[Fungal infections in primary care]

Fungal infections are of minor importance in general practice. With the possible exception of cryptococcosis in HIV-infected patients deep fungal infections are rarely seen in ambulatory medicine. Some exceptions are discussed. Candida spp. are normally found on the surfaces of the gastrointestinal and genital tract. The documentation of yeast from these sites is therefore not an indication for antifungal therapy. Esophagitis oral or vaginal thrush should however be treated promptly with oral fluconazole. Cutaneous mycoses are best treated topically or if too extensive with itraconazole or terbinafine. Treatment of nail infection, if treatment is warranted at all is best treated with terbinafine. Any attempts to attribute uncharacteristic complaints to an intestinal colonization with yeasts or nutritional fungal toxins lacks a scientific background. The practice to diagnose from blood films obscure fungal infections is quackery at best.