Which types of fungus are the patient most likely infected with? A 36-year-old man who is HIV-positive presents to the physician with fever, cough, headaches, and myalgias. Questioning reveals that the man has just returned from a visit with his brother, who lives in Mississippi. No action is taken at the time, and the patient is sent home. A few weeks later, the patient returns to the hospital with an intracellular lung disease resembling tuberculosis (TB). Microscopic examination of the patient’s sputum reveals a fungal infection.

Histoplasma

The correct answer is C. Histoplasmosis does not typically lead to a symptomatic presentation. When symptoms are present, they usually manifest as a flu-like illness with fever, cough, headaches, and myalgias. Histoplasmosis can result in a lung disease resembling tuberculosis and widespread disseminated infection affecting the liver, spleen, adrenal glands, mucosal surfaces, and meninges. On light microscopy, histoplasmosis appears as small particles inside macrophages. Histoplasmosis occurs most commonly in the Mississippi and Ohio river valleys Answer A is incorrect. Blastomycosis can present with flu-like symptoms, fevers, chills, productive cough, myalgia, arthralgia, and pleuritic chest pain. Some patients will fail to recover from an acute infection and progress to develop chronic pulmonary infection or widespread disseminated infection. Fluconazole or ketoconazole is used for the treatment of local blastomycosis, and amphotericin B is used for the treatment of systemic infections Answer B is incorrect. Cryptococcus neoformans infection does not often present with any symptoms in an immunocompetent host. However, in an immunocompromised individual, it can present with meningoencephalitis. Cryptococcus is a heavily encapsulated yeast that is not dimorphic. The fungus is found in soil and pigeon droppings Answer D is incorrect. Mucor species is a mold with irregular nonseptate hyphae branching at wide angles (>90 degrees). Symptoms of Mucor infection include an allergic reaction and infarction of distal tissue due to fungal proliferation in the walls of blood vessels. The disease is mostly seen in patients with ketoacidotic diabetes and leukemia. High doses of amphotericin B are used to treat mucormycosis Answer E is incorrect. Malassezia furfur infection causes tinea versicolor. Symptoms of this infection include hypo- or hyperpigmented skin lesions that occur in hot and humid weather. Topical miconazole or selenium sulfides (Selsun) are used to treat M. furfur.