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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
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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
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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