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