Talaromycosis (formerly Penicilliosis)
[Lancet Infect Dis 2021;21:e364-74]
Usual Pathogen
Talaromyces marneffei (formerly Penicillium marneffei)
- Thermally dimorphic fungi endemic throughout southeast Asia, northern Thailand, Vietnam, Myanmar, Hong Kong, Taiwan, southern China, northeastern India.
- HIV is a major risk factor – causes opportunistic infections including bloodstream infections.
- Infectious Diseases consult strongly recommended.
Mild
| Empiric Therapy | Duration | |
|---|---|---|
| Itraconazole | 200mg PO bid | 12 weeks |
| then | ||
| Itraconazole | 200mg PO daily | Until CD4 >100 x 6 months |
Moderate-severe
| Empiric Therapy | Duration | |
|---|---|---|
|
Induction therapy: |
|
|
| Amphotericin B, liposomal | 3-5mg/kg IV daily | 10-14 days |
| or | ||
| Amphotericin B deoxycholate | 0.7mg/kg IV daily |
10-14 days |
| Consolidation therapy: |
|
|
| Itraconazole | 200mg PO bid |
10 weeks |
| Maintenance therapy: |
|
|
| Itraconazole | 200mg PO daily |
Prolonged; depends on clinical response and immunosuppression (CD4 >100 x 6 months) |