PULMONARY PENICILLOSIS-MARNEFFEI - REPORT OF THE FIRST IMPORTED CASE IN CANADA

A 57-year-old female, born in Laos and who had lived in Thailand prior to immigrating to Canada in 1989, was seen by her physician with a ch ief complaint of cough and dyspnea. Her chest X-ray showed bilateral p ulmonary air fluid levels. A fungus, with a diffusible red pigment, te ntatively identified as Penicillium marneffei, was isolated from the p atient's bronchial washings and sputum specimens. At 37 degrees C, the fungus converted to a yeast from when cultured on brain heart infusio n agar. Microscopic examination of this culture revealed yeast cells t hat reproduced by fission. The identity of the patient's isolate was c onfirmed as P. marneffei with an exoantigen test. The patient's serum demonstrated specific antibodies to P. marneffei antigen. Treatment wi th amphotericin B and ketoconazole resulted in clinical improvement, c learing of chest X-rays and conversion to sere-negativity. Our case is the first recorded diagnosis of imported penicillosis marneffei in Ca nada, The minimal inhibitory concentrations recorded for the patient's isolate to fluconazole, 5-fluorocytosine, itraconazole and miconazole were 12.5, 0.39, <0.195 and <0.195 mu g/ml, respectively.