Fungal infection endemic

The diagnosis of endemic fungal infections is often prompted by a patient history of prolonged (subacute) infectious symptoms, travel or residence in an endemic area, and/or participation in activities that result in exposures to soil contaminated by endemic fungi. 

The approach to antifungal therapy in patients with endemic fungal infections is determined by the severity of clinical presentation, the patient s underlying immunosuppression, and potential toxicities and drug interactions associated with antifungal treatment. 

What are this patient s risk factors for developing an endemic fungal infection ... 

Two of the most common endemic fungal infections (histoplasmosis and North American blastomycosis) are found in... 

The approach to antifungal therapy in patients with endemic fungal infections is determined by the severity of... 

TABLE 81-2. Therapeutic Approach to Endemic Fungal Infections... 

Amphotericin B is the mainstay of treatment of patients with severe endemic fungal infections. The conventional deoxycholate formulation of the drug can be associated with substantial infusion-related adverse effects (e.g., chills, fever, nausea, rigors, and in rare cases hypotension, flushing, respiratory difficulty, and arrhythmias). Pre-medication with low doses of hydrocortisone, acetaminophen, nonsteroidal anti-inflammatory agents, and meperidine is common to reduce acute infusion-related reactions. Venous irritation associated with the drug can also lead to thrombophlebitis, hence central venous catheters are the preferred route of administration in patients receiving more than a week of therapy. 

Response to antifungal therapy in invasive candidiasis is often more rapid than for endemic fungal infections. Resolution of fever and sterilization of blood cultures are indications of response to antifungal therapy. Toxicity associated with antifungal therapy is similar in these patients as described earlier with the caveat that some toxicities maybe more pronounced in crit-ically-ill patients with invasive candidiasis. Nephrotoxicity and electrolyte disturbances, with amphotericin B in particular, are problematic and may not be avoidable even with lipid amphotericin B formulations. Fluconazole and echinocandins are generally safer options, and are generally well tolerated. Decisions to use one class of agents over the other is principally driven by concerns of non-albicans species, patient tolerability, or history of prior fluconazole exposure (risk factor for non-albicans species.). 

Has there been any recent travel, for example, to endemic areas of fungal infections or developing countries ... 

For many years, fungal infections were classified as either superficial nuisance diseases, such as athlete s foot or vulvovaginal candidiasis, or as relatively rare infections confined primarily to endemic areas of the country. When invasive fungal infections were encountered, amphotericin B was the only consistently effective, systemi-cally active agent available for the treatment of systemic mycoses. 

This helps to understand the transmission of certain diseases by air. Valley Fever, for example, is a sometimes very serious disease caused by the fungal agent Coccidioides immitis (Cl). Infection starts with the inhaling of airborne particles, most of these averaging less than 10 microns in diameter. Over 80 percent of people in certain endemic areas of the western United States test positive for having been exposed to CI,25 a clear demonstration of how infectious particles can spread by aerosol. 

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