Fungal Infection Diagnosis and Management

David W. Warnock - National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Preface to the first edition, xxviii

Acknowledgements, xxix

1 Introduction, 1

1.1 The nature of fungi, 1

1.2 Classification and nomenclature of fungi and fungal diseases, 3

1.3 Fungi as human pathogens, 5

1.4 The changing pattern of fungal infection, 7

1.5 New directions in diagnosis, 9

1.6 New directions in treatment and prevention, 10

2 Laboratory diagnosis of fungal infection, 12

2.1 Introduction, 12

2.2 Collection of specimens, 13

2.3 Specimens for serological tests, 18

2.4 Specimens for antifungal drug level determinations, 18

2.5 Transport of specimens, 18

2.6 Interpretation of laboratory test results, 18

2.7 Molecular diagnosis of fungal infection, 28

3 Antifungal drugs, 32

3.1 Introduction, 32

3.2 Allylamines, 32

3.4 Other allylamine compounds for topical administration, 35

3.5 Azoles, 35

3.6 Fluconazole, 40

3.7 Itraconazole, 44

3.8 Ketoconazole, 48

3.9 Posaconazole, 50

3.10 Voriconazole, 53

3.11 Other imidazole compounds for topical administration, 57

3.12 Echinocandins, 59

3.13 Anidulafungin, 60

3.14 Caspofungin, 61

3.15 Micafungin, 63

3.16 Polyenes, 65

3.17 Amphotericin B, 66

3.18 Other polyene compounds for topical administration, 76

3.19 Flucytosine, 76

3.20 Griseofulvin, 79

3.21 Other miscellaneous compounds for topical administration, 81

3.22 Prophylactic treatment for prevention of fungal infection, 82

3.23 Empirical treatment of suspected fungal infection in the neutropenic patient, 84

3.24 Pre-emptive antifungal treatment, 85

3.25 Combination antifungal treatment of invasive fungal infections, 85

3.26 Laboratory monitoring, 86

4 Dermatophytosis, 91

4.1 Introduction, 91

4.2 The causal organisms and their habitat, 92

4.3 Epidemiology, 93

4.4 Laboratory diagnosis of dermatophytosis, 94

4.5 Tinea capitis, 95

4.6 Tinea corporis, 102

4.7 Tinea cruris, 105

4.8 Tinea pedis, 107

4.9 Tinea manuum, 111

4.10 Tinea unguium, 113

5 Superficial candidosis, 121

5.1 Definition, 121

5.2 Geographical distribution, 121

5.3 The causal organisms and their habitat, 121

5.4 Epidemiology, 122

5.5 Clinical manifestations, 124

5.6 Essential investigations and their interpretation, 130

5.7 Management, 130

5.8 Prevention, 136

6 Other cutaneous fungal infections, 138

6.1 Pityriasis versicolor, 138

6.2 Other Malassezia infections, 142

6.3 Piedra, 143

6.4 White piedra, 144

6.5 Black piedra, 145

6.6 Tinea nigra, 147

6.7 Neoscytalidium infection, 148

6.8 Alternaria infection, 149

7 Mould infections of nails, 151

7.1 Definition, 151

7.2 Geographical distribution, 151

7.3 The causal organisms and their habitat, 151

7.4 Epidemiology, 152

7.5 Clinical manifestations, 152

7.6 Differential diagnosis, 153

7.7 Essential investigations and their interpretation, 153

7.8 Management, 154

7.9 Prevention, 155

8 Keratomycosis, 156

8.1 Definition, 156

8.2 Geographical distribution, 156

8.3 The causal organisms and their habitat, 156

8.4 Epidemiology, 157

8.5 Clinical manifestations, 158

8.6 Essential investigations and their interpretation, 159

8.7 Management, 160

9 Otomycosis, 162

9.1 Definition, 162

9.2 Geographical distribution, 162

9.3 The causal organisms and their habitat, 162

9.4 Epidemiology, 162

9.5 Clinical manifestations, 163

9.6 Differential diagnosis, 164

9.7 Essential investigations and their interpretation, 164

9.8 Management, 164

10 Aspergillosis, 166

10.1 Definition, 166

10.2 Geographical distribution, 166

10.3 The causal organisms and their habitat, 166

10.4 Epidemiology, 167

10.5 Clinical manifestations, 170

10.6 Essential investigations and their interpretation, 182

10.7 Management, 186

10.8 Empirical treatment of suspected invasive aspergillosis, 194

10.9 Prevention, 195

11 Invasive candidosis, 201

11.1 Definition, 201

11.2 Geographical distribution, 201

11.3 The causal organisms and their habitat, 201

11.4 Epidemiology, 202

11.5 Clinical manifestations, 208

11.6 Candidosis in special hosts, 217

11.7 Essential investigations and their interpretation, 217

11.8 Management, 221

11.9 Empirical treatment of suspected invasive candidosis, 232

11.10 Prevention, 232

12 Cryptococcosis, 236

12.1 Definition, 236

12.2 Geographical distribution, 236

12.3 The causal organisms and their habitat, 236

12.4 Epidemiology, 238

12.5 Clinical manifestations, 240

12.6 Essential investigations and their interpretation, 244

12.7 Management, 246

12.8 Prevention, 251

13 Mucormycosis, 253

13.1 Definition, 253

13.2 Geographical distribution, 253

13.3 The causal organisms and their habitat, 253

13.4 Epidemiology, 254

13.5 Clinical manifestations, 256

13.6 Differential diagnosis, 259

13.7 Essential investigations and their interpretation, 259

13.8 Management, 260

13.9 Prevention, 262

14 Pneumocystosis, 264

14.1 Definition, 264

14.2 Geographical distribution, 264

14.3 The causal organisms and their habitat, 264

14.4 Epidemiology, 265

14.5 Clinical manifestations, 268

14.6 Differential diagnosis, 269

14.7 Essential investigations and their interpretation, 270

14.8 Management, 271

14.9 Prevention, 274

15 Blastomycosis, 277

15.1 Definition, 277

15.2 Geographical distribution, 277

15.3 The causal organism and its habitat, 277

15.4 Epidemiology, 278

15.5 Clinical manifestations, 279

15.6 Differential diagnosis, 282

15.7 Essential investigations and their interpretation, 282

15.8 Management, 283

15.9 Prevention, 286

16 Coccidioidomycosis, 288

16.1 Definition, 288

16.2 Geographical distribution, 288

16.3 The causal organisms and their habitat, 288

16.4 Epidemiology, 289

16.5 Clinical manifestations, 291

16.6 Differential diagnosis, 294

16.7 Essential investigations and their interpretation, 294

16.8 Management, 297

16.9 Prevention, 301

17 Histoplasmosis, 304

17.1 Definition, 304

17.2 Geographical distribution, 304

17.3 The causal organism and its habitat, 305

17.4 Epidemiology, 305

17.5 Clinical manifestations, 307

17.6 Differential diagnosis, 312

17.7 Essential investigations and their interpretation, 313

17.8 Management, 316

17.9 Prevention, 320

18 Paracoccidioidomycosis, 322

18.1 Definition, 322

18.2 Geographical distribution, 322

18.3 The causal organism and its habitat, 322

18.4 Epidemiology, 323

18.5 Clinical manifestations, 324

18.6 Differential diagnosis, 327

18.7 Essential investigations and their interpretation, 327

18.8 Management, 329

18.9 Prevention, 331

19 Chromoblastomycosis, 332

19.1 Definition, 332

19.2 Geographical distribution, 332

19.3 The causal organisms and their habitat, 332

19.4 Epidemiology, 333

19.5 Clinical manifestations, 333

19.6 Differential diagnosis, 334

19.7 Essential investigations and their interpretation, 334

19.8 Management, 335

20 Entomophthoromycosis, 338

20.1 Introduction, 338

20.2 Basidiobolomycosis, 338

20.3 Conidiobolomycosis, 341

21 Mycetoma, 344

21.1 Definition, 344

21.2 Geographical distribution, 344

21.3 The causal organisms and their habitat, 344

21.4 Epidemiology, 346

21.5 Clinical manifestations, 346

21.6 Differential diagnosis, 347

21.7 Essential investigations and their interpretation, 348

21.8 Management, 349

22 Sporotrichosis, 352

22.1 Definition, 352

22.2 Geographical distribution, 352

22.3 The causal organism and its habitat, 352

22.4 Epidemiology, 353

22.5 Clinical manifestations, 354

22.6 Differential diagnosis, 356

22.7 Essential investigations and their interpretation, 357

22.8 Management, 358

22.9 Prevention, 360

23 Hyalohyphomycosis, 362

23.1 Introduction, 362

23.2 Fusarium infection, 362

23.3 Scedosporium infection, 369

23.4 Other agents of hyalohyphomycosis, 373

24 Penicillium marneffei infection, 376

24.1 Introduction, 376

24.2 Geographical distribution, 376

24.3 The causal organism and its habitat, 376

24.4 Epidemiology, 377

24.5 Clinical manifestations, 378

24.6 Differential diagnosis, 378

24.7 Essential investigations and their interpretation, 379

24.8 Management, 380

24.9 Prevention, 381

25 Phaeohyphomycosis, 383

25.1 Introduction, 383

25.2 Geographical distribution, 384

25.3 The causal organisms and their habitat, 384

25.4 Epidemiology, 385

25.5 Clinical manifestations, 387

25.6 Differential diagnosis, 390

25.7 Essential investigations and their interpretation, 391

25.8 Management, 392

26 Other invasive yeast infections, 396

26.1 Introduction, 396

26.2 Systemic Malassezia infection, 396

26.3 Trichosporonosis, 399

26.4 Other yeast infections, 402

27 Unusual fungal and pseudofungal infections, 405

27.1 Introduction, 405

27.2 Adiaspiromycosis, 405

27.3 Lacaziosis, 408

27.4 Pythiosis, 410

27.5 Rhinosporidiosis, 414

Further reading, 416

Select bibliography, 419

Index, 421

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