Fungal Pneumonia
Paul C. Stillwell, MD, FAAP
Introduction/Etiology/Epidemiology
•Endemic fungal pneumonias can occur in otherwise healthy or immunocompromised hosts.
•The endemic fungal pneumonias include
—Histoplasmosis
—Coccidioidomycosis
—Blastomycosis
—Cryptococcus gattii (not Cryptococcus neoformans)
•Common characteristics of the endemic fungi are listed in Table 60-1.
•Immunocompromised hosts can get fungal pneumonia from organisms that do not commonly cause invasive infection in normal hosts.
—Aspergillus fumigatus (most common example)
—Pneumocystis jirovecii
—Candida albicans and other Candida species
—Mucormycetes
—Rhizopus
—Scedosporium
—Bipolaris
—Curvularia
Clinical Features
•In the otherwise healthy host, fungal pneumonia manifests similarly to any community-acquired pneumonia (CAP), although the illness may be more protracted or subacute than common bacterial or viral pneumonia.
—Cough, low-grade fever, dyspnea, malaise, chest pain
—Localized crackles may be present at examination
•For endemic fungal infections, multiple organ systems may be involved (Table 60-2).
•In the immunocompromised host:
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