This site is not optimized for mobile devices. For the best mobile experience we suggest you download our mobile app!
Download on App Store App Store Icon App Store Google Play Store Icon Google Play

Talaromycosis

Talaromyces (former Penicillium marneffei)

Diagnosis and treatment

Consider diagnosis in persons with HIV who live/lived in Asia

Diagnosis:
antigen detection in blood, urine or broncho-alveolar fluid, OR positive microscopy, OR mycological culture of blood, urine, broncho-alveolar fluid, CSF or tissue biopsy or PCR in blood OR other clinical samples. Next generation sequencing may provide rapid diagnosis

Notes on treatment:
see Anti-infective drugs & ARVs table for treatment optimization

  Drug/Dose Comments
Disseminated talaromycosis  Induction therapy:
liposomal amphotericin B
3 mg/kg qd iv

For 2 weeks or until clinical improvement

If liposomal amphotericin B is not available, consider using Deoxycholate amphotericin B 0.7 mg/kg/day IV for 2 weeks

Consolidation therapy:
itraconazole

200 mg tid po for 3 days,
then 200 mg bid po

For at least 10 weeks (followed by secondary prophylaxis)

A recent trial suggested that voriconazole (6 mg/kg bid day 1, then 4 mg/kg bid for 2 weeks) may be an alternative therapy for induction phase if amphotericin B not available/not clinically indicated

Secondary Prophylaxis, Maintenance Therapy

Secondary prophylaxis: itraconazole 200 mg qd po

Stop: if CD4 count > 100 cells/μL and HIV-VL undetectable over 6 months, negative fungal blood cultures or negative PCR/ negative antigen