Dimorphic fungi

• Fungi that exist in a mold form at lower temperatures in the environment, and a yeast form at higher temperatures in the host body
• Cryptococcus does exhibit dimorphism, though it is predominately yeast and its dimorphism is not likely related to disease

Organism	Distribution	Diseases	Treatment
Blastomyces species	eastern US and Canada, with some reported in Africa	pulmonary infection, verrucous skin lesions, osteomyelitis, CNS infection	itraconazole (with amphotericin B induction if severe)
Coccidioides species	southwestern US and parts of South and Central America	pulmonary infection, verrucous skin lesions, osteomyelitis, CNS infection	fluconazole (with amphotericin B and flucytosine induction if severe)
Histoplasma capsulatum	worldwide, including eastern North America, Central and South America, sub-Saharan Africa, and parts of Southeast Asia	pulmonary infection, CNS infection	itraconazole (with amphotericin B induction if severe)
Paracoccidioides brasiliensis	South America	pulmonary infection	itraconazole (with amphotericin B induction if severe)
Sporothrix schenckii	essentially worldwide	nodular lymphangitis	itraconazole
Talaromyces marneffei	Southeast Asia	disseminated (common in advanced HIV), pulmonary infection, abdominal abscess, skin lesions, osteomyelitis	amphotericin B induction followed by itraconazole

Distribution

• Endemic dimorphic fungi are widely distributed1

Histoplasmosis

Histoplasmosis

Coccidiomycosis

Coccidiomycosis

Blastomycosis

Blastomycosis