The Curbsiders Internal Medicine Podcast #495 Fungal Infections -Histo/Blasto/Cocci with Dr. Andrej Spec
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Aug 18, 2025 Dr. Andrej Spec, an infectious disease expert and co-director of the Invasive Mycoses Clinic at Washington University, dives into the intricacies of fungal infections. He discusses how mislabeling mycoses can lead to diagnostic confusion and the impact of climate change on fungal disease spread. Through real-life cases, he highlights the importance of patient history in diagnosis and urges clinicians to proactively test for conditions like histoplasmosis and blastomycosis. Listeners will also learn about updated treatment approaches that can make all the difference.
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Endemic Label Misleads Clinicians
- The term "endemic mycoses" is misleading because these fungi are found worldwide and maps cause premature closure.
- Missing cases becomes a self-reinforcing loop when clinicians assume rarity and therefore do not test.
Order Broad Early Testing
- Test broadly and early for dimorphic fungi rather than relying on geographic maps.
- Order histoplasma antigen plus antibodies and coccidioides/blastomyces antibodies for most patients with concerning pneumonia.
Test After One Failed Antibiotic
- Consider fungal testing when community-acquired pneumonia fails one appropriate antibiotic.
- The CDC pathway recommends testing after that first treatment failure to reduce missed diagnoses.
