Table 3.

Salient Points Regarding Central Nervous System (CNS) Talaromycosis.

Clinical Aspects

➢Rare manifestation of talaromycosis ➢Almost all cases reported in patients with HIV/AIDS with CD4 cells <100/μL ➢Almost all patients have widespread disseminated infection

Diagnosis

➢Definite CNS talaromycosis: positive culture from cerebrospinal fluid (CSF) ➢Presumptive CNS talaromycosis: positive culture from blood or another involved site OR positive histopathology from another involved site in a patient with disseminated talaromycosis and symptoms and signs of meningitis ➢Serology not useful

Treatment and Outcomes

➢Amphotericin B, preferably lipid formulation, 5 mg/kg daily for 4–6 weeks ➢Step-down therapy with itraconazole, 200 mg twice daily for at least 12 months ➢Voriconazole, 200–400 mg twice daily, might be efficacious, if itraconazole is not tolerated ➢Antiretroviral therapy for patients with HIV infection ➢Outcomes are dismal; most patients have died