Fungal pneumonia is an

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dis ...

of the lungs by

fungi A fungus ( : fungi or funguses) is any member of the group of eukaryotic organisms that includes microorganisms such as yeasts and molds, as well as the more familiar mushrooms. These organisms are classified as a kingdom, separately from ...

. It can be caused by either

endemic Endemism is the state of a species being found in a single defined geographic location, such as an island, state, nation, country or other defined zone; organisms that are indigenous to a place are not endemic to it if they are also found else ...

opportunistic Opportunism is the practice of taking advantage of circumstances – with little regard for principles or with what the consequences are for others. Opportunist actions are expedient actions guided primarily by self-interested motives. The term ...

fungi or a combination of both. Case mortality in fungal pneumonias can be as high as 90% in

immunocompromised Immunodeficiency, also known as immunocompromisation, is a state in which the immune system's ability to fight infectious diseases and cancer is compromised or entirely absent. Most cases are acquired ("secondary") due to extrinsic factors that a ...

patients, though immunocompetent patients generally respond well to anti-fungal therapy.

Signs and symptoms

Fungal pneumonia can present similarly to that of the common flu or other common illnesses. Symptoms often include

fever Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...

cough A cough is a sudden expulsion of air through the large breathing passages that can help clear them of fluids, irritants, foreign particles and microbes. As a protective reflex, coughing can be repetitive with the cough reflex following three ph ...

, headaches,

rash A rash is a change of the human skin which affects its color, appearance, or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, c ...

es, muscle aches, and/or joint pain. This can lead to treatment being delayed or unsought altogether.Fungal Pneumonia: a silent epidemic , CDC PDF www.cdc.gov/fungal/pdf/cocci-fact-sheet-sw-us-508c.pdf In a very small portion of people, fungal pneumonia can lead to chronic pneumonia, fungemia (presence of fungi in the blood), meningitis (infection of the meninges of the brain or spine), or even death. However, this is extremely rare and the vast majority of cases go untreated, unreported, or are asymptomatic (e.g. the infected person is not aware they are or were infected).

Causes

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

Coccidioidomycosis Coccidioidomycosis (, ), commonly known as cocci, Valley fever, as well as California fever, desert rheumatism, or San Joaquin Valley fever, is a mammalian fungal disease caused by '' Coccidioides immitis'' or ''Coccidioides posadasii''. Coccid ...

, which begins with an often self-limited respiratory infection (also called "Valley fever" or "San Joaquin fever") * Pneumocystis pneumonia, which typically occurs in immunocompromised people, especially AIDS * Sporotrichosis — primarily a skin disease, but can involve the lungs as well *

Cryptococcus ''Cryptococcus'' is a genus of fungi in the family Cryptococcaceae that includes both yeasts and filamentous species. The filamentous, sexual forms or teleomorphs were formerly classified in the genus ''Filobasidiella'', while ''Cryptococcus'' ...

species can sometimes invade the lungs * Aspergillosis, resulting in invasive pulmonary aspergillosis * rarely,

candidiasis Candidiasis is a fungal infection due to any type of '' Candida'' (a type of yeast). When it affects the mouth, in some countries it is commonly called thrush. Signs and symptoms include white patches on the tongue or other areas of the mouth ...

has pulmonary manifestations in immunocompromised patients. *

Histoplasmosis Histoplasmosis is a fungal infection caused by '' Histoplasma capsulatum''. Symptoms of this infection vary greatly, but the disease affects primarily the lungs. Occasionally, other organs are affected; called disseminated histoplasmosis, it can ...

or Spelunker's lung

Pathophysiology

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,

travel into the spaces between the cells and also between adjacent alveoli through connecting pores. This invasion triggers the

immune system The immune system is a network of biological processes that protects an organism from diseases. It detects and responds to a wide variety of pathogens, from viruses to parasitic worms, as well as cancer cells and objects such as wood splint ...

to respond by sending white blood cells responsible for attacking microorganisms (

neutrophil Neutrophils (also known as neutrocytes or heterophils) are the most abundant type of granulocytes and make up 40% to 70% of all white blood cells in humans. They form an essential part of the innate immune system, with their functions varying ...

s) 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.

Diagnosis

Fungal pneumonia can be diagnosed in a number of ways. The simplest and cheapest method is to culture the fungus from a patient's respiratory fluids. However, such tests are not only insensitive but take time to develop which is a major drawback because studies have shown that slow diagnosis of fungal pneumonia is linked to high mortality. Microscopy is another method but is also slow and imprecise. Supplementing these classical methods is the detection of

antigen In immunology, an antigen (Ag) is a molecule or molecular structure or any foreign particulate matter or a pollen grain that can bind to a specific antibody or T-cell receptor. The presence of antigens in the body may trigger an immune respons ...

s. This technique is significantly faster but can be less sensitive and specific than the classical methods.

Treatment

Fungal pneumonia can be treated with

antifungal drug An antifungal medication, also known as an antimycotic medication, is a pharmaceutical fungicide or fungistatic used to treat and prevent mycosis such as athlete's foot, ringworm, candidiasis (thrush), serious systemic infections such as Cryptoc ...

s and sometimes by surgical debridement.

References

External links

*
Coccidioidomycosis
{{DEFAULTSORT:Fungal Pneumonia Pneumonia Infectious diseases Fungal diseases