The Major Endemic Mycoses in the Setting of AIDS: Clinical Manifestations

Abstract

There are four major endemic systemic mycoses, including coccidioidomycosis, paracoccidioidomycosis, blastomycosis, and histoplasmosis. All of these are commonly found in geographically circumscribed areas of the western hemisphere, but histoplasmosis is uncommonly scattered about the eastern hemisphere as well. None of these infections were initially associated with AIDS, and as recently as 1985 histoplasmosis, the most commonly seen, was reported in only 0.5% of AIDS patients. The situation has changed considerably since 1985. At present there are increasing numbers of patients who have developed coccidioidomycosis in the setting of HIV exposure (Ampel et al., 1989). These are discussed elsewhere in this book (see Galgiani et al.). Two others, paracoccidioidomycosis and blastomycosis, remain rarities in the setting of AIDS. Of 2 patients with North American blastomycosis, neither had other concurrent infections, neither had diagnostic serologic titers, and both had disseminated disease (Chiu et al., 1988). One reported patient with paracoccidioidomycosis also had disseminated disease (Bakos et al., 1988). Remarkably, this developed while he was receiving ketoconazole for esophageal candidiasis. The disease did respond to intravenously administered amphotericin B. There are other scattered unreported cases of these infections in AIDS patients.