewchanvit S, Hirunsri P, Baosoung V, Uthammachai C, Chaimongkol B; et al. (1992). "An efficacy study of itraconazole in the treatment of Penicillium marneffei infection". J Med Assoc Thai. 75 (12): 688–91. PMID 1339213.
- ↑ 2.0 2.1 Supparatpinyo K, Schlamm HT (2007). "Voriconazole as therapy for systemic Penicillium marneffei infections in AIDS patients". Am J Trop Med Hyg. 77 (2): 350–3. PMID 17690411.
- ↑ Sirisanthana T, Supparatpinyo K (1998). "Epidemiology and management of penicilliosis in human immunodeficiency virus-infected patients". Int J Infect Dis. 3 (1): 48–53. PMID 9831676.
- ↑ Supparatpinyo K, Perriens J, Nelson KE, Sirisanthana T (1998). "A controlled trial of itraconazole to prevent relapse of Penicillium marneffei infection in patients infected with the human immunodeficiency virus". N Engl J Med. 339 (24): 1739–43. doi:10.1056/NEJM199812103392403. PMID 9845708.