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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 AIDS

  • Increasingly reported in other immunocompromising conditions, particularly those affecting cell-mediated immunity

  • 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

  • Central nervous system 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/d intravenously, or liposomal amphotericin B, 3–5 mg/kg/d, 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

    • 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

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