Infectious Disease Compendium

Talaromyces marneffei. Was Penicillium marneffei

Microbiology

A dimorphic fungus; does not bud (like most yeasts), but divides by fission and can make a red pigment. There are 200 other penicillium species, none of which are pathogenic. It occurs during the rainy season in Thailand.

Epidemiologic Risks

Found in SE Asia (esp northern Thailand), it is found in the soil and associated with bamboo rat burrows. Rats are the vector, but probably not the primary reservoir. In Vietnam, the diease is more common in the rainy season (PubMed).

Autoantibodies to gamma interferon is a risk (Pubmed); patients act like HIV.

Syndromes

Disseminated disease in AIDS patients, rarely other immunosuppressed patients; chronic illness with fever, weight loss, hepatosplenomegaly, and one or more skin lesions. It can disseminate to any organ, lymphadenopathy is common. Skin lesions can resemble molluscum contagiosum.

Bone lesions, which can occur in non-AIDS, bode ill (PubMed).

Treatment

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Start with Amphotericin B, especially in HIV patients, as it has a better outcome for "6-month mortality, clinical response, and fungicidal activity". (PubMed).

Amphotericin B 0.6 mg/kg for 2 weeks then itraconazole (200 bid) for 8 weeks.

Notes

Fluconazole has a high rate of failure; life time suppression with itraconazole (200 qd) in AIDS. Primary prophylaxis in AIDS with CD4 < 200 with itraconazole (200 qd) is effective.