Fact Sheet: Fungal Infections

Thrush is the most common fungal infection in HIV + people. Thrush can affect the mouth, throat, skin, stomach, and vagina. Usually thrush is easily treated, but in people with HIV it can cause more serious problems. Thrush is sometimes called candidiasis, because the fungus that commonly causes the infection is called candida albicans. Thrush can also be caused by some medications, such as antibiotics, steroids, and cancer medications.

Oral thrush looks like white or red patches in the mouth. Symptoms are sore throat, pain when swallowing, and nausea. You may also not want to eat, and find that eating is painful and that food tastes different. Treatments for oral thrush include mouthwashes and tablets called troches. Some people try baking soda or hydrogen peroxide mixed with water to rinse the mouth. If the thrush is advanced, this won't work. Treatments for thrush include clotrimazole (Mycelex), fluconazole (Diflucan), and itraconazole oral solution (Sporanox). Continuous use of these drugs to prevent thrush is not generally recommended, because thrush can become resistant and is then harder to treat. Resistant thrush is usually treated with the drug amphotericin B (Fungizone).

Vaginal candidiasis is a common yeast infection of the vagina. Symptoms include severe itching, burning, and a thick discharge, often white in color. Nystatin tablets are used for treatment. Clotrimazole ointment is another treatment, which is sold over-the-counter as Gyne-Lotrimin, Lotrimin, or Mycelex. Fluconazole is also used to treat candidiasis. Ongoing use of fluconazole to prevent candidiasis is not generally recommended, because candidiasis that becomes resistant to fluconazole and is harder to treat.

Cryptococcal meningitis is a very serious fungal infection, caused by a fungus found mainly in dirt and bird droppings. Meningitis means swelling of the meninges. The meninges cover the brain and spinal cord. The Network has a separate Simple Fact Sheet on cryptococcal meningitis. Call (800) 734-7104 for a free copy.

Aspergillosis is an illness caused by the Aspergillus fungus. This fungus commonly infects the lungs but can spread throughout the body. In people with AIDS aspergillosis can be life-threatening. Symptoms can be a fever, cough and chest pain. The standard treatment is amphotericin B given intravenously. Amphotericin B has a lot of side effects. A new liposomal form of amphotericin B called ABELCET is approved for treating aspergillosis. Liposomal means the drug is put inside microscopic bubbles of fat called liposomes. The liposomes may help reduce side effects.

Histoplasmosis can be a life-threatening fungal infection and commonly occurs in the Southwestern U.S. The fungus is found in chicken coops, bird roosts and caves and it is recommended that people with HIV avoid these locations. Symptoms include fever and swollen lymph nodes. Severe cases are treated with amphotericin B, but milder cases can be treated with itraconazole.

Blastomycosis is a fungal infection that usually affects the lungs but can spread to the skin and other parts of the body. The fungus is of unknown natural source. Most reported cases are from the southeaster states and the Mississippi River valley, and occur in men ages 20 to 40. When infection occurs in the lungs, a dry hacking or productive cough, chest pain, fever, chills, drenching sweats, and shortness of breath are symptoms. Amphotericin B usually works well as a treatment. Improvement takes about a week, with rapid disappearance of the fungal organisms. Ongoing treatment with itraconazole or ketoconazole may be necessary.

Coccidioidomycosis is a fungal infection most often found in the southwestern USA and northern Mexico. It is also known as Valley Fever. The fungus can infect many different parts of the body, including the lungs and the brain. Symptoms are fevers, fatigue, weight loss and coughing. Amphotericin B is the standard treatment, but there have also been reports of successful treatment using fluconazole.