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Key Features

  • Talaromyces (formerly Penicillium) marneffei is a dimorphic fungus, endemic in southeast Asia

  • Causes systemic infection predominantly in immunocompromised persons, most commonly patients with advanced HIV; one-third of cases may occur in otherwise healthy persons

Clinical Findings

  • Fever

  • Lymphadenopathy

  • Generalized umbilicated papular skin rash

  • Cough

  • Diarrhea

  • CNS infection

Diagnosis

  • Identification of the organism on smears, histopathologic specimens, or culture; the fungus produces a characteristic red pigment in culture media

  • Best sites for isolation include skin, blood, bone marrow, respiratory tract, lymph nodes

  • Antigen and antibody tests have been developed in endemic regions

Treatment

  • Amphotericin B, 0.7–1.0 mg/kg/day intravenously

    • Superior to itraconazole for initial therapy

    • Associated with significantly faster clinical resolution and fungal clearance as well as lower rate of relapse and immune reconstitution inflammatory syndrome (IRIS)

    • Should be continued until patients have had a satisfactory clinical response, at which time they can be switched to itraconazole, 400 mg orally divided into two doses daily for 8 weeks

  • Because relapse rate after successful treatment is 50%, maintenance therapy with itraconazole, 200–400 mg orally once daily is indicated indefinitely or until immune reconstitution occurs

  • Criteria for immune reconstitution include CD4 cells > 100/mcL for ≥ 6 months after the initiation of antiretroviral therapy

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