“FUNGAL PNEUMONIA”

WHAT IS PNEUMONIA??

Pneumonia Is An Infection Of One Or Both Lungs.

Which Is Usually Caused By Bacteria, Viruses, Or Fungi.

FUNGAL PNEUMONIA

• Fungal pneumonia is a type of lung infection caused by FUNGI.

• Though this condition is uncommon in most people, those with compromised immune systems due to certain types of infection, such as HIV, are at an increased risk of developing fungal pneumonia.

• The symptoms of fungal pneumonia are similar to those experienced by people with bacterial or viral pneumonia

• Case mortality in fungal pneumonias can be as high as 90% in immunocompromised patients

“CAUSES”• 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").

• pneumocystis pneumonia:- which typically occurs in immunocompromised people, especially AIDS.

• cryptococcosis :-contracted through inhalation of soil contaminated with the yeast, it can manifest as a pulmonary infection and as a disseminated one

“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, 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.

SYMPTONS

Cough:- Fungi within the lungs can irritate and inflame a person & airway passages. This inflammation can lead to symptoms of cough which is usually dry although mucus (sometimes blood stained) may be seen in a productive cough that can develop later.

Chest pain:- which may initially start as discomfort particularly when inhaling.

• Weight loss:-A person with fungal pneumonia can experience unintended weight loss as a symptom of infection. Weight loss can occur in conjunction with fever and may contribute to symptoms of fatigue.

• Fatigue:-Fungal pneumonia can cause fatigue. Fatigue symptoms can also occur in conjunction with muscle or body aches. Affected people may need to sleep for longer periods throughout the day and can have difficulty remaining alert and attentive.

• Fever:- Fever symptoms can arise in people who have fungal pneumonia. Typically fever symptoms exceed 100.5 degrees F and persist for several days. People who develop a fever can also experience unusual sweating, chills or headache symptoms. Additionally, a fever can cause a person skin to appear flushed or be warm to the touch.

• Difficulty Breathing:- Lung inflammation due to the presence of a fungal infection can cause constriction of a person airways. Airway constriction makes it harder for oxygen to reach the lungs, leading to breathing difficulties in people with fungal pneumonia. Affected people can experience unusual shortness of breath, especially during or after physical activity. When oxygen can reach the lungs in an efficient manner, affected people can also experience sensations of pain or tightness in the chest. Severe breathing difficulties can cause a person skin or nails to appear blue in color due to lack of oxygen. Persistent or severe breathing problems can be a serious medical problem that requires prompt attention from a physician.

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

• A molecular test based on quantitative PCR is also available from Myconostica. Relying on DNA detection, this is the most sensitive and specific test available for fungi but it is limited to detecting only pneumocystis jirovecii and aspergillus

“TREATMENT”• Fungal pneumonia can be treated with antifungal drugs and sometimes by surgical

debridement.

• Although antifungal medication is very effective in treating fungal pneumonia, the mortality rate is quite high in some instances. This is largely due to the delay in seeking medical treatment and the fact that people who develop fungal pneumonia are often immune compromised. Therefore it is imperative to treat the underlying condition that is contributing to the immune deficiency, although this may not always be possible.

• Antifungal Drugs:- Amphotericin B is the mainstay of treatment, particularly in acutely ill patients.

Voriconazole and other azoles are preferred over amphotericin B these days especially for aspergillosis.

Echinocandins like anidulafungin, caspofungin and micafungin are used for Candida infections