An HIV-positive patient from Manipur presents with fever, weight loss, hepatosplenomegaly, and multiple skin papules. Bone marrow smear shows intracellular yeast-like organisms with a clear central transverse septum. Which staining feature best confirms the diagnosis?

• A Methenamine silver stain showing cup-shaped cystic forms
• B India ink preparation showing a wide polysaccharide capsule
• C PAS stain showing broad-based budding yeast cells
• D Giemsa stain showing yeast cells dividing by fission with a central septum, giving a sausage shape ✓

Explanation

Talaromyces (Penicillium) marneffei is endemic in Southeast Asia and northeastern India and causes disseminated infection in advanced AIDS. Unlike other thermally dimorphic fungi, its yeast phase divides by binary fission rather than budding, so Giemsa-stained smears show oval cells with a central transverse septum, often described as sausage-shaped. India ink positivity would indicate cryptococcosis, broad-based budding indicates blastomycosis, and cup-shaped cysts on silver stain indicate Pneumocystis.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.