Talaromycosis (Penicilliosis) Basics

Key points

  • Talaromycosis (formerly penicilliosis), a fungal infection, spreads in Southeast Asia, southern China, and India.
  • Talaromycosis usually affects people with weakened immune systems.
  • Bumps on the skin are common. Other symptoms vary and affect different parts of the body.
  • Talaromycosis typically affects people with HIV differently than others who get infected.
Global burden of talaromycosis

Overview

Talaromycosis, formerly called penicillosis, is an infection caused by the fungus Talaromyces marneffei.

Talaromycosis affects people who live in or visit Southeast Asia, southern China, or northeastern India. Most people who get talaromycosis have a weakened immune system. People living with HIV are particularly at risk.

Skin bumps are a common sign of Tarlarmycosis. Other symptoms can include fever and cough. Talaromycosis usually affects people with HIV differently than other people who get infected.

Signs and symptoms

Most people who get talaromycosis already had a weakened immune system. Talarmycosis typically affects people with HIV differently than other people who get infected.

Common symptoms

Bumps on the skin are a common symptom. They are usually small and painless. The bumps usually appear on the face and neck but can also appear in other places on the body.

Other symptoms include:

  • Fever
  • General discomfort
  • Weight loss
  • Cough or shortness of breath
  • Swollen lymph nodes, liver, or spleen
  • Diarrhea
  • Abdominal pain

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

Infections in people who have HIV

In people with advanced HIV disease, talaromycosis is more likely to spread to the bloodstream and other parts of the body. Skin bumps, fever and swelling of the spleen are also more common symptoms in people living with HIV. Skin bumps have a slightly different appearance and have a dent in the middle.

Infections in people who do not have HIV

Talaromycosis more commonly affects the mouth, throat, lungs, liver, and bone in people who do not have HIV. However it is still possible for infections to spread into the blood and other parts of hte body. Skin bumps are smooth without indentation in people with talaromycosis who do not have HIV.

Risk factors

Talaromycosis affects people who live in or visit Southeast Asia, southern China, or eastern India. Healthy people rarely get talaromycosis.

Most people who get talaromycosis have a medical condition that weakens their immune system, such as:

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

Agricultural workers and farmers, particularly those working during the rainy season, appear to be more likely to get talaromycosis.

A map showing the global burden of talaromycosis
Global burden of talaromycosis

Causes

Scientitsts believe that people get talaromycosis after breathing in T. marneffei from the environment. Bamboo rats can also get talaromycosis but there is no evidence that it spreads from rats to people. Talaromycosis does not spread from person to person.

In Thailand, infections are more common during rainy seasons so rain might promote the growth of the fungus.

Talaromyces marneffei

Talaromyces marneffei can change from its native mold form in the environment to a parasitic yeast once in a warm-blooded host. In the environment (at 25°C), the mold form produces yellow green colonies and a characteristic soluble red pigment

image of Talaromyces in outdoor environment as mold spores with diagrams of the spores being inhaled by bamboo rats and by a human. In both they turn to parasitic yeast.
Lifecyle of talaromycosis

(1). The mold produces spores that are easily aerosolized (2). The spores are inhaled by the host and are settled into the lungs (3), where they are phagocytosed by the host's alveolar macrophages (4). The higher body temperature (at 37°C) triggers a morphologic change from the mold to a yeast form, which uniquely divides by binary fission forming a characteristic midline septum (5). The yeasts multiply until they cause rupture of the macrophage (6), releasing yeasts that can spread within the lungs and can disseminate to other organs. At the demise of the hosts, the yeast returns to the mold, in abundance, and the cycle repeats.

Prevention

A healthcare provider might prescribe medicine to prevent talaromycosis in high-risk individuals. This includes people with weakened immune systems and who live in places where the fungus is present. Itraconazole is the most commonly used medicine to prevent talaromycosis. However, healthcare providers also can prescribe other antifungal medicines.

Testing and diagnosis

Talaromycosis can be diagnosed by using a sample from the body part that is affected. For example:

  • Bone marrow
  • Blood
  • Fluid in and around the lungs
  • Lymph node
  • Skin

The sample is sent to a laboratory for a fungal culture or to be examined under the microscope. The sample can also be tested for the presence of a protein or DNA of the fungus.

Treatment and recovery

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

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