Indigenous disseminated Penicillium marneffei infection in the state of Manipur, India: Report of four autochthonous cases

We describe four cases of disseminated infection caused by endemic Penicill ium marneffei in human immunodeficiency virus (HIV)-infected patients from the Manipur state of India. The most common clinical features observed were fever, anorexia, weight loss, hepatosplenomegaly, and, more importantly, s kin lesions resembling molluscum contagiosum. The diagnosis in each of the four cases was achieved by direct examination of smears, observance of intr acellular yeast-like cells multiplying by fission in biopsied tissue from s kin lesions, and isolation of the dimorphic P. marneffei in pure culture in each case. In one case, fluorescent antibody studies allowed specific diag nosis. This report documents a new area in which P. marneffei is endemic, l ocated in eastern India, and describes the first occurrence in India of P. marneffei in HIV-infected patients as well as the extension of the areas of P. marneffei endemicity westward to the northeastern state of Manipur.