Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
ENDEMIC MYCOSES
Infect Dis Ther; 3:285-314 1989. Unique Identifier : AIDSLINE ICDB/90665451 Threlkeld MG; Dismukes WE; Div. of Infectious Disease, Dept. of Medicine, Univ. of Alabama; Sch. of Medicine, Birmingham, Alabama
Abstract:
Endemic fungi are important pathogens within their respective habitats, but they are an uncommon cause of disease among persons living outside the endemic area. The major organisms in this group are Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides immitis. Sporothrix schenckii, although not a true endemic fungus, is often included with them, and in the present discussion, Candida spp and other nonendemic fungi, are also considered. Topics include histoplasmosis and coccidioidomycosis (clinical presentation, laboratory diagnosis, and treatment), sporotrichosis (laboratory diagnosis and treatment), blastomycosis, disseminated candidiasis, and prevention of endemic fungus diseases. All these organisms can produce disease in normal individuals, but they do not commonly cause progressive, disseminated disease in hosts with intact cellular immunity. Fulminant, multisystem disease is far more likely to develop in immunocompromised hosts, particularly patients (pts) with AIDS. A high index of suspicion is crucial to the diagnosis of any of these diseases because their clinical presentations usually are nonspecific. A careful travel history and review of prior places of residence should be a part of the initial evaluation of every pt with AIDS. Establishing the presence of one pathogen does not exclude the presence of another. Pts not responding to therapy for a nonfungal infection should be evaluated for the possibility of a concomitant, opportunistic fungal disease. Transbronchial and bone marrow biopsy appear to be the most useful techniques for diagnosis of disseminated fungal disease in pts with AIDS. Skin and other superficial mucosal lesions, when present, should be biopsied for culture and histologic examination. Blood cultures occasionally are diagnostic and should be obtained routinely. Additional invasive procedures may be necessary for diagnosis in some pts. There is no curative therapy for any serious fungal disease in pts with AIDS. Although many pts will respond to treatment with amphotericin B, relapse predictably occurs when the drug is discontinued. Lifelong suppressive or maintenance therapy with either ketoconazole or intermittent amphotericin B appears necessary once primary therapy has been completed. New antifungal azoles, such as itraconazole and fluconazole, are being investigated. (57 Refs)
Keywords: Acquired Immunodeficiency Syndrome/*COMPLICATIONS/DIAGNOSIS Blastomycosis/COMPLICATIONS Candidiasis/COMPLICATIONS Coccidioidomycosis/COMPLICATIONS Histoplasmosis/COMPLICATIONS Human Mycoses/*COMPLICATIONS/DIAGNOSIS Opportunistic Infections/*COMPLICATIONS/DIAGNOSIS Risk Factors Sporotrichosis/COMPLICATIONS JOURNAL ARTICLE REVIEW, TUTORIAL REVIEW 901030
M90A0685
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
