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Fungal pneumonias. The endemic mycoses
M Goldman1, P C Johnson, G A Sarosi
1Department of Medicine, Indiana University School of Medicine, Indianapolis, USA. mgoldman@iupui.edu
Abstract:
Each year, a vast number of individuals are infected with the endemic fungi. An expanding population, along with further land development in endemic areas, will likely continue to place individuals at risk for exposure to these organisms. A high index of suspicion may be required to diagnose histoplasmosis, blastomycosis, or coccidioidomycosis, particularly for patients who do not reside in endemic areas. Although the majority of patients with histoplasmosis, blastomycosis, and coccidioidomycosis experience self-limited infections, treatment is necessary for patients with severe pneumonitis as well as various forms of chronic pulmonary and disseminated infections. The newer azole agents--itraconazole and fluconazole--are useful in the treatment of these infections and have provided alternatives to long-term therapy with amphotericin B for many patients.
Insights
Endemic fungal infections like histoplasmosis, blastomycosis, and coccidioidomycosis require high suspicion for diagnosis. Newer azole antifungals offer effective treatment alternatives for severe or chronic cases.
Area of Science:
- Mycology
- Infectious Diseases
- Pulmonology
Background:
- Endemic fungal infections pose a growing risk due to population expansion and land development.
- Histoplasmosis, blastomycosis, and coccidioidomycosis are significant public health concerns.
- Diagnosis can be challenging, especially in non-endemic areas, necessitating a high index of suspicion.
Purpose of the Study:
- To review the epidemiology, diagnosis, and treatment of endemic fungal infections.
- To highlight the role of newer azole agents in managing these conditions.
Main Methods:
- Literature review of endemic fungal infections.
- Analysis of treatment outcomes with azole antifungals and amphotericin B.
Main Results:
- Most infections are self-limiting, but severe or chronic cases require treatment.
- Newer azole agents like itraconazole and fluconazole are effective.
- Azoles provide alternatives to prolonged amphotericin B therapy.
Conclusions:
- Prompt diagnosis and appropriate treatment are crucial for managing endemic fungal infections.
- Azole antifungals represent a significant advancement in treating histoplasmosis, blastomycosis, and coccidioidomycosis.