Pulmonary fungal infections in HIV-infected persons.

Fungal infections account for a large number of AIDS-index diagnoses and complicate the course of most patients with HIV disease. Infection with Cryptococcus neoformans is the most commonly encountered deep-seated fungal infection in AIDS and represents a major threat to HIV-infected people worldwide. Although most patients with cryptococcosis present with meningitis, pulmonary disease may occasionally dominate the clinical picture. Treatment of symptomatic pulmonary cryptococcosis remains amphotericin-B with or without 5-flucytosine. The toxicity and difficulty of administration of amphotericin-B has engendered interest in treatment alternatives with the new triazoles. As HIV infection has become more common in the American heartland, it has overlapped areas endemic for Histoplasma capsulatum, Coccidioides immitis, and Blastomycosis dermatitidis. Disease from these deep-seated fungal pathogens, whether from de novo exposure or reactivation, has protean manifestations. Common to all is a protracted, febrile, wasting illness, with or without respiratory symptoms. Treatment of choice for all these infections remains amphotericin-B, followed by lifelong-maintenance therapy with a triazole. In this article I review the microbiology, epidemiology, presentation, diagnosis, and treatment of AIDS-associated deep-seated fungal infections.