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SYNOPSISIn regions to which T. marneffei infection is endemic, serologicsurveillance for patients receiving targeted therapymight be useful in the early diagnosis of T. marneffei infection,as in the case of AIDS patients (19). In non-endemicregions, such as the United States, clinicians should bevigilant of this infrequent infection in at-risk hematologypatients who have resided in or are returning from diseaseendemicareas.This study was partly supported by donations from the HuiHoy and Chow Sin Lan Charity Fund Limited; the Health andMedical Research Fund (ref. no. 13121342) and HKM-15-M07(commissioned study) of the Food and Health Bureau of HongKong Special Administrative Region Government; the StrategicResearch Theme Fund, The University of Hong Kong; and aCroucher Senior Medical Research Fellowship.Dr. Jasper F.W. Chan is a clinical assistant professor in theDepartment of Microbiology, The University of Hong Kong,Hong Kong, China. His research interests include emerginginfectious diseases and opportunistic infections in immunocompromisedhosts.References1. Vanittanakom N, Cooper CR Jr, Fisher MC, Sirisanthana T.Penicillium marneffei infection and recent advances in theepidemiology and molecular biology aspects. Clin Microbiol Rev.2006;19:95–110. http://dx.doi.org/10.1128/CMR.19.1.95-110.20062. Samson RA, Yilmaz N, Houbraken J, Spierenburg H, Seifert KA,Peterson SW, et al. Phylogeny and nomenclature of the genusTalaromyces and taxa accomodated in Penicillium subgenusBiverticillium. Stud Mycol. 2011;70:159–83. http://dx.doi.org/10.3114/sim.2011.70.043. Tang BS, Chan JF, Chen M, Tsang OT, Mok MY, Lai RW, et al.Disseminated penicilliosis, recurrent bacteremic nontyphoidalsalmonellosis, and burkholderiosis associated with acquiredimmunodeficiency due to autoantibody against gamma interferon.Clin Vaccine Immunol. 2010;17:1132–8. http://dx.doi.org/10.1128/CVI.00053-104. Chan JF, Trendell-Smith NJ, Chan JC, Hung IF, Tang BS,Cheng VC, et al. Reactive and infective dermatoses associatedwith adult-onset immunodeficiency due to anti-interferon-gammaautoantibody: Sweet’s syndrome and beyond. Dermatology.2013;226:157–66. http://dx.doi.org/10.1159/0003471125. Lee PP, Chan KW, Lee TL, Ho MH, Chen XY, Li CH, et al.Penicilliosis in children without HIV infection – are theyimmunodeficient? Clin Infect Dis. 2012;54:e8–19. http://dx.doi.org/10.1093/cid/cir7546. Lee PP, Mao H, Yang W, Chan KW, Ho MH, Lee TL, et al.Penicillium marneffei infection and impaired IFN-g immunity inhumans with autosomal-dominant gain-of-phosphorylation STAT1mutations. J Allergy Clin Immunol. 2014;133:8948–6.e5.7. Wong SS, Woo PC, Yuen KY. Candida tropicalis and Penicilliummarneffei mixed fungaemia in a patient with Waldenstrom’smacroglobulinaemia. Eur J Clin Microbiol Infect Dis.2001;20:132–5. http://dx.doi.org/10.1007/PL000112438. Woo PC, Lau SK, Lau CC, Chong KT, Hui WT, Wong SS, et al.Penicillium marneffei fungaemia in an allogeneic bone marrowtransplant recipient. Bone Marrow Transplant. 2005;35:831–3.http://dx.doi.org/10.1038/sj.bmt.17048959. Cheng VC, Chan JF, Ngan AH, To KK, Leung SY, Tsoi HW,et al. Outbreak of intestinal infection due to Rhizopus microsporus.J Clin Microbiol. 2009;47:2834–43. http://dx.doi.org/10.1128/JCM.00908-0910. Yuen KY, Woo PC, Ip MS, Liang RH, Chiu EK, Siau H, et al.Stage-specific manifestation of infection and impaired moldinfections in bone marrow transplant recipients: risk factors andclinical significance of positive concentrated smears. Clin InfectDis. 1997;25:37–42. http://dx.doi.org/10.1086/51449211. Wong SS, Wong KH, Hui WT, Lee SS, Lo JY, Cao L, et al.Differences in clinical and laboratory diagnostic characteristics ofpenicilliosis marneffei in human immunodeficiency virus (HIV)-and non-HIV-infected patients. J Clin Microbiol. 2001;39:4535–40.http://dx.doi.org/10.1128/JCM.39.12.4535-4540.200112. Yuen KY, Wong SS, Tsang DN, Chau PY. Serodiagnosis ofPenicillium marneffei infection. Lancet. 1994;344:444–5.http://dx.doi.org/10.1016/S0140-6736(94)91771-X13. Wu TC, Chan JW, Ng CK, Tsang DN, Lee MP, Li PC. Clinicalpresentations and outcomes of Penicillium marneffei infections: aseries from 1994 to 2004. Hong Kong Med J. 2008; 14:103–9 .14. Dang VD, Hilgenberg E, Ries S, Shen P, Fillatreau S. From theregulatory functions of B cells to the identification of cytokineproducingplasma cell subsets. Curr Opin Immunol. 2014;28:77–83. http://dx.doi.org/10.1016/j.coi.2014.02.00915. Anolik JH, Friedberg JW, Zheng B, Barnard J, Owen T, Cushing E,et al. B cell reconstitution after rituximab treatment of lymphomarecapitulates B cell ontogeny. Clin Immunol. 2007;122:139–45.http://dx.doi.org/10.1016/j.clim.2006.08.00916. Wysham NG, Sullivan DR, Allada G. An opportunistic infectionassociated with ruxolitinib, a novel janus kinase 1,2 inhibitor.Chest. 2013;143:1478–9. http://dx.doi.org/10.1378/chest.12-160417. Hopman RK, Lawrence SJ, Oh ST. Disseminated tuberculosisassociated with ruxolitinib. Leukemia. 2014;28:1750–1.http://dx.doi.org/10.1038/leu.2014.10418. Teo M, O’Connor TM, O’Reilly SP, Power DG. Sorafenib-inducedtuberculosis reactivation. Onkologie. 2012;35:514–6.http://dx.doi.org/10.1159/00034182919. Wang YF, Xu HF, Han ZG, Zeng L, Liang CY, Chen XJ, et al.Serological surveillance for Penicillium marneffei infection inHIV-infected patients during 2004−2011 in Guangzhou, China.Clin Microbiol Infect. 2014;Dec 26:pii:S1198-743X(14)00167-0.[Epub ahead of print].Address for correspondence: Patrick C.Y. Woo, State Key Laboratoryof Emerging Infectious Diseases, Department of Microbiology, CarolYu Centre for Infection, The University of Hong Kong, UniversityPathology Bldg, Queen Mary Hospital Compound, Pokfulam Rd, HongKong, China; email: pcywoo@hku.hk1106 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 21, No. 7, July 2015

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