Fungal Infections

Carol A. Kauffman, MD

In This Article

Abstract and Introduction

Opportunistic fungal infections in immunocompromised patients are associated with a high mortality rate. Endemic mycoses are often asymptomatic, but in appropriate hosts, fungi can cause severe and even fatal infection. Skin lesions and multiple nodules or mass-like lung lesions seen on CT scans or radiographs may be clues to specific types of fungal infections. Some fungi grow better in the presence of iron and may cause infection in patients being treated with deferox amine. Face pain in an immunocompromised patient may signify invasive fungal sinusitis. Treatment with antifungal agents needs to be individualized according to factors such as the fungus involved, presence of renal failure, or pregnancy. Combining antifungal agents or addition of other approaches, such as surgical debridement or steps to control intracranial pressure, may be needed for adequate treatment of certain types of fungal infections.

Opportunistic fungal infections constitute an increasing proportion of infections seen in immunocompromised patients; these infections are associated with a very high mortality rate. On the other hand, the endemic mycoses affect tens of thousands of persons who encounter the fungi that cause these infections in the course of every day activities in certain geographic areas. These infections are often asymptomatic, but endemic fungi can cause severe and even fatal infection in the appropriate host. New antifungal agents have changed the treatment of many fungal infections in the past few years. One can now choose from multiple effective drugs for many of the invasive mycoses. The following "clinical pearls" emphasize some clinical syndromes that aid in the diagnosis of fungal infections and highlight various nuances of treatment with antifungal agents.