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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
Summary
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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