Diagnosis and treatment of Penicillium (Talaromyces) marneffei infection
- Khuanchai Supparatpinyo, MD
Khuanchai Supparatpinyo, MD
- Professor of Medicine
- Chiang Mai University
- Thira Sirisanthana, MD
Thira Sirisanthana, MD
- Professor of Medicine
- Chiang Mai University
Talaromyces marneffei (formerly Penicillium marneffei) is an important cause of morbidity and mortality in HIV-infected and other immunosuppressed patients who live in or are from Southeast Asia, and can occasionally cause disease in such patients who have had travel-related exposure to this organism . Penicillium marneffei was renamed Talaromyces marneffei in 2015; however, the disease is still referred to as penicilliosis.
For HIV-infected individuals, this systemic fungal infection was commonly diagnosed prior to the era of potent antiretroviral therapy (ART). The widespread use of ART has led to a significant decline of opportunistic infections (OIs), including T. marneffei infection in highly endemic areas. However, despite the widespread availability of ART, T. marneffei infection continues to cause considerable morbidity and mortality in AIDS patients who are unaware of their HIV infection, who do not have access to ART, or who have a suboptimal response to HIV therapy.
The diagnosis and treatment of P. marneffei will be reviewed here. The mycology, epidemiology, and clinical manifestations of P. marneffei are discussed elsewhere. (See "Epidemiology and clinical manifestations of Penicillium (Talaromyces) marneffei infection".)
The diagnosis of penicilliosis should be considered in patients who live in or are from Southeast Asia, northern Australia, South Asia (including India), and China and present with fever, weight loss, non-productive cough, skin lesions, hepatosplenomegaly, and/or generalized lymphadenopathy. Penicilliosis typically occurs in patients who are severely immunocompromised (eg, those with AIDS); however, cases have also been reported in those with other underlying conditions (eg, autoimmune disorders, cancer, diabetes) [2,3]. (See "Epidemiology and clinical manifestations of Penicillium (Talaromyces) marneffei infection", section on 'Epidemiology'.)
A definitive diagnosis is usually made by culture of the fungus from blood, skin biopsy, bone marrow, or lymph nodes. However, given the need for early treatment, a presumptive diagnosis can be made by demonstrating the characteristic morphologic findings of this fungus in biopsy material or in blood smears of patients with fungemia (picture 1) [1,4,5]. T. marneffei (formerly P. marneffei) appear as oval or elongated yeast-like organisms with a clearly defined central septum. The presence of a centrally located transverse septum (eg, "cross wall") differentiates T. marneffei from Histoplasma capsulatum (picture 2) .
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- Molecular diagnostics
- Galactomannan antigen detection
- DIFFERENTIAL DIAGNOSIS
- Treatment approach
- Available agents
- Induction therapy
- - Moderate to severe disease
- - Mild disease
- Maintenance therapy (secondary prophylaxis)
- Patient monitoring
- When to initiate antiretroviral therapy
- Discontinuing maintenance therapy
- Recurrent infection
- Initiating primary prophylaxis
- Discontinuation of primary prophylaxis
- SUMMARY AND RECOMMENDATIONS