Epidemiology of mycoses in the HIV-infected patient: clinical aspects.

Among the major problems confronting patients with AIDS are opportunistic fungal infections. Primary infections include candidiasis, cryptococcosis, the major endemic mycoses, and aspergillosis. The endemic mycoses of AIDS consist of Histoplasma found mostly in the U.S. and Latin America, Coccidioides in parts of Latin America and the southwest U.S., Penicillium marneffei in Thailand and other parts of southeast Asia, and Blastomyces worldwide. The latter, however, has so far been rare in AIDS. The major endemic mycoses tend to target patients very late in AIDS, with CD4 counts commonly below 100. Diagnosis is usually made by characteristic morphology of the fungal elements as seen at microscopy, and the pathogens are readily cultured from infected tissues, and in the case of Histoplasma, from blood.