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Penicilliosis, Cryptococcosis, and Histoplasmosis: a Comparative Study Between Epidemiology, Clinical Features, Microbiology, Treatment, and Outcome P

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Penicilliosis, Cryptococcosis, and Histoplasmosis: a Comparative Study Between Epidemiology, Clinical Features, Microbiology, Treatment, and Outcome P P795 Abstract (poster session) Penicilliosis, cryptococcosis, and histoplasmosis: a comparative study between epidemiology, clinical features, microbiology, treatment, and outcome P. Uppathamnarakorn*, A. Jindamporn, C. Suankratay (Bangkok, TH) Objectives: Penicilliosis, cryptococcosis, and histoplasmosis are among the most common yeast infections in Thailand. It is very much difficult to distinguish disseminated infection caused by these 3 fungi based on clinical manifestations alone. The aim of this study was to compare epidemiology, clinical features, microbiology, treatment, and outcome between these 3 fungal infections. Methods: Medical records of all patients with diagnosis of Penicillium marneffei, Cryptococcus neoformans, Histoplasma capsulatum attended at King Chulalongkorn Memorial Hospital, Bangkok, Thailand from January 2001 to December 2010 were analyzed. Results: Of 122 patients, there were 28, 50, and 42 P. marneffei, C. neoformans, and H. capsulatum infections, respectively. HIV infection was the most common preexisting condition, accounting for 82.1%, 46%, and 82.1% of penicilliosis, cryptococcosis, and histoplasmosis, respectively. Of 28 patients with penicilliosis, all had disseminated infections. Of 50 patients with cryptococcosis, there were 35 (70%) localized (33 and 2 patients with meningitis and lung infection) and 15 disseminated infections. Of 42 patients with histoplasmosis, there were 5 (11.9%) localized (4 and 1 patients with adrenal glands infection and myelitis) and 37 disseminated infections. Interestingly, the characteristic umbilicated skin lesions were noted in 22 (78.5%), 2 (4%), and 17 (40.5%) patients with penicilliosis, cryptococcosis, and histoplasmosis, respectively. The most common diagnostic method was based on microscopic examination of clinical specimens in 25 (89.3%), 49 (98%), and 41 (97.6%) patients with penicilliosis, cryptococcosis, and histoplasmosis. A definite diagnosis was made based on positive cultures in 17 (58%), 12 (24%), and 6 (14%) patients with penicilliosis, cryptococcosis, and histoplasmosis, respectively. The mortality was 7 (24%), 9 (18%), and 10 (23%) in penicilliosis, cryptococcosis, and histoplasmosis, respectively. Conclusion: Most patients with penicilliosis and histoplasmosis present with disseminated infection. In contrast, subacute and chronic meningitis is the most common presentation in most patients with cryptococcosis. In addition, the characteristic umbilicated skin lesions are frequently noted in patients with penicilliosis and histoplasmosis, compared to those with cryptococcosis. .
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