ABSTRACT
Endemic mycoses have historically been geographically-restricted, dimorphic fungi that primarily cause pulmonary disease in the form of acute to chronic pneumonia. However, they have been known to cause a wide spectrum of illnesses from subclinical infection to widely disseminated disease in certain hosts. Exposure usually occurs with direct inoculation of fungal spores, either by inhalation or skin implantation. Subsequent disease is then determined by the effectiveness of the host immune response. HIV co-infection can play a role in the manifestation of these fungal infections and poses a challenge for optimal therapy. Systemic antifungal therapy with an azole continues to be the mainstay of treatment. Although in seriously ill patients, induction therapy will generally be with a polyene. In this chapter, we discuss the different manifestations of Histoplasmosis, Sporothricosis, Blastomycosis, Coccidioidomycosis, and Talaromycosis, and outline the antifungal strategies needed for treatment success and their limitations.
