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PubMed This is a summary of 18 peer-reviewed journal articles Updated
Infectious Disease

Navigating Your Diagnostic Tests

At a Glance

Talaromycosis diagnosis often requires combining tests: blood cultures can take weeks and may be negative after antifungal treatment, while Mp1p antigen testing may be faster when available. Doctors may add genetic sequencing or tissue testing when results remain unclear.

Diagnosing talaromycosis is a race against time. Because the fungus grows slowly but can spread quickly through the body, doctors use a combination of reference cultures, rapid antigen tests, and advanced genetic sequencing to piece the puzzle together [1][2].

The Reference Standard: Cultures

A culture involves taking a sample of your blood, bone marrow, or tissue and placing it in a specialized environment to see if the fungus grows.

  • Blood Cultures: These are successful in about 73% to 79% of patients in advanced-HIV cohorts [1][3]. However, they can be slow, often requiring 7 days to 2 weeks—and sometimes up to 4 weeks—to show growth [4][2]. A negative culture does not guarantee you don’t have the infection, especially if you have already started antifungal medicine.
  • Bone Marrow Cultures: If a blood culture is negative but your doctor still suspects the fungus, they may test your bone marrow. This can sometimes identify the fungus when blood tests fail [5].

Rapid Testing: Mp1p Antigen

To avoid the long wait for cultures, doctors may use the Mp1p antigen test where available. This test looks for a specific protein (Mp1p) that the fungus secretes into your body [3].

  • Speed: Depending on the specific lab assay, results can be available in as little as 15 minutes for a lateral flow test or 6 hours for an ELISA lab test [6][1].
  • Accuracy: Testing both your plasma (blood) and urine together is the most effective strategy, detecting about 96% of cases in studied HIV cohorts [3]. Note that this test is not universally available and its accuracy may vary in non-HIV patients.

Advanced Genetic Tools: mNGS

Metagenomic Next-Generation Sequencing (mNGS) is a cutting-edge tool that sequences nucleic acids in a sample to find foreign DNA [7].

  • When it’s used: It is an adjunct test particularly helpful for patients who do not have HIV or those with rare immune disorders [7][8].
  • Performance: mNGS can detect the fungus rapidly, sometimes with 97% to 100% sensitivity in selected studies [9][10]. However, performance varies by lab.
  • Caution: If the test shows a very low number of reads, your doctor must carefully compare it with your symptoms to ensure it isn’t a false alarm or contamination [11].

Understanding Your Pathology Report

If you had a biopsy (a tissue sample taken from a skin lesion or lymph node), a pathologist will look at it under a microscope. Biopsies are selected case by case to exclude malignancy or other infections; they are not required for every patient. You may see these technical terms:

  • Dimorphic: Refers to the fungus changing from a mold to a yeast, a strong clue it could be T. marneffei [12].
  • GMS and PAS Stains: Special silver and sugar-based dyes used to make the fungus visible under the microscope [13][14].
  • Transverse Septa: This is a very useful characteristic clue for Talaromyces. It refers to a visible wall or split across the middle of the yeast cell, showing it is dividing by fission [13][15].
  • Intracellular: This means the fungus was found residing inside your own immune cells (macrophages) [13].

Diagnostic Workup Components

A complete evaluation for talaromycosis may include:

  1. Fungal Cultures: Both blood and, if clinically indicated, bone marrow or tissue [16].
  2. Antigen Testing: Combined plasma and urine Mp1p tests, where available [3].
  3. Immune Evaluation: Testing for HIV and checking CD4 counts [17].
  4. Imaging: Chest X-rays or CT scans to look for lung or lymph node involvement [18].
  5. Site-Specific Biopsy: If you have skin spots or enlarged lymph nodes, a biopsy may be selected to provide morphological clues (like septa) [13].

Common questions in this guide

How long can a blood culture take to diagnose talaromycosis?
A blood culture may need 7 days to 2 weeks to grow Talaromyces, and some cultures take as long as 4 weeks. A negative result does not completely rule out talaromycosis, especially if antifungal treatment was started before the sample was collected.
What is the Mp1p antigen test for talaromycosis?
The test looks for Mp1p, a protein released by the fungus. Depending on the method, results may be available in about 15 minutes to 6 hours; testing plasma and urine together can improve detection, but availability and accuracy vary, particularly in people without HIV.
What do transverse septa mean on a talaromycosis pathology report?
Transverse septa are visible walls across the middle of a yeast cell, suggesting it is dividing by splitting and providing a useful clue for Talaromyces. GMS and PAS stains can help the pathologist see the fungus, and the finding must be interpreted with the rest of the report and clinical picture.
What does mNGS show in suspected talaromycosis?
Metagenomic next-generation sequencing, or mNGS, searches genetic material in a sample and can provide a rapid supporting result, especially for patients without HIV or with unusual immune disorders. A very low number of fungal reads may reflect contamination or an uncertain signal, so clinicians compare it with symptoms and other test results.
What happens if my talaromycosis blood culture is negative?
If suspicion remains high, a clinician may consider bone marrow or tissue testing because these samples can sometimes find the fungus when blood does not. The choice depends on your symptoms, examination, and overall health; a biopsy is not needed for every patient.

Questions For You

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Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Was my blood culture incubated long enough to detect a slow-growing fungus like Talaromyces?
  2. 2.Do my pathology results show 'transverse septa,' and how does that help confirm the diagnosis?
  3. 3.Should we perform an Mp1p antigen test on both my urine and plasma to increase the chance of a quick result?
  4. 4.If my blood cultures come back negative but my symptoms persist, is a bone marrow biopsy the next step?
  5. 5.What did the mNGS report show regarding the number of 'reads' for this fungus, and how certain are we of that result?

References

References (18)
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    Superiority of a Novel Mp1p Antigen Detection Enzyme Immunoassay Compared to Standard BACTEC Blood Culture in the Diagnosis of Talaromycosis.

    Thu NTM, Chan JFW, Ly VT, et al.

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2021; (73(2)):e330-e336 doi:10.1093/cid/ciaa826.

    PMID: 32564074
  2. 2

    Diagnostic laboratory immunology for talaromycosis (penicilliosis): review from the bench-top techniques to the point-of-care testing.

    Pruksaphon K, Intaramat A, Ratanabanangkoon K, et al.

    Diagnostic microbiology and infectious disease 2020; (96(3)):114959 doi:10.1016/j.diagmicrobio.2019.114959.

    PMID: 31836254
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    Comparative performance of a commercial and in-house Mp1p antigen-detecting enzyme immunoassay for the rapid diagnosis of talaromycosis.

    Barwatt J, Brown L, Thu NTM, et al.

    PLoS neglected tropical diseases 2025; (19(8)):e0013248 doi:10.1371/journal.pntd.0013248.

    PMID: 40749024
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    Characteristics and Prognosis of Talaromyces marneffei Infection in HIV-positive Children in Southern China.

    Xue X, Zou J, Fang W, et al.

    Mycopathologia 2022; (187(2-3)):169-180 doi:10.1007/s11046-021-00614-5.

    PMID: 35157189
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    Occult Talaromyces marneffei Infection Unveiled by the Novel Mp1p Antigen Detection Assay.

    Ly VT, Thanh NT, Thu NTM, et al.

    Open forum infectious diseases 2020; (7(11)):ofaa502 doi:10.1093/ofid/ofaa502.

    PMID: 33269295
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    Development and Clinical Evaluation of a Novel Talaromyces marneffei Mp1p Lateral Flow Assay for Rapid Diagnosis of Talaromycosis.

    Thu NTM, Brown L, Hawkins O, et al.

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2026; doi:10.1093/cid/ciag004.

    PMID: 41495935
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    Metagenomic Next-Generation Sequencing as an Effective Diagnostic Tool for Talaromycosis in HIV-Negative Patients.

    Jiang L, Liang TW, Al-Odaini N, et al.

    Mycopathologia 2024; (189(4)):63 doi:10.1007/s11046-024-00866-x.

    PMID: 38985209
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    Rapid diagnosis of Talaromyces marneffei infection by metagenomic next-generation sequencing technology in a Chinese cohort of inborn errors of immunity.

    Liu L, Sun B, Ying W, et al.

    Frontiers in cellular and infection microbiology 2022; (12()):987692 doi:10.3389/fcimb.2022.987692.

    PMID: 36159645
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    Emergence of Next-Generation Sequencing for Laboratory Diagnosis of Talaromyces marneffei.

    Xing F, Deng C, Luo Z, et al.

    Mycopathologia 2025; (191(1)):12 doi:10.1007/s11046-025-01028-3.

    PMID: 41422439
  10. 10

    Clinical performance of metagenomic next-generation sequencing for the rapid diagnosis of talaromycosis in HIV-infected patients.

    Mao Y, Shen H, Yang C, et al.

    Frontiers in cellular and infection microbiology 2022; (12()):962441 doi:10.3389/fcimb.2022.962441.

    PMID: 36339344
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    Clinical usefulness of metagenomic next-generation sequencing for Talaromyces marneffei diagnosis in China: a retrospective study.

    Zhang X, Yao X, Chen H, et al.

    European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology 2024; (43(7)):1367-1374 doi:10.1007/s10096-024-04856-1.

    PMID: 38801485
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    Laboratory Maintenance and Growth of Talaromyces marneffei.

    Andrianopoulos A

    Current protocols in microbiology 2020; (56(1)):e97 doi:10.1002/cpmc.97.

    PMID: 32040264
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    Talaromycosis clinically and histopathologically mimicking histoplasmosis in an immunocompromised patient.

    Widaty S, Santoso ID, Ricky D, et al.

    Dermatology online journal 2020; (26(9)).

    PMID: 33054937
  14. 14

    CD86 immunohistochemical staining for the detection of Talaromyces marneffei in lesions.

    Fang J, Chen H, Hamal K, Liu D

    Microbiology spectrum 2025; (13(4)):e0206324 doi:10.1128/spectrum.02063-24.

    PMID: 39992148
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    Unusual disseminated Talaromyces marneffei infection presenting with fever and diarrhea in an AIDS patient: a case report and literature review.

    Tan Y, Zhang Z, Wu M, et al.

    Acta clinica Belgica 2023; (78(1)):67-70 doi:10.1080/17843286.2022.2067957.

    PMID: 35467497
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    An overview of rapid non-culture-based techniques in various clinical specimens for the laboratory diagnosis of Talaromyces marneffei.

    Wei H, Thammasit P, Amsri A, et al.

    Frontiers in cellular and infection microbiology 2025; (15()):1591429 doi:10.3389/fcimb.2025.1591429.

    PMID: 40487313
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    Talaromyces marneffei, Coccidioides species, and Paracoccidioides species-a systematic review to inform the World Health Organization priority list of fungal pathogens.

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    Non-HIV talaromycosis: Radiological and clinical analysis.

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This page explains talaromycosis diagnostic testing for educational purposes and does not replace medical advice. Your clinician and pathologist should interpret your results in the context of your symptoms and overall health.