Endemic Fungi Presenting as Community-Acquired Pneumonia: A Review

Azar, Marwan M.; Malo, Joshua; Hage, Chadi A.

doi:10.1055/s-0040-1702194

Cited by 10 publications

(7 citation statements)

References 168 publications

(158 reference statements)

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“…The coinfection reported in a HIV-negative patient was in the setting of persistent pulmonary histoplasmosis when pulmonary imaging prompted SARS-CoV-2 testing [115]. Typical radiological abnormalities for the endemic mycoses are summarised in (Table 2) [116]. SARS-CoV-2 coinfections with other dimorphic fungi-Blastomyces, Emergomyces, Paracoccidioides, Sporothrix, or Talaromyces-have not yet been reported but would not be unexpected in the appropriate clinical context.…”

Section: Endemic Mycosesmentioning

confidence: 99%

Fungal Infections Other Than Invasive Aspergillosis in COVID-19 Patients

Basile¹,

Halliday

Kok

et al. 2022

JoF

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Invasive fungal disease (IFD) associated with Coronavirus Disease 2019 (COVID-19) has focussed predominantly on invasive pulmonary aspergillosis. However, increasingly emergent are non-Aspergillus fungal infections including candidiasis, mucormycosis, pneumocystosis, cryptococcosis, and endemic mycoses. These infections are associated with poor outcomes, and their management is challenged by delayed diagnosis due to similarities of presentation to aspergillosis or to non-specific features in already critically ill patients. There has been a variability in the incidence of different IFDs often related to heterogeneity in patient populations, diagnostic protocols, and definitions used to classify IFD. Here, we summarise and address knowledge gaps related to the epidemiology, risks, diagnosis, and management of COVID-19-associated fungal infections other than aspergillosis.

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Section: Endemic Mycosesmentioning

confidence: 99%

Fungal Infections Other Than Invasive Aspergillosis in COVID-19 Patients

Basile¹,

Halliday

Kok

et al. 2022

JoF

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“…66 In areas with prevalent endemic fungi, these organisms are an important consideration for community-acquired pneumonia. 67 Coccidioidomycosis, for example, can be responsible for over a quarter of community-acquired pneumonias regionally in the Southwest US. 68 Acute pneumonia frequently causes focal consolidation that closely resembles bacterial infection.…”

Section: Lobar or Sublobar Pneumonia With Negative Or Unknown Covid-1...mentioning

confidence: 99%

Community-Acquired Pneumonia: Postpandemic, Not Post-COVID-19

Ketai

Febbo

Busby

et al. 2022

Semin Respir Crit Care Med

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The coronavirus disease 2019 (COVID-19) pandemic upended our approach to imaging community-acquired pneumonia, and this will alter our diagnostic algorithms for years to come. In light of these changes, it is worthwhile to consider several postpandemic scenarios of community-acquired pneumonia: (1) patient with pneumonia and recent positive COVID-19 testing; (2) patient with air space opacities and history of prior COVID-19 pneumonia (weeks earlier); (3) multifocal pneumonia with negative or unknown COVID-19 status; and (4) lobar or sublobar pneumonia with negative or unknown COVID-19 status. In the setting of positive COVID-19 testing and typical radiologic findings, the diagnosis of COVID-19 pneumonia is generally secure. The diagnosis prompts vigilance for thromboembolic disease acutely and, in severely ill patients, for invasive fungal disease. Persistent or recurrent air space opacities following COVID-19 infection may more often represent organizing pneumonia than secondary infection. When COVID-19 status is unknown or negative, widespread airway-centric disease suggests infection with mycoplasma, Haemophilus influenzae, or several respiratory viruses. Necrotizing pneumonia favors infection with pneumococcus, Staphylococcus, Klebsiella, and anaerobes. Lobar or sublobar pneumonia will continue to suggest the diagnosis of pneumococcus or consideration of other pathogens in the setting of local outbreaks. A positive COVID-19 test accompanied by these imaging patterns may suggest coinfection with one of the above pathogens, or when the prevalence of COVID-19 is very low, a false positive COVID-19 test. Clinicians may still proceed with testing for COVID-19 when radiologic patterns are atypical for COVID-19, dependent on the patient's exposure history and the local epidemiology of the virus.

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“…Identification of H capsulatum on histopathology and culture is the classical diagnostic standard [ 2 , 10 , 15 ]. The narrow based budding ovoid Histoplasma yeast (2–4 μM in diameter) is visualized via direct microscopic examination or the use of Gomori methenamine silver, Giemsa, periodic acid-Schiff, or hematoxylin eosin stains of specimens such as respiratory samples, lymph node tissue, or lung tissue ( Figure 1 A) [ 1 , 2 , 8 , 9 , 11 , 16 , 17 , 18 ]. Cytopathologic examination of bronchoalveolar lavage (BAL) fluid is positive in up to 50% of cases [ 2 , 3 , 8 ].…”

Section: Histoplasmosismentioning

confidence: 99%

“…Antibody testing is also used to diagnose histoplasmosis. Because antibodies take time to develop after acute infection, they are more useful in SPH and CPH than APH and negative initial antibody testing should be repeated in one to two months if suspicion is high [ 2 , 3 , 8 , 9 , 10 , 11 , 13 , 14 , 17 ]. Additionally, antibody testing may be negative in immunocompromised patients and may cross react with other endemic mycoses such as Blastomyces , Paracoccidioides , and Coccidioides [ 2 , 8 , 9 , 11 ].…”

Section: Histoplasmosismentioning

confidence: 99%

Diagnosis of Pulmonary Infections Due to Endemic Fungi

et al. 2021

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Endemic mycoses including Histoplasma, Blastomyces, Coccidioides, Paracoccidioides, and Talaromyces are dimorphic fungi that can cause a variety of clinical manifestations, including respiratory infections. Their pulmonary presentations are variable, and diagnosis is often delayed as they can mimic other infectious and non-infectious causes of pulmonary disease. Delay in diagnosis can lead to unnecessary antibiotic use, repeat hospitalizations, and increased morbidity and mortality. The diagnosis of endemic fungal pulmonary infections often relies on multiple diagnostic tests including culture, tissue histopathology, antigen assays, and antibody assays. Due to the increased use of immunosuppressive agents and the widening geographic ranges where these infections are being found, the prevalence of endemic fungal infections is increasing. Physicians need to be aware of the clinical manifestations of pulmonary infections due to endemic fungal in order to ensure that the proper diagnostic work up is obtained promptly. A high index of suspicion is particularly important in patients with suspected pulmonary infections who have failed to improve despite antibiotics in the appropriate setting. We present a review diagnostic testing for pulmonary infections due to endemic mycoses.

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Endemic Fungi Presenting as Community-Acquired Pneumonia: A Review

Cited by 10 publications

References 168 publications

Fungal Infections Other Than Invasive Aspergillosis in COVID-19 Patients

Fungal Infections Other Than Invasive Aspergillosis in COVID-19 Patients

Community-Acquired Pneumonia: Postpandemic, Not Post-COVID-19

Diagnosis of Pulmonary Infections Due to Endemic Fungi

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