Fungal Lung Infections
Respiratory (12%) Core Clinical Conditions
2B The Physician Associate is able to undertake the day to day management of the patient and condition once the diagnosis and strategic management decisions have been made by another.
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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management
Definition
Fungal lung infections are respiratory infections caused by fungi that infiltrate the lungs and cause inflammation, tissue damage, and respiratory symptoms. Aspergillosis, histoplasmosis, cryptococcosis, and coccidioidomycosis are the most common types of fungal lung infections.
Aetiology
There are numerous types of fungal lung infections, each of which is caused by a unique fungus. It is essential to distinguish between opportunistic and endemic diseases. Immunocompromised individuals are susceptible to opportunistic fungal infections, such as following a transplant or HIV infection. While endemic fungal infections are likely to affect travellers, they are less likely to affect locals.
Opportunistic: Candida spp., which causes candidiasis, and Aspergillus spp., which causes aspergillosis, are examples of opportunistic fungal pathogens.
Endemic: Infectious fungi such as Histoplasma capsulatum, which causes histoplasmosis, are endemic.
Pathophysiology
Fungal spores inhaled into the lungs > germination > inflammation > immune response.
Risk factors
Travelling to a region where fungal infections are endemic.
Exposure to bird, bat, or rodent droppings on a regular basis in endemic regions.
Immunocompromised persons.
Male gender.
Sign and symptoms
Persistent fever.
Persistent cough.
Pleuritic chest pain.
Shortness of breath on exertion (SOBOE).
Haemoptysis.
O/E: tachycardia, fever, wheeze, dullness on percussion.
Diagnosis and investigations
Blood test: raised WCC + Eosinophilia may be observed.
CXR: may show consolidation or pleural effusion.
Blood cultures.
Sputum cultures.
CT/MRI thorax.
Bronchoscopy.
Biopsy.
Lumbar puncture.
PCR and ELISA assays.
Management
Antifungal medications: azoles (eg, voriconazole) are most often used. Fluconazole can also be used if the patient is clinically stable.
Surgery may be considered to remove infected lung tissue or drain fluid from the lungs.
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