Talaromyces (formerly Penicillium) marneffei Infection

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

• Individuals with diabetes mellitus or tuberculosis seem to be at increased risk

• 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, or liposomal amphotericin B, 3–5 mg/kg/day, if available

  • 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)

  • Parenteral therapy 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