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Endobronchial fungal disease: an under-recognized entity

Demet Karnak1, Robin K Avery, Thomas R Gildea

  • 1Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey, and Department of Chest Medicine, KEM Hospital, Mumbai, India.

Respiration; International Review of Thoracic Diseases
|July 26, 2006
PubMed

Insights

Endobronchial fungal infection (EBFI) is a rare but increasingly recognized condition, often seen in immunocompromised patients. Early diagnosis and treatment are crucial for managing this airway disease.

Area of Science:

  • Medical Mycology
  • Pulmonology
  • Infectious Diseases

Background:

  • Fungal infections typically affect the lungs via inhalation, but endobronchial fungal infection (EBFI) is a less common manifestation.
  • EBFI presentation is influenced by environmental exposures and host immune status.
  • The rise of flexible bronchoscopy has led to increased recognition of EBFI.

Purpose of the Study:

  • To review the literature on endobronchial fungal infections.
  • To characterize the clinical presentation, causative fungi, and outcomes of EBFI.
  • To highlight the importance of considering EBFI in the differential diagnosis of airway lesions.

Main Methods:

  • Systematic literature search of English-language publications on EBFI.
  • Analysis of reported cases, identifying causative fungal species and patient characteristics.
  • Inclusion of a novel case of endobronchial Pseudallescheria boydii infection.

Main Results:

  • A total of 228 EBFI cases were identified.
  • Aspergillus species were the most common cause (121 cases), followed by Coccidioides immitis (38), Zygomycetes (31), Candida species (14), Cryptococcus neoformans (13), and Histoplasma capsulatum (11).
  • Most patients were immunocompromised, presented with systemic fungal disease, and improved with therapy.

Conclusions:

  • EBFI is an important consideration in immunocompromised individuals, particularly those from endemic areas.
  • Bronchoscopic findings in EBFI range from inflammation to airway obstruction.
  • EBFI requires inclusion in the differential diagnosis for airway lesions in susceptible populations.

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