Fungal pneumonia

Pneumonia Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Pneumonia from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
Diagnostic Algorithm
History and Symptoms
Physical Examination
Laboratory Findings
Chest X Ray
CT
Other Imaging Findings
Treatment
Medical Therapy
Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Fungal pneumonia On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Fungal pneumonia All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Fungal pneumonia
CDC onFungal pneumonia
Fungal pneumonia in the news
Blogs on Fungal pneumonia
Directions to Hospitals Treating Pneumonia
Risk calculators and risk factors for Fungal pneumonia

Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Philip Marcus, M.D., M.P.H.[2]

Overview

Fungal pneumonia is an infection of the lungs by fungi. It can be caused by either endemic or opportunistic fungi or a combination of both.Fungal pneumonia is uncommon, but it may occur in individuals with immune system problems due to AIDS, immunosuppresive drugs, or other medical problems. The pathophysiology of pneumonia caused by fungi is similar to that of bacterial pneumonia. Fungal pneumonia is most often caused byHistoplasma capsulatum, Cryptococcus neoformans, Pneumocystis jiroveci, and Coccidioides immitis.Histoplasmosis is most common in the Mississippi River basin, and coccidioidomycosis in the southwestern United States.

Pathophysiology & Etiology

Fungi typically enter the lung with inhalation of their spores, though they can reach the lung through the bloodstream if other parts of the body are infected. Also, fungal pneumonia can be caused by reactivation of a latent infection. Once inside the alveoli, fungi travel into the spaces between the cells and also between adjacent alveoli through connecting pores. This invasion triggers the immune system to respond by sending white blood cells responsible for attacking microorganisms (neutrophils) to the lungs. The neutrophils engulf and kill the offending organisms but also release cytokines which result in a general activation of the immune system. This results in the fever, chills, and fatigue common in bacterial and fungal pneumonia. The neutrophils and fluid leaked from surrounding blood vessels fill the alveoli and result in impaired oxygen transportation.

Etiologic agent

Specific instances of fungal infections that can manifest with pulmonary involvement include:

• Pneumocystis jirovecii pneumonia
• Histoplasmosis, which has primary pulmonary lesions and hematogenous dissemination
• Coccidioidomycosis, which begins with an often self-limited respiratory infection (also called "Valley fever" or "San Joaquin fever")
• Pulmonary blastomycosis
• Sporotrichosis - primarily a lymphocutaneous disease, but can involve the lungs as well
• Cryptococcosis - contracted through inhalation of soil contaminated with the yeast, it can manifest as a pulmonary infection and as a disseminated one
• Aspergillosis, resulting in invasive pulmonary aspergillosis
• rarely, Candidiasis has pulmonary manifestations in immunocompromised patients.

Risk Stratification and Prognosis

Case mortality in fungal pneumonias can be as high as 70% in immunocompromised patients, though immunocompetent patients generally respond well to anti-fungal therapy.

Treatment

Fungal pneumonia can be treated with antifungal drugs and sometimes by surgical debridement.