Microbiology
A dimorphic fungus; does not bud (like most yeasts), but divides by fission and can make a red pigment. There are 40 plus other Talaromyces species, none of which are pathogenic. It occurs during the rainy season in Thailand.
Found in air and soil.
There are also T. amestolkiae, T. purpurogenus, and T. piceus that occur outside of Asia and can cause disease (PubMed).
Epidemiologic Risks
Found in SE Asia (especially 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 disease is more common in the rainy season (PubMed).
Autoantibodies to gamma interferon is a risk (Pubmed); patients act like HIV and portends a poor outcome (PubMed).
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
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; lifetime suppression with itraconazole (200 qd) in AIDS.
Primary prophylaxis in AIDS with CD4 < 200 with itraconazole (200 qd) is effective.
Last Update: 10/17/19.