Talaromyces marneffei - mycosis

Systemic infectious disease caused by a dimorphic pathogen (formerly Penicillium marneffei), which poses a potentially fatal risk, particularly in HIV-infected persons. The infection is the third most frequent oppertunistic infection in Southeast Asia among HIV-infected persons (after tuberculosis and cryptococcosis). Mycoses caused by Talaromyces marneffei belong to the AIDS-defining diseases.

Talaromyces marneffei (formerly Penicillium marneffei) is a dimorphic pathogen of a systemic mycosis with infestation of the lung and other organs. The skin is involved in about 75% of cases. The pathogen is endemic in Southeast Asia; here in North Thailand, South China, Hong Kong, Vietnam, Indonesia, Singapore and Myanmar. The only known natural reservoir is bamboo rats. The route of infection is by inhalation aerogenic; a transmission from person to person is not known.

In case of immunocompetence clinically inapparent course. Pneumonia has occasionally been reported in children without predisposing underlying disease. In immunosuppressed persons (immunosuppressive therapy, HIV infection), the infection of the lungs (fever, shortness of breath, haemoptysis) can lead to dissemination with hepatosplenomegaly, lymphadenopathy, anaemia, weight loss. Skin lesions: In 2/3 of these patients there is skin manifestation with mollusca contagiosa-like papules, erosions and ulcerations. Oral mucous membrane infection with flat papules, erosions and ulcers may also occur.

Nodular dermatitis with epitheloid cell granulomas. In PAS staining, detection of intracellular yeast-like fungal elements.

Culture: Depending on the clinical symptoms: cultural evidence of the pathogen from the respiratory tract, blood cultures, bone marrow biopsies, skin biopsies, etc.; Talaromyces (Penicillium) marneffei can be cultivated on conventional fungal culture media within a few days.

Serology: Commercial methods for antigen and antibody detection are not available; antibody detection by immunodiffusion or western blot is possible and may be positive even in HIV infection.

Good response to Amphotericin B (i.v.) Followed by oral maintenance dose with itraconazole or other triazole antifungals. Since these patients are almost exclusively HIV-infected, antiretroviral therapy is mandatory.