Voriconazole or caspofungin is preferred to amphotericin B in treatment of invasive aspergillosis, due to better outcome and less toxicity.

Fungal screen

Beta-d-glucan and Galactomannan

Histoplasmosis

Histoplasma capsulatum

mold in soil and in bird and bat droppings

endemic to Mississippi and Ohio River basins; Missouri river beds; Eastern Great Lakes; in other words, central and southern US

(Histoplasmosis is reportable in some states, including Kentucky, Minnesota, Illinois, Mississippi, Michigan, Indiana, and Pennsylvania.)

Pulmonary and Disseminated forms

Dx

mostly Caseating granulomas, but may be non-caseating granulomas only - found as oval yeast cells within macrophages on biopsy

Culture (25°C): forms branching hyphae

Careful fungal tissue stains and culture, along with Histoplasma urinary antigen testing

Histoplasmosis closely mimics the presentation of sarcoidosis and should be considered when a patient with suspects sarcoidosis deteriorates after immunosuppressive therapy.

In endemic regions, dimorphic fungi (e.g Histoplasma, Blastomyces, Coccidioides) should be excluded before immunosuppression is initiated.

Blastomyces

A dimorphic fungus, Blastomyces dermatitidis