Table 2.

Comparison of T.amestolkiae and T.marneffei.

	Talaromyces amestolkiae	Talaromyces marneffei
Risk factors	Immunocompromised patient. Case reported in an acute lymphoblastic leukemia patient [15] and we found this pathogen in an AIDS patient.	AIDS (majority of cases having a CD4 count <100 cells/mm3) [16,17,18], autoimmune disorders, cancer, diabetes mellitus [19,20,21].
Clinical manifestations	Respiratory symptoms Productive cough, mild dyspnea, and occasional low grade fever [15] Other symptoms Lymphadenopathy	Respiratory symptoms Nonproductive cough, fever, dyspnea, and chest pain Gastrointestinal symptoms Diarrhea and abdominal pain Skin lesions Papules on the face, chest, and extremities. Subsequently, the center of the papule becomes necrotic, giving the appearance of an umbilicated papule, which can resemble molluscum contagiosum [22]. Mucosal lesions Mucosal lesions appear similar to skin lesions. Distributed in the oral cavity, oropharynx, hypopharynx, stomach, colon, and genitalia had been reported [9,23,24,25]. Other symptoms Weight loss, hepatomegaly, splenomegaly, and/or generalized lymphadenopathy [22].
Definitive diagnosis
Culture	7 days in CYA at 25 °C [2]	May need 4~7 days to grow
	-Colonies slightly raised at the center, slightly sulcate; margins low, plane, entire (2–3 mm) -Soluble pigments very weak brownish-red, in some strains absent (at 37 °C yellowish-red) -No exudates	-mold-to-yeast conversion (the only thermally dimorphic Talaromyces species) -grows readily in Sabouraud dextrose agar
	7 days in MEA at 25 °C	At 25 °C to 30 °C, yellow-green colonies with sulcate folds and a red diffusible pigment in the medium are produced. At 32 to 37 °C (yeast phase)
	-Colonies slightly raised at the center, plane, in some colonies black sclerotia produced in a longer cubation; margins low, plane, entire (3–5 mm) [2]	Morphological transition from a mold to a yeast, producing colonies without a red diffusible pigment [22]
Molecular diagnostics	PCR amplification Sequence identification of specific regions	PCR amplification Sequence identification of specific regions
Treatment
	Pulmonary infection [15] Oral Voriconazole 200 mg every 12 h for 2 months Our patient (co-infected with cryptococcus neoformans meningitis) Amphotericin B for 6 weeks then oral Voriconazole	Recommended induction therapy [22] Amphotericin B, preferably liposomal amphotericin B 3 to 5 mg/kg body weight/day or Deoxycholate amphotericin B 0.7 mg/kg body weight/day, IV for 2 weeks
		Consolidation therapy oral itraconazole, 200 mg every 12 h for a subsequent duration of 10 weeks [26]
		Maintenance therapy (or secondary prophylaxis) oral Itraconazole 200 mg/day
		-Prevent recurrence until the CD4 count increases above 100 cells/mm3 for 6 months [27]
Special consideration		For patients who cannot tolerate any form of amphotericin induction therapy with IV Voriconazole 6 mg/kg every 12 h on day 1 (loading dose), then 4 mg/kg every 12 h or with oral Voriconazole 600 mg every 12 h on day 1 (loading dose), then 400 mg every 12 h for 2 weeks is recommended [28,29]