Natural recovery without any treatment usually occurs, especially in patients with mild infection and is immunocompetent without dissemination. This only happens in endemic mycoses. In acute cases, fungal pneumonia treatment has to be administered.
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Ancillary Events
If in a person with weakened immune system, aspergillosis, mucormycosis, and candidiasis occur, then the factors affecting the patient's immune status could be reversed. This will assure successful recovery of the patient from the infection. The following ancillary events can be followed to promote recovery from the opportunistic infection:
- Ensure neutropenia recovery, with the use of growth factors in patients undergoing chemotherapy and bone marrow transplants.
- Streamline or withdraw the use of steroids and immunosuppressive drugs.
- In patients with candidiasis, remove catheters that are infected or are highly colonized.
Medical Treatment
Coccidioidomycosis
Antifungal therapy can be initiated in patients if they show the following indications:
- Chronic pulmonary disease
- Disseminated disease
- Severe pulmonary infection associated with hypoxia or protracted morbidity for more than 1-2 months
- Immunosuppressed host (worst outcome, 70% mortality)
It is necessary to conduct surgical debridement or resection of infective tissue in addition to antifungal treatment. Anti-inflammatory agents are recommended for rheumatologic syndromes. Antifungal agents like Amphotericin B, fluconazole or itraconazole are used.
Cryptococcosis
Following indications suggest antifungal therapy:
- Immunosuppressed and symptomatic patients
- Patients who are immunocompetent with disease progression
- Any patients with meningitis or disseminated disease
Amphotericin B, Fluconazole are used to treat cryptococcosis.
Histoplasmosis
The indications are:
- Acute pulmonary histoplasmosis with hypoxia has moderate symptoms that prolong for more than 1 month.
- Disseminated disease that occurs in an immunocompromised patient
- Mortality rate for untreated disseminated disease is 80%.
- Can be reduced to 25% with treatment
Surgical care and other treatments include recurrent pneumonia; repair of bronchopleural fistula; significant hemoptysis; corticosteroids in severe hypoxia and anti-inflammatory agents to treat rheumatologic syndromes. Antifungal drug used is Amphoterin B.
Aspergillosis; mucormycoses
Indications of the disease are as follows:
- All patients with invasive disease
- Patients who have low immunity
- Prognosis associated with the severity and outcome of underlying disease
- Early diagnosis of the disease and persistent fever not responsding to empiric treatment of broad-spectrum antibiotics
- High mortality seen, once infiltrates and symptoms appear;
- In patients with AIDS, mortality is of 50-60%
- In patients with prior bone marrow transplantation mortality is as high as 85%.
Aggressive surgical debridement of necrotic tissue is important in mucormycosis, especially if confined to lungs. Swift tapering of immunosuppressive agents and corticosteroids and reversal of neutropenia is recommended.
Blastomycosis
The indications for antifungal therapy are as follows:
- Disseminated disease
- Recurrence of symptoms of acute or chronic pulmonary disease or Persistence of symptoms or with pleural involvement
Amphotericin B, Itraconazole, Ketoconazole, Fluconazole are the antifungal drugs recommended.
Candidiasis
Indications are as follows:
- In all patients with invasive disease or dissemination, it is important to reverse factors affecting the immune status.
- Reducing the use of immunosuppressive agents and corticosteroids is important to remove indwelling infected intravenous lines or urinary catheters in setting of hematogenous spread
Amphotericin B, Flucytosine, Fluconazole and Echinocandins are some of the antifungal used to treat this disease.
