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.