Histoplasma, Coccidioides, Blastomyces, Cryptococcus, Aspergillus, Candida, Sporothrix.
| Fungus | Region | Reservoir | Features | Diagnosis | Treatment |
|---|---|---|---|---|---|
| Histoplasma capsulatum | Ohio + Mississippi River valleys | Bird/bat droppings (caves) | Flu-like + pulmonary nodules; immunocompromised: disseminated (hepatosplenomegaly, pancytopenia, oral ulcers); intracellular yeast in macrophages | Urine antigen, serology, biopsy | Itraconazole; amphotericin if severe/disseminated |
| Coccidioides immitis | SW US (Arizona, S. California), Mexico | Soil after rain/dust storms | 'Valley fever' = pulm + erythema nodosum + arthralgias; can disseminate to skin/bone/meninges (esp. AA/Filipino, pregnant) | Serology, spherules on biopsy | Fluconazole or itraconazole; ampho for severe/meningitis |
| Blastomyces dermatitidis | Mississippi + Ohio Valleys + Great Lakes | Decaying wood, soil | Pulmonary + skin (verrucous ulcers), bone, GU; broad-based budding yeast | Biopsy/culture | Itraconazole; ampho for severe |
| Paracoccidioides | Latin America | Soil | Pulm + mucocutaneous oral ulcers; 'captain's wheel' yeast | Biopsy | Itraconazole; ampho if severe |
| Sporothrix schenckii | Worldwide (rose gardener) | Soil/thorny plants | Linear ulcers along lymphatics from scratch ('rose gardener') | Culture | Itraconazole |
| Fungus | Patient | Features | Treatment |
|---|---|---|---|
| Cryptococcus neoformans | HIV (CD4<100), immunocompromised | Meningitis (headache + AMS + ↑opening pressure); India ink shows encapsulated yeast; serum/CSF cryptococcal antigen | Amphotericin B + flucytosine 2 weeks → fluconazole consolidation/maintenance |
| Aspergillus fumigatus | Neutropenic / transplant | Invasive: pulm with halo/air crescent sign; angioinvasion. Aspergilloma (fungal ball in old cavity). ABPA (asthma + brown sputum) | Voriconazole (invasive); aspergilloma observe; ABPA steroids ± itraconazole |
| Mucormycosis (Rhizopus) | DKA + ferric overload (deferoxamine) | Black necrotic eschar in nose/sinus → invades orbit/brain; non-septate hyphae | Emergent surgical debridement + amphotericin B |
| Pneumocystis jirovecii | HIV CD4<200, steroids | Bilateral interstitial infiltrates + hypoxia + ↑LDH | TMP-SMX + steroids if PaO₂<70 or A-a>35 |
| Candida albicans | Diabetes, abx, immunocompromised, IV lines | Oral thrush, esophagitis (white plaques on EGD), vulvovaginitis, candidemia | Fluconazole (uncomplicated); echinocandin (severe/candidemia) |