Endemic mycoses in patients with hematologic malignancies

Area of Science:

• Mycology
• Hematology
• Infectious Diseases

Background:

• Histoplasmosis, blastomycosis, and coccidioidomycosis are uncommon but life-threatening fungal infections.
• Patients with hematologic malignancies are at increased risk, particularly those with cellular immune deficiencies.
• Infections can arise from new environmental exposure or reactivation of latent disease.

Purpose of the Study:

• To review the risks, diagnosis, and management of histoplasmosis, blastomycosis, and coccidioidomycosis in patients with hematologic malignancies.
• To highlight the importance of early diagnosis and appropriate antifungal therapy in this vulnerable population.

Main Methods:

• Review of clinical manifestations, diagnostic approaches, and treatment strategies for endemic mycoses in immunocompromised patients.
• Emphasis on histopathologic evaluation of tissue biopsy for initial diagnosis.
• Discussion of current therapeutic recommendations, including initial and suppressive antifungal regimens.

Main Results:

• Severe pulmonary and disseminated infections are the most common presentations in patients with hematologic malignancies.
• Tissue biopsy with histopathologic evaluation is the primary method for early diagnosis.
• Amphotericin B is recommended as the initial treatment of choice for immunosuppressed patients.

Conclusions:

• Prompt diagnosis and aggressive management are essential for improving outcomes in patients with hematologic malignancies and endemic fungal infections.
• Amphotericin B should be the preferred initial antifungal agent.
• Azoles may be used for step-down therapy or long-term suppression in select cases.