Talaromycosis is a fungal infection that presents with painless skin lesions of face and neck, fever, anaemia, large lymph glands and liver.It is caused by the fungusTalaromyces marneffei, which is found in soil and decomposing organic matter. The infection is thought to be acquired by breathing in the fungus from the environment, however, the environmental source of the organism is not known. It typically occurs in people who are already sick and unable to fight infection such as HIV/AIDS, cancer, organ transplant, long-term steroid use, old age, malnutrition or autoimmune disease. It generally does not affect healthy people and does not spread from person to person. Diagnosis is usually made by identification of the fungus from clinical specimens, either by microscopy or culture. Biopsies of skin lesions, lymph nodes, and bone marrow demonstrate the presence of organisms on histopathology. Medical imaging may reveal shadows in the lungs. The disease can look similar to tuberculosis and histoplasmosis.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. The disease is fatal in 75% of those not given treatment.Talaromycosis is endemic exclusively to southeast Asia (including southern China and eastern India), and particularly in young farmers. The exact number of people in the world affected is not known. Men are affected more than women. The first natural human case of talaromycosis was reported in 1973 in an American minister with Hodgkins disease who lived in Southeast Asia.
People taking elagolix with new or existing depressive symptoms should be promptly evaluated to determine whether the benefits of treatment outweigh the risks. In those with new or existing depressive symptoms, referral to a mental health professional, as appropriate, may be warranted. Immediate medical attention should be sought for those with suicidal ideation and behavior.Elagolix dose-dependently produced elevated liver enzymes, including elevations of serum alanine aminotransferase of at least 3-fold the upper limit, in clinical trials. This was observed in one woman (0.2%) with 150 mg once per day and in five women (1.1%) with 200 mg twice per day, compared to one woman (0.1%) given placebo. Medical attention should be sought if signs or symptoms of liver injury, such as jaundice, are noticed. The lowest effective dosage of elagolix may be used to minimize the risk of liver problems, and in those who develop elevated liver enzymes during elagolix therapy, prompt evaluation should be done to determine whether the benefits of treatment outweigh the risks. Overdose
In the event of an overdose of elagolix, the person should be monitored for any signs or symptoms of adverse reactions and should be treated on a symptomatic basis as needed. Elagolix has been assessed in clinical studies at a dose as high as a single administration of 1,200 mg, which resulted in concentrations of the medication that were 17 times higher than with the typical high clinical dosage of 200 mg twice per day. No adverse effects were mentioned.