OPPORTUNISTIC FUNGAL-INFECTIONS - FILAMENTOUS FUNGI AND CRYPTOCOCCOSIS

Older patients with diabetes mellitus or pulmonary diseases and those receiving immunosuppressive drugs are at an increased risk of infectio n with environmentally-acquired, opportunistic fungal diseases. Asperg illus most often produces invasive pulmonary or sinus infection in sev erely immunocompromised patients. Chronic necrotizing pulmonary and si noorbital aspergillosis present subacutely and are often misdiagnosed. Mucormycosis classically presents with rhinocerebral disease in diabe tic patients with ketoacidosis, whereas pulmonary infection mimics inv asive pulmonary aspergillosis and occurs mostly in patients who are ne utropenic. Cryptococcal meningitis in the older patient may manifest s imply as confusion. Amphotericin B is the preferred initial treatment for all three fungal infections.