Endemic mycoses in AIDS: a clinical review

Histoplasmosis and coccidioidomycosis are serious opportunistic infections in patients with AIDS who reside in areas of endemicity of the United States and Central and South America. Blastomycosis, although less common, also must be recognized as an opportunistic infection in patients with AIDS. Prompt diagnosis requires knowledge of the clinical syndromes and diagnostic tests as well as a high index of suspicion. Histoplasmosis and blastomycosis respond well to antifungal treatment, but relapse is common without chronic suppressive therapy. Improvements in treatment are needed in coccidioidomycosis. Research is needed to identify preventive strategies for patients at risk. These strategies may include use of prophylactic antifungal therapy or vaccination.