These small organisms filling macrophages are yeasts of Penicillium marnefeii, a fungus endemic in Southeast Asia, the Guangxi province of China, and Hong Kong. Infections with P marnefeii used to be rare but have increased markedly during the past several years because of the acquired immunodeficiency syndrome (AIDS) pandemic with more persons in Asia becoming infected with human immunodeficiency virus (HIV). The manifestations of P marnefeii infection typically occur later in the course of AIDS, with a CD4 count <100/microliter. Signs and symptoms include fever (99%), anemia (78%), pronounced weight loss (76%), generalized lymphadenopathy (58%), hepatomegaly (51%), and skin lesions (71%) that appear most commonly as papules with central necrotic umbilication. Diagnostic sensitivity is best with bone marrow culture (100%), followed by skin lesion culture (90%), and blood culture (76%). P marnefeii is sensitive to amphotericin B, itraconazole, and ketoconazole.
| Our winner is: Petr Skapa of Zdar nad Sazavou, CZECH REPUBLIC
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