All can cause pneumonia and can disseminate.All are caused by dimorphic fungi: cold (20°C) = mold; heat (37°C) = yeast. Only exception is Coccidioides, which is a spherule (not yeast in tissue).Systemic mycoses can form granulomas (like TV); cannot be transmitted person-to-person.- Treatment: fluconazole/itraconazole for local infection; amphotericin B for systemic infection.

Histoplasmosis: Dimorphic fungi with septate hyphae- Mississippi and Ohio River Valleys- Bird (eg, starlings) or bat droppings- Palatal/tongue ulcers, splenomegaly- Macrophage filled with Histoplasma (smaller than RBC)- Diagnosis via urine/serum antigen.

Blastomycosis: Broad-based budding- Eastern and Central US.- Inflammatory lung disease, can disseminate to skin/bone. - Verrucous skin lesions can simulate squamous cell carcinoma.- Forms granulomatous nodules.

Coccidioidomycosis: Spherule filled with endospores- Southwestern United States, California.- Causes pneumonia and meningitis, disseminates to skin/bone.- Erythema nodosum (desert bumps) or multiforme.- Arthralgias (desert rheumatism).

Paracoccidioidomycosis: Budding yeast with "captain's wheel" formation- Latin America- Similar to blastomycosis, males > females