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 |
| 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 |
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