Talaromycosis (formerly Penicilliosis)

Definition

Talaromycosis is an infection caused by the fungus Talaromyces marneffei. The name of the fungus and the name of the infection have changed. T. marneffei used to be called Penicillium marneffei, and talaromycosis used to be called penicilliosis.1 Talaromycosis only affects people who live in or visit Southeast Asia, southern China, or eastern India.2 Most people who get talaromycosis have a medical condition that weakens their immune system, such as HIV/AIDS, or another condition that lowers the body’s ability to fight germs and sickness.2

Symptoms

Bumps on the skin are a common symptom.3-5 These bumps are usually small and painless. The bumps usually appear on the face and neck but can also appear in other places on the body.2,3 Other symptoms include:3,5,6

  • Fever
  • General discomfort
  • Weight loss
  • Cough
  • Swollen lymph nodes
  • Difficulty breathing
  • Swelling of the liver and spleen
  • Diarrhea
  • Abdominal pain

Talaromycosis may affect people living with HIV differently than people who do not have HIV. In people with HIV, talaromycosis is more likely to spread through the blood and affect the whole body.2-4 In people who do not have HIV, talaromycosis commonly affects the lungs, liver, and mouth, although sometimes it spreads through the blood and affects the whole body.2-4 In people with HIV, skin bumps due to talaromycosis usually have a small dent in the center.5,7 In people who do not have HIV, these bumps are more likely to appear smooth.7 Talaromycosis is also more likely to cause fever and swelling of the spleen in people who have HIV.7

The fungus can make people sick weeks to years after they come in contact with it.6,8,9

Risk and Prevention

Who gets talaromycosis?

Talaromycosis only affects people who live in or visit Southeast Asia, southern China, or eastern India.2 Healthy people rarely get talaromycosis.2,4 Most people who get talaromycosis have a medical condition that weakens their immune system, such as HIV/AIDS, or another condition such as:2,4,5

  • Cancer
  • Organ transplant
  • Adult-onset immunodeficiency syndrome
  • Other autoimmune diseases

 Young farmers in certain parts of Southeast Asia, southern China, or eastern India appear to be more likely to get talaromycosis.10

How can I prevent talaromycosis?

A healthcare provider might prescribe medicine to prevent talaromycosis for people who have a condition that weakens their immune system and who live in places where the fungus is present.3 Itraconazole is the most commonly used medicine to prevent talaromycosis, but healthcare providers also can prescribe other antifungal medicines.3

Sources

Scientists believe that people get talaromycosis after breathing in T. marneffei from the environment.2,3 However, the exact environmental source is unknown. T. marneffei has been found in bamboo rats and their burrows, but people who touch or eat these rats are not more likely to get sick from T. marneffei.2,6,10  Talaromycosis does not spread from person to person.2 In Thailand, talaromycosis is more common during rainy seasons, and some scientists believe that rain helps the fungus grow in the environment.10 In rare cases, other species of Talaromyces other than T. marneffei can also cause talaromycosis.1

Diagnosis & Testing

Talaromycosis can be diagnosed by using a small sample from the body part that is affected, for example: bone marrow, skin, blood, lung, or lymph node.11 The sample is sent to a laboratory for a fungal culture or to be examined under the microscope.11

Treatment

Talaromycosis must be treated with prescription antifungal medicine. The most common treatment is amphotericin B, given through a vein for two weeks, followed by itraconazole, given by mouth for 10 weeks.3  Other antifungal medicines that can be used include itraconazole by itself or voriconazole.3

Statistics

The total number of cases of talaromycosis worldwide is not known. The number of T. marneffei infections in people who have HIV/AIDS has been decreasing due to antiretroviral therapy (ART).2 However, the number of cases in people without HIV/AIDS has increased in parts of Asia since the mid-1990s, probably because of improved diagnosis and a growing number of people with other conditions that weaken their immune systems.4 Scientists estimate that more than 3 in 4 people with talaromycosis will die without treatment with an antifungal medicine.2,5,12 When treated with antifungals, fewer than 1 in 4 people with talaromycosis die.7

References
  1. Yilmaz N, Visagie CM, Houbraken J, Frisvad JC, Samson RA. Polyphasic taxonomy of the genus Talaromyces. Stud Mycol 2014;78:175-341.
  2. Vanittanakom N, Cooper CR, Jr., Fisher MC, Sirisanthana T. Penicillium marneffei infection and recent advances in the epidemiology and molecular biology aspects. Clin Microbiol Rev 2006;19:95-110.
  3. Penicilliosis marneffei. U.S. Department of Health and Human Services, 2013. 2017, at https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-oi-prevention-and-treatment-guidelines/349/penicilliosisExternal.)
  4. Chan JF, Lau SK, Yuen KY, Woo PC. Talaromyces (Penicillium) marneffei infection in non-HIV-infected patients. Emerg Microbes Infect 2016;5:e19.
  5. Supparatpinyo K, Khamwan C, Baosoung V, Nelson KE, Sirisanthana T. Disseminated Penicillium marneffei infection in southeast Asia. Lancet 1994;344:110-3.
  6. Wong SY, Wong KF. Penicillium marneffei Infection in AIDS. Patholog Res Int 2011;2011:764293.
  7. Kawila R, Chaiwarith R, Supparatpinyo K. Clinical and laboratory characteristics of penicilliosis marneffei among patients with and without HIV infection in Northern Thailand: a retrospective study. BMC Infect Dis 2013;13:464.
  8. Bulterys PL, Le T, Quang VM, Nelson KE, Lloyd-Smith JO. Environmental predictors and incubation period of AIDS-associated penicillium marneffei infection in Ho Chi Minh City, Vietnam. Clin Infect Dis 2013;56:1273-9.
  9. Zheng J, Gui X, Cao Q, et al. A Clinical Study of Acquired Immunodeficiency Syndrome Associated Penicillium Marneffei Infection from a Non-Endemic Area in China. PLoS One 2015;10:e0130376.
  10. Chariyalertsak S, Sirisanthana T, Supparatpinyo K, Praparattanapan J, Nelson KE. Case-control study of risk factors for Penicillium marneffei infection in human immunodeficiency virus-infected patients in northern Thailand. Clin Infect Dis 1997;24:1080-6.
  11. Sirisanthana T. Penicillium marneffei infection in patients with AIDS. Emerg Infect Dis 2001;7:561.
  12. Supparatpinyo K, Nelson KE, Merz WG, et al. Response to antifungal therapy by human immunodeficiency virus-infected patients with disseminated Penicillium marneffei infections and in vitro susceptibilities of isolates from clinical specimens. Antimicrob Agents Chemother 1993;37:2407-11.