Fungal Disease Experts Call for Talaromycosis to be listed as a Neglected Tropical Disease

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An international panel of experts is calling on global health organisations like the WHO to classify Talaromycosis as a Neglected Tropical Disease (NTD). Shanti Narayanasamy, working with Thuy Le at the Duke University School of Medicine, has summarised the strong arguments in favour of NTD designation in a paper in Lancet Global Health, found here (paper link).

Per the paper, Talaromycosis fulfils all four WHO criteria for inclusion on the NTD list:

  • Causes stigma, morbidity, and mortality among impoverished people
  • Primarily occurs in tropical or subtropical regions of Asia
  • Research support for Talaromycosis has been insufficient to determine the optimal diagnostic and treatment approaches
  • Control of Talaromycosis is feasible with known public health strategies
Positive blood culture showing growth of T. marneffei and its characteristic red pigment.

Talaromycosis is caused by the fungus Talaromyces marneffei and is endemic in the tropical and subtropical regions of Asia. Human infection is presumed to occur via inhalation of T. marneffei spores from the environment and predominantly occurs in those with AIDS and other immune deficits. The HIV pandemic has led to a rapid rise in global incidence, particularly in the hyperendemic areas of southeast Asia (Thailand, Vietnam, and Myanmar), East Asia (southern China, Hong Kong, Taiwan), and northeastern India. About 17,300 talaromycosis cases occur annually leading to 4,900 associated deaths.

Talaromycosis is characterised by disfiguring cutaneous lesions that predominate on the face and extremities. They are a feature of disseminated infection, which prompts hospital admission and epitomise the visually stigmatising nature of the disease. Blood cultures are usually positive for the fungus. A new antigen assay has been developed and is in commercial development outside China: Aspergillus antigen testing may also be positive, because of cross-reactivity.

Talaromycosis is predominantly confined to rural communities in low-income SE Asian communities and so access to diagnosis and treatment is problematic. By raising the profile of this condition the authors hope to encourage public health awareness and research funding.

Professor Thuy Le declared: “Talaromycosis meets all criteria to be included in the WHO neglected tropical disease list and shares many features of other infectious diseases associated with poverty currently recognised by WHO, the journal PLOS Neglected Tropical Diseases and the US FDA. The substantial challenges in the diagnosis and treatment of talaromycosis represent enormous opportunities to make an impact on the disease at both the individual and population levels. Recognition of talaromycosis as an NTD by global public health organisations, funders, and other stakeholders will show the commitment and provide the necessary impetus to improve the control and prevention of this deadly infectious disease.”

To find out more about the global burden of this infection and how it can be curtailed, you can access the full journal article and its supplement in The Lancet Global Health:

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