Organism
Candida albicans (less
commonly, Candida
galabrata)
Sx
Mucosal: oral thrush &
vaginal monilia. Esophageal
candidiasis (AIDS)
Cutaneous: red, pustular
rash. Intertigo; diaper rash
(satellite lesions + macule
periphery)
Chronic monocutaneous
candidiasis: congenital
immunodeficiency
Candidemia: risk in
catheter use. Can travel thru
blood to eye (retinitis,
endophthalmitis)
Cryptococci
Meningitis: common in
neoformans
AIDS, if found in blood and
lungs, CSF C. neoformans
(Cryptococci gatti
is suspected.
less common)
Lung infection: less
common, portal of entry
Skin lesions: uncommon,
umbilicated lesions (AIDS)
Pneomocystis jirovecci
Pneumocystis carinii
pneumonia seen in
previously healthy gay
men— 1st proof of AIDS
pandemic.
Histoplasmosis
low exposure: asx
mild exposure: selflimiting flu-like sx w/
hiliar/mediastinal
adenopathy or lung
Dx
Superficial and
cutaneous fungal
infections  KOH prep
of skin. Gram stain
shows as if Gram +
(purple).
Easy to culture in sheep
blood agar and blood cx
bottles.
Tx
Vaginal: azole drugs
Oral/esophageal:
nystatin, fluconazole, or
caspofungin.
Systemic infection:
amphotericin B,
fluconazole,
caspofungin.
Special Notes
Normal component of
skin, lower GI, oral,
and vaginal flora.
Infections not treated:
onchomycosis of
toenails, candiduria,
and candida in
respiratory sample
(does not cause
pneumonia!!)
CSF visualized with
India ink
Tissue biopsy:
mucicarmine stain of
capsule (RED + test)
Amphotericin B +
flucytosine followed by
months of fluconazole.
CXR: interstitial
infiltrates
Silver stain:
trophozoites present in
sputum
Pathology, culture
fungus (biosafety hood)
Histoplasma antigen test
(urine and/or serum)
TrimothaprimSulfamethoxazole
Yeast with prominent
capsule
Major opportunist
(AIDS)
Can also affect
immunocompetent
Non-contageous
between humans.
No ergosterol in plasma
membrane
Does not respond to
antifungals
Nothing for many
patients.
Mild: PO itraconazole
Severe: IV
amphotericin B (toxic,
Endemic to Ohio &
Mississipi.
Mold lives in soil with
high nitrogen content
due to bird & bat poop
infiltrates on CXR
Heavy: overwhelming lung
infection
Chronic: TB mimetic
Disseminated: affects bone
marrow, spleen (splenic
calcification), meninges.
Mainly in children and
immunocompromised.
last resort) accompanied
by PO itracomazole (1-2
years duration) and
fluconazole if
meningitis occurs
Inhaled after soil
disturbance.
Not contagious to
humans (yeast form)
Blastomycosis
(Blastomyces
dermatitidis)
Sx similar to
histoplasmosis. Cutaneous
(skin) involvement due to
dissemination from lung OR
direct inoculation.
Pathology: large yeast
with broad-based
budding.
*cultured with caution,
infectious
urine antigen assay
Mild: PO itraconazole
Severe: IV
amphotericin B
Endemic to Ohio &
Mississippi, much less
common.
Affects dogs.
Route of infection: lung
inhalation
Coccidioidomycosis
(Coccidioides
immitis*, c. posa
dasii)
Erythema nodosum in legs
(primary pulmonary
disease)
Multiple skin lesions from
dissemination of primary
lung infection
Spherules and endospores in
lungs
Pathology  spherules
Culture fungus  done
in biosafety hood
Serology (increased IgG
or IgM)
Endemic: arid & semiarid SW USA
“San Joaquin Valley
Fever”
Mold lives in soil,
growth ++ rainy season
Inhalation of only a few
particles causes
infection
Aspergillosis
(Aspergillus
fumigatus*,
Aspergillus flavus)
3 classical sx:
1) Allergic
bronchopulmonary
aspergillosis rxn to airway
colonization with asthmalike sx, eosinophilia,
Pathology: septated
hyphae with 45o
branching in GomoriGrocott Methenamine
silver stain (GMS stain)
Unecessary for most
patients with 1o lung
infection
Severe OR
immunocompromised
OR pregnant: IV
amphotericin B (esp. if
disseminated) w/ PO
itraconazole/fluconazole
for monts-1+year
1) steroids +/itraconazole or
voriconazole
2) voriconazole +
surgical
resection if
Widely distributed in
nature
Found in hospital vents
Biggest risk factor:
prolonged neutropenia
Angioinvasive 
fleeting infiltrates, elevated
serum IgE
2) Invasive aspergillosis,
seen in patients with
prolonged neutropenia.
Pulmonary nodules +
positive serum
galactomannan
3) Aspergilloma or fungus
ball in pre-existing lung
cavity. Not invasive, no
antifungal prescribed.
Mucomycosis (mucor,
*Angioinvasive infarct
(worse than aspergillus)
rhizopus, absidia,
*Rhinocerebral
etc)
mucomycosis (acute, lifethreatening) typified by
black necrotic eschars in
nose, sinuses, and palate.
Requires debridement for
survival
*Pulmonary
mucormycosis (similar to
invasive aspergillus) 
pleuritic chest pain due to
infarct
*cutaneous mucormycosis:
nodular lesions
single lesions.
3) Surgical resectin
*Nonseptated hyphae
with 90o branching and
nonparallel walls on
GMS stain
*Nonseptated, broad,
ribbon-like hyphae on
routine hematoxylin and
eosin (H&E) stain.
*Debridement
*amphotericin B
infarcts
Pathogen lives in soil
and decaying veggies
Transmission: inhaled
or wound
contamination
RF: DKA, steroids,
neutropenia, iron
overload &
deferoxamine that
releases iron to fungus,
renal failure,
prophylaxis with
voriconazole