Fungal Pneumonia - Types, Symptoms, Causes, and Treatment

Introduction:

Fungal pneumonia is a pulmonary fungal infection caused by fungal spores in the soil, air, or clinical environments. It generally affects persons with a weakened immune system and can be fatal if left untreated. The condition can be most commonly seen in the following:

• Children under two years and adults over 60 years.

• Persons with chronic diseases, such as cancer or human immunodeficiency virus.

• Patients with hematologic (blood) and autoimmune disorders and tobacco smokers.

• Patients who have undergone bone marrow transplantation.

• Those taking large doses of corticosteroids for a long time.

Among the different types of fungi responsible for causing fungal pneumonia, the three most common types are pneumocystis, aspergillus, and cryptococcus. Fungal pneumonia results from the inhalation of these fungal spores.

What Are the Symptoms of Fungal Pneumonia?

The symptoms of fungal pneumonia are found to be similar to other viral or bacterial lung infections, which can lead to delays in the proper diagnosis and treatment. The symptoms are:

• Chills.

• Fever.

• Persistent shortness of breath.

• Cough with phlegm.

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• Pain while coughing.

• Diarrhea.

• Nausea.

• Vomiting.

• Fatigue.

• Confusion and sometimes disorientation.

How Does Fungal Pneumonia Manifest at Different Ages?

Age plays a vital role in the type and severity of the symptoms in patients affected with fungal pneumonia.

• Older Adults: In adults, the symptoms are mild, but they may result in mental confusion, which needs medical attention immediately.

• Infants and Toddlers: In this condition, the affected infants and toddlers may present with pale-colored skin, breathing difficulties, decreased urine output, a limp appearance, feeding difficulties, and fussiness.

What Are the Causes of Fungal Pneumonia?

Fungal pneumonia is primarily caused when fungal spores are inhaled. In addition, these can occur as opportunistic infections, which can take place in both indoor and outdoor settings, including hospital-acquired infections. The most common fungal organisms involved in causing opportunistic fungal infections include pneumocystis jirovecii and aspergillus.

These fungal infections that arise from the different types of fungus that belongs to specific regions include:

• Coccidioides: These types of fungi are most commonly found in the soil of parts of Central America, South America, and southwest regions of America.

• Cryptococcus Neoformans: These are found in the soil and also in bird droppings all over the world.

• Blastomyces: Blastomyces exist in the rotting leaves, wood, and damp soil in the south-central, midwest, and southeastern states.

• Histoplasma Fungi: This type of fungi grows from the droppings of certain bird and bat species that are found in the eastern and central United States, particularly in the Mississippi river valleys. These are also found in other places such as South America, Central America, Asia, Africa, and Australia.

What Are the Types of Fungal Pneumonia Infections?

Depending on the type of fungus involved, pneumonia types are classified into various types that are as follows:

• Coccidioidomycosis (Valley Fever): This is caused by the fungal organism named coccidioides, which is scattered in the soil over parts of Central and South America. It most commonly affects farmers and construction workers exposed to dusty environments. The symptoms are:

• Fever.

• Headache.

• Rashes.

• Cough.

• Muscle and joint pain.

• Histoplasmosis: Histoplasmosis is caused by the histoplasma fungus, which manifests symptoms between 3 to 17 days after exposure. Most cases resolve independently, but some cases may become severe and cause life-threatening situations. The symptoms of this infection include:

• Fatigue.

• Fever.

• Coughing.

• Other typical symptoms of pneumonia.

• In advanced cases, infections spread from the lungs to the spinal cord and the brain.

• Pneumocystis Pneumonia: It is caused by the fungus pneumocystis jirovecii. The typical characteristic feature of this fungi is that it impacts only immunocompromised patients, like those undergoing chemotherapy, infected with human immunodeficiency virus, and those treated with higher doses of corticosteroids. This can be the leading cause of death among acquired immunodeficiency patients. The treatment includes oral antifungal medications or daily intravenous injections for three weeks.

• Cryptococcus: It is caused by the fungus cryptococcus neoformans. This infection manifests with the usual symptoms of pneumonia, but if left untreated, the infection may spread to the spinal cord or brain, resulting in cryptococcal meningitis. Antifungal medications are prescribed and should be taken for at least six months.

• Aspergillosis: It is caused by the fungus aspergillus, a mold commonly seen in indoor and outdoor environments. It is most commonly associated with immunodeficiency patients and hospital-acquired environments. The typical feature of this infection is that it can form masses called “fungal balls” in the lungs. This infection can be disseminated to other organs. Antifungal therapy supports well and can be easily taken in the early stages of infection.

What Are the Investigations Done for Fungal Pneumonia?

• Chest X-ray: Chest X-ray reveals the pattern of inflammation, severity, and fluid build-up in the lungs.

• Blood Culture: A blood culture is taken to confirm that the infection has not spread from the lungs to other body parts. Blood samples are taken and checked for any pathogens in the bloodstream.

• Pulse Oximetry: The oxygen levels in the blood are checked through pulse oximetry. If the oxygen levels are too low, it indicates emergency conditions, and immediate care is required.

• Chest Computed Tomography (CT) Scan: This test is taken in the case of complications and significant damage to the lungs, which provides more detailed and accurate findings than the chest X-ray.

• Pleural Fluid Culture: The pleura refers to the tissue covering the lining of the chest cavity. The fluid samples are taken from the pleural cavity to screen for any signs of fungi.

• Bronchoscopy: A camera is fixed at the end of the retractable tube, providing a realistic view of the lungs and the air passages.

How Is Fungal Pneumonia Treated?

Antifungal medicines are the primary choice of treatment for fungal pneumonia. The method of administration and the dosages vary individually depending on the type of infection. Antifungal medications include:

• Itraconazole: It belongs to the antifungal group of triazoles, and it is mostly indicated in the treatment of histoplasmosis, blastomycosis, and aspergillosis. It is available in tablet and liquid form.

• Fluconazole: It belongs to the antifungal group of triazoles and is most commonly used to treat infections of cryptococcus, and valley fever, to prevent fungal pneumonia in human immunodeficiency patients. It is administered in the form of a tablet or intravenously.

• Trimethoprim: The combination of Sulfamethoxazole and Trimethoprim is effective in cases of pneumocystis pneumonia.

• Echinocandins: These are most effective in treating aspergillus infections by preventing the spreading of infections by acting directly on the specific fungus. There are three types, such as caspofungin, anidulafungin, and micafungin.

• In most severe or advanced cases, oxygen therapy is recommended to improve oxygen levels, and breathing exercises are suggested to strengthen the lung muscles.

• The treatment duration can take up to one year usually.

• In the advanced cases of valley fever, cryptococcus, and aspergillosis, fungal masses called mycetomas are formed, which can be treated surgically.

Conclusion:

Fungal pneumonia is a serious fungal infection of the lungs to be considered and taken seriously, preferring its early diagnosis and treatment. An interprofessional team approach is required for the proper diagnosis and prompt management. This condition may go unnoticed and untreated, leading to worsening outcomes and even death.