From the Guidelines
Fungal pneumonia is primarily caused by inhalation of fungal spores, with Aspergillus species being a common causative organism, especially in severely immunocompromised patients. The primary route of acquiring Aspergillus sp. infection is by inhalation of the fungal spores 1. Fungal pneumonia occurs more frequently in immunocompromised individuals, such as those with HIV/AIDS, organ transplant recipients on immunosuppressive medications, patients undergoing chemotherapy, or those with chronic conditions like diabetes.
Some key points to consider:
- The most common causative organisms include Aspergillus species, Cryptococcus neoformans, Histoplasma capsulatum, Coccidioides immitis, Blastomyces dermatitidis, Pneumocystis jirovecii, and Candida species.
- Environmental exposure plays a significant role, with certain fungi being endemic to specific geographical regions, such as Histoplasma in the Ohio and Mississippi River valleys and Coccidioides in the southwestern United States.
- The fungi cause inflammation in the lungs after inhalation, leading to symptoms similar to bacterial pneumonia, including cough, fever, chest pain, and difficulty breathing, though fungal infections often progress more slowly and may be more difficult to diagnose and treat than bacterial pneumonia.
- Treatment options for fungal pneumonia, such as Candida pneumonia, include intravenous amphotericin B or oral or intravenous fluconazole 1.
It is essential to note that prompt diagnosis and treatment of fungal pneumonia are crucial to prevent high mortality and morbidity, especially in immunocompromised patients. The treatment should be guided by the severity of the disease, the causative organism, and the patient's underlying health conditions.
From the Research
Fungal Pneumonia Causes
Fungal pneumonia is caused by various types of fungi, including:
- Aspergillus spp. 2, 3, 4
- Cryptococcus neoformans 2, 3, 4
- Dimorphic fungi 4
- Coccidioides 2, 3, 5
- Histoplasma 2, 3, 5
- Blastomyces 2, 5
- Candida spp. 5
- Fusarium 3
- Rhizopus 3
- Mucor spp. 5
- Pneumocystis 5
Risk Factors
The risk of developing fungal pneumonia is increased in individuals with certain underlying conditions, including:
- Immunocompromised state, such as HIV infection or immunosuppressive therapy 2, 4, 6
- Thrombocytopenia 4
- Environmental exposures, such as construction or renovation 4
- Organ transplantation 2
- Bone marrow replacement 2
Diagnosis and Treatment
Diagnosis of fungal pneumonia can be challenging, but various tests are available, including:
- Culture and direct visualization of fungal organisms 5
- Antigen and antibody testing 5, 4
- Molecular methods, such as polymerase chain reaction (PCR) 5, 4
- Imaging studies, such as radiography 6 Treatment of fungal pneumonia typically involves antifungal medications, such as:
- Amphotericin B 2, 4
- Fluconazole 2
- Itraconazole 2
- Voriconazole 4
- Caspofungin 4
- Echinocandins and triazoles 2, 4