Talaromycosis
Talaromyces (former Penicillium marneffei)
Treatment
- Consider diagnosis in PLWH who lives/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. Aspergillus galactomanan assays may be helpful to diagnose disseminated infections as cross reactivity occurs
| Drug/Dose | Comments | |
| Severe 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) | |
| Moderate talaromycosis | itraconazole 200 mg tid po for 3 days, then 200 mg bid po |
For 8 weeks (followed by secondary prophylaxis) |
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