Systemic fungal infections

The management of candidiasis and aspergillosis is discussed in the light of these new agents and advances in susceptibility testing for Candida sp. and of diagnostic tests for aspergillosis. Cryptococcal meningitis remains a leading cause of death in HIV-infected patients in Africa and Asia. Initial treatment is with amphotericin plus flucytosine. Patients with high cerebrospinal fluid opening pressure may need serial therapeutic lumbar punctures. Rhinocerebral mucormycosis is a rare but devastating infection in diabetic and neutropenic patients, presenting with orbital swelling, fever and facial pain. The endemic dimorphic fungal infections include histoplasmosis, which is widespread but most common in the Ohio and Mississippi valleys, and penicilliosis in South-East Asia.