++
Fungal infections are increasingly recognized as the use of broad-spectrum antimicrobial agents has expanded and the number of patients with immune deficiency or on immune modulators has grown. Some pathogens (eg, Cryptococcus, Pneumocystis, Fusarium) rarely cause serious disease in immunocompetent hosts. Other endemic fungi (eg, Histoplasma, Coccidioides, Paracoccidioides) commonly cause disease in immunocompetent persons but tend to be more aggressive in immunocompromised ones. Superficial mycoses are discussed in Chapter 6. Successful management of most systemic fungal infections requires knowledge of the natural history of these diseases and the specific tests needed to make a diagnosis as well as familiarity with the unique pharmacokinetics, adverse effects, and drug interactions of the various therapeutic agents. Consequently, clinicians with extensive experience in the management of fungal infections should be routinely consulted.