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  • Image not available. Systemic mycoses can be caused by pathogenic fungi and include histoplasmosis, coccidioidomycosis, cryptococcosis, blastomycosis, paracoccidioidomycosis, and sporotrichosis, or infections by opportunistic fungi such as Candida albicans, Aspergillus species, Trichosporon, Candida glabrata, Fusarium, Alternaria, and Mucor.
  • Image not available. The diagnosis of fungal infection generally is accomplished by careful evaluation of clinical symptoms, results of serologic tests, and histopathologic examination and culture of clinical specimens.
  • Image not available. Histoplasmosis is caused by Histoplasma capsulatum and is endemic in parts of the central United States along the Ohio and Mississippi River valleys. Although most patients experience asymptomatic infection, some can experience chronic, disseminated disease.
  • Image not available. Asymptomatic patients with histoplasmosis are not treated, although patients who do not have acquired immune deficiency syndrome (AIDS) patients with evident disease are treated with either oral ketoconazole or intravenous amphotericin B; AIDS patients are treated with amphotericin B and then receive lifelong suppression.
  • Image not available. Blastomycosis is caused by Blastomyces dermatitidis and generally is an asymptomatic, self-limited disease; however, reactivation can lead to chronic disease. Although treatment for self-limited disease is controversial, patients with chronic pulmonary disease or extrapulmonary disease should be treated with ketoconazole, and those with central nervous system (CNS), progressive, or life-threatening disease should receive amphotericin B.
  • Image not available. Coccidioidomycosis is caused by Coccidioides immitis and is endemic in some parts of the southwestern United States. It can cause nonspecific symptoms, acute pneumonia, or chronic pulmonary or disseminated disease. Primary pulmonary disease (unless severe) frequently is not treated, whereas extrapulmonary disease is treated with amphotericin B, and meningitis is treated with fluconazole.
  • Image not available. Cryptococcosis is caused by Cryptococcus neoformans and occurs primarily in immunocompromised patients. Patients with acute meningitis are treated with amphotericin B with flucytosine. Patients infected with human immunodeficiency virus (HIV) often require long-term suppressive therapy with fluconazole or itraconazole.
  • Image not available. A variety of Candida species (including C. albicans, C. glabrata, Candida tropicalis, Candida parapsilosis, and Candida krusei) can cause diseases such as mucocutaneous, oral, esophageal, vaginal, and hematogenous candidiasis, as well as candiduria. Candidemia can be treated with a variety of antifungal agents; the optimal choice depends on previous patient exposure to antifungal agents, potential drug interactions and toxicities of each agent, and local epidemiology of intensive care unit or hematology-oncology centers.
  • Image not available. Aspergillosis can be caused by a variety of Aspergillus species that can cause superficial infections, pneumonia, allergic bronchopulmonary aspergillosis, or invasive infection. Treatment with amphotericin B or voriconazole generally is instituted but often is not successful. Combination therapy, while widely used, lacks clinical trial data to support its use.

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After reviewing this chapter the reader should be able to:

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  • 1. Describe the difference between filamentous molds and yeasts.
  • 2. Describe the current methodology for susceptibility testing of fungi.
  • 3. List 3 clinical circumstances in which plasma level monitoring of antifungal agents may be indicated.
  • 4. List 3 resistance mechanisms of azole antifungal agents.
  • 5. Describe the difference between “acquired" and “intrinsic" resistance to fluconazole
  • 6. List 2 treatment options for the therapy of progressive histoplasmosis ...

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