Clinical Presentation

Presentation of any of the endemic mycoses depends on the patient's underlying immune status, as well as on the degree of exposure. For example, in patients with significant immune suppression (CD4+ lymphocyte counts <150/pL), histoplasmosis can manifest with signs and symptoms of disseminated multiorgan infection, whereas patients with more intact immune symptoms can have more localized pulmonary symptoms and signs. Blastomycosis is often a self-limited infection, but it can lead to chronic pneumonia or skin, musculoskeletal, or CNS involvement (Pappas, 2004). Cough, dyspnea, and fever, with or without weight loss or night sweats, are the most common symptoms (Baumgard-ner et al., 2004). Coccidioidomycosis similarly can manifest as a self-limited pulmonary infection. In the case of intense exposure or in immunosuppressed patients, it can manifest as a severe fulminant pulmonary infection with ARDS or as a disseminated infection (peritonitis, lymphadenopathy, skin nodules, meningitis, musculoskeletal or liver involvement).

Respiratory disease caused by Aspergillus can take the form of pseudomembranous tracheitis or invasive pneumonia. Pseudomembranous tracheitis can lead to airway obstruction. Both respiratory syndromes are associated with cough, fever, dyspnea, and hemoptysis, and pneumonia also produces hypoxia. Chest x-ray films can show diffuse interstitial infiltrates or even signs of pulmonary infarction caused by fungal invasion of vascular tissue.

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