Tuberculosis and Human T-Cell Lymphotropic Virus Type 1 Infection

1026

CORRESPONDENCE Tuberculosis and Human T-Cell Lymphotropic Virus Type 1 Infection SIR- In a recent review of the infectious complications of human T-cell lymphotropic virus type I (HTLV-I) infection, Marsh [1] suggested that those individuals infected with HTLV-I may be at increased risk of tuberculosis. This risk may be due to reduced delayed-type hypersensitivity to PPD in asymptomatic patients infected with HTLV-l. Up to 14% of the population in Papua New Guinea are infected with HTLV-I [2] and this Melanesian virus is genetically distinct from HTLV-1 isolated elsewhere [3]. Tuberculosis is the commonest reason for hospital admissions of adults in Papua New Guinea, and the national incidence of active disease is estimated to be 0.9 per 1,000 population per annum [4]. Tuberculosis complicates symptomatic HIV infection in 69% of patients in Papua New Guinea (author's unpublished data), but as yet, rates of HIV infections are low among patients receiving treatment at tuberculosis clinics. Despite these findings, investigators who recently studied a heterogeneous population in Papua New Guinea with use of a particle agglutination test [5] failed to detect any patients with HTLV-I infection among 102 HIV-negative patients with laboratory-proven tuberculosis (86 cases of pulmonary infection and 16 cases of extrapulmonary infection). Although the possibility of an associa~ion between tuberculosis and HTLV-1 infection is compelling, it IS not yet clinically obvious in Papua New Guinea, where both infections are endemic. Other established clinical associations with HTLV-1 infection in Papua New Guinea remain elusive. The relatively short life expectancy of Papua New Guinea residents coupled with the long latent period of disease related to HTLV-1 that has been reported elsewhere may make such associations -in particular an association with tuberculosis, which is primarily a disease of children and young to middle-aged adults-difficult to identify. Detection of HTLV-l-related disease in Papua New Guinea may be improved if specific ethnic groups with high seroprevalence rates, such as the highland fringe-dwelling Hagahai [2], are targeted.

R. A. Seaton Infection and Immunodeficiency Unit, Kings Cross Hospital, Dundee, United Kingdom References 1. Marsh BJ. Infectious complications of human T cell leukemia/lymphoma virus type I infection. Clin Infect Dis 1996;23:138-45. 2. Yanagihara R, Jenkins CL, Alexander SS, Mora CA, Garruto RM. Human T lymphotropic virus type 1 infection in Papua New Guinea: high prevalence among the Hagahai confirmed by western analysis. J Infect Dis 1990; 162:649-54. 3. Gessain A, Yanagihara R, Franchini G, et al. Highly divergent molecular variants of human T-lymphotropic virus type 1 from isolated populations in Papua New Guinea and the Solomon islands. Proc Nat! Acad Sci USA 1991; 88:7694-8. 4. Perera J, Manlapig A, Pipi A, Trvertz O. Serosurveillanceof tuberculosis patients [abstract]. In: Abstracts of the Medical Society of Papua New Guinea 29th annual medical symposium. Port Moresby, Papua New Guinea, 1993.

5. Seaton RA, Wembri JP, Nwokolo N. Clinical associations with human T celllymphotropic virus type-I (HTLV-l) in Papua New Guinea. Med J Aust 1996; 165:403-6. ~ep~nts or correspondence: R. A. Seaton, Infection and Immunodeficiency Uillt, Kings Cross Hospital, Clepington Road, Dundee DD3 8EA, United Kingdom. Clinical Infectious Diseases 1997;24:1026 © 1997 by The University of Chicago. All rights reserved.

1058--4838/97/2405 -0058$02.00

Penicillium marneffei Infection Associated with AIDS SIR-In Duong's review of Penicillium marneffei infection [1], he stated that the first case of penicilliosis mameffei associated with HIV infection was reported in the United States in 1988 [2]. In fact, two other cases that were not referred to in Duong's review but that were indexed in MEDLINE were reported in 1988 in France [3] and England [4]. The French case was diagnosed in a 30-year-oldhomosexual male 9 months after he traveled to Indonesia and Southeast Asia. The patient developed fever associated with pulmonary infiltrates and pleural and pericardialeffusion. P. marneffei was culturedfrom blood, pleural fluid, and bronchoalveolar lavage specimens, and the fungus was identified after it was inoculated into golden hamsters by the Mycology Reference Laboratory at the Pasteur Institute. When we submitted this case to prominent medicaljournals, we were informed that reporting isolated cases of opportunistic fungi in patients with AIDS was not of interest. Nine years later, P. mameffei definitely appears to be an important "emerging systemic mycosis in AIDS patients traveling or living in southeast Asia" [5].

J. Dupouy-Camet and T. Aneelle Department of Parasitology-Mycology, Cochin Hospital, Descartes University, Paris, France References 1. Duong TA. Infection due to Penicillium marnefJei, an emerging pathogen: review of 155 reported cases. Clin Infect Dis 1996;23:125-30. 2. Piehl MR, Kaplan RL, Haber MH. Disseminated penicilliosis in a patient with acquired immunodeficiency syndrome. Arch Pathol Lab Med 1988' 112:1262-4. ' 3. Ancelle T, Dupouy-Camet J, Pujol F, et al. Un cas de penicilliose disseminee it Penicillium marnefJeichez un malade atteint d'un syndrome immunodeficitaire acquis. Presse Med 1988; 17:1095-6. 4. Peto TE, Bull R, Millard PR, et al. Systemic mycosis due to Penicillium marnefJei in a patient with antibody to human immunodeficiency virus. J Infect 1988; 16:285-90. 5. Drouhet E. Penicilliosis due to Penicillium marnefJei: a new emerging systemic mycosis in AIDS patients travelling or living in Southeast Asia. Journal de Mycologie Medicale 1993;4:195-224. Reprints or correspondence: Dr. Jean Dupouy-Camet, Laboratoire de Parasitologie-Mycologie, Universite Rene Descartes (Paris V), UFR Cochin Port Royal, 27 rue du Faubourg St. Jacques, 75014 Paris, France. Clinical Infectious Diseases 1997;24:1026 © 1997 by The University of Chicago. All rights reserved. 1058--4838/97/2405 ~0059$02.00