Talaromycosis

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Talaromycosis
Other namesPenicillium marneffei,
Antifungals[1]
MedicationAmphotericin B followed by itraconazole or voriconazole[1]
PrognosisOften fatal if untreated[1]
Frequencyunknown[1] M>F[4]

Talaromycosis is a

skin lesions of the face and neck, as well as an associated fever, anaemia, and enlargement of the lymph glands and liver.[1][5]

It is caused by the fungus

Biopsies of skin lesions, lymph nodes, and bone marrow demonstrate the presence of organisms on histopathology.[2] Medical imaging may reveal shadows in the lungs.[4] The disease can look similar to tuberculosis and histoplasmosis.[4]

Talaromycosis may be prevented in people at high risk, using the

antifungal medication itraconazole, and is treatable with amphotericin B followed by itraconazole or voriconazole.[2] The disease is fatal in 75% of those not given treatment.[2]

Talaromycosis is endemic exclusively to southeast Asia (including southern China and eastern India), and particularly in young farmers.

Hodgkin's disease who lived in Southeast Asia.[6]

Signs and symptoms

There may be no symptoms,

difficulty breathing, diarrhoea, abdominal pain, swelling of the spleen (splenomegaly), liver swelling (hepatomegaly), swollen lymph nodes (lymphadenopathy),[2] and anemia.[2][4] There may be no symptoms.[4]

In those without HIV infection, the lungs, liver, and mouth are usually affected, with systemic infection rarely occurring.[2] The skin lesions are also often smooth.[2] The disease tends to present differently in those with HIV infection; they are more likely to experience widespread infection.[2] Their skin lesions however, are usually dented in the centre and can appear similar to molluscum contagiosum.[2][4]

Cause

Talaromycosis is usually caused by T. marneffei, however, other species of the Talaromyces genus are also known to cause the disease in rare cases.[2]

Risk factors

Talaromycosis rarely affects healthy people and generally occurs in people who are already sick and

long-term steroid use, old age, malnutrition or autoimmune disease.[2][4]

Mechanism

The infection is thought to be acquired through breathing in the organism from the environment. However, the exact source of infection is not known.[2] The infection is not spread person-to-person.[2] In Thailand, talaromycosis is more common during the rainy season; rain may promote the proliferation of the fungus in the environment.[2]

Diagnosis

There is no accurate fast

serological test.[3] Diagnosis relies on identifying Talaromyces marneffei in cultures from clinical specimens such as sputum, blood, skin scrapings, lymph node, and bone marrow,[4] by which time the disease is in the late-stage.[7] Fungi in blood are found in half of case.[4]

Non-specific laboratory findings may show evidence of the fungus invading tissue, such as

elevated transaminases due to liver involvement.[8]

Biopsies of skin lesions, lymph nodes, and bone marrow demonstrate the presence of organisms on histopathology.[8] Intracellular and extracellular forms are oval and have a characteristic transverse septum.[4] In culture, colonies are powdery green and produce red pigment; however, cultures are negative in a significant number of cases.[7]

Medical imaging may reveal shadows in the lungs.[4]

Differential diagnosis

The disease can look similar to tuberculosis and histoplasmosis[4]

Treatment

Talaromycosis may be prevented in people at high risk, using the

antifungal medication itraconazole, and is treatable with amphotericin B followed by itraconazole or voriconazole.[2]

Outcomes

With treatment, less than 25% of those affected die.[2] Without treatment, more than 75% will die.[2]

Epidemiology

The exact number of people in the world affected is not known.

antiretroviral treatment, the number of cases in those without HIV began to rise in some endemic areas since the mid-1990s, likely due to improved diagnosis and an increase in other conditions that reduce immunity.[2] The disease has been found to be more common in young farmers.[2] Men are affected more than women.[4]

History

T. marneffei was first isolated from a

Hodgkin's disease who lived in Southeast Asia.[6]

Research

An antigen assay has been developed to detect a key virulence factor Mp1p that has been shown to have a high specificity for Talaromyces marneffei.[7]

References

  1. ^ a b c d e f g h i "ICD-11 - ICD-11 for Mortality and Morbidity Statistics". icd.who.int. Retrieved 11 July 2021.
  2. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae "Talaromycosis (formerly Penicilliosis) | Fungal Diseases | CDC". www.cdc.gov. 3 March 2021. Archived from the original on 12 July 2021. Retrieved 12 July 2021.
  3. ^
    PMID 29621346
    .
  4. ^
    ISBN 978-0-323-56866-1
    .
  5. ^
    S2CID 26045334
    .
  6. ^
    S2CID 208744711
    .
  7. ^
    PMID 32564074
    .
  8. ^ a b Bennett; Dolin; Blaser; Mandell; Bennett (2015). Principles and Practice of Infectious Diseases. Elsevier/Saunders.

External links

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