Talaromycosis

Talaromyces (former Penicillium marneffei)

Treatment

[7]

  • Consider diagnosis in PLWH who 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