Approach to the diagnosis of the endemic mycoses

The endemic mycoses are often overlooked in the evaluation of community-acquired pneumonia, and appropriate testing is not performed until the patient has failed to improve on antibacterial therapy. Antigen detection and fungal serology may be helpful in diagnosis of endemic mycoses as causes for pneumonia. Guidelines for recognition and evaluation of endemic mycoses as causes for community-acquired pneumonia are proposed. Performance of antigen testing on bronchial washings or lavage fluid may improve the sensitivity for diagnosis over microscopic examination and the speed of diagnosis over culture. This article focuses on antigen detection and serology for diagnosis of endemic mycoses. Of note is that isolation of the fungus by culture remains the only method for definitive diagnosis, and the only method for diagnosis in some patients.