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Pneumonia and lung infections due to emerging and unusual fungal pathogens
Sharon C-A Chen1, Christopher C Blyth, Tania C Sorrell
1Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, Australia. sharon.chen@swahs.health.nsw.gov.au
Abstract:
Invasive mold infections affecting the lungs are increasing in incidence and diversity. Severely immunocompromised patients are particularly vulnerable to infection from unusual, normally nonpathogenic fungi that are found naturally in the environment. Certain fungi such as Scedosporium and the dematiaceous fungi also cause lung disease in hosts without overt immune compromise. The impacts of these emerging pathogens range from airway colonization to locally invasive lung, and disseminated, disease. Diagnosis requires isolation and identification of the etiologic agent by either or both phenotypic and molecular biology methods. Evidence of tissue invasion on histopathology is often required to distinguish infection from colonization. Diagnostic imaging techniques are nonspecific, and there are no reliable serological biomarkers of infection. Many rare molds and yeasts demonstrate reduced in vitro susceptibility to antifungal agents. Although amphotericin B formulations remain clinically useful for many of these infections, voriconazole and posaconazole are more effective for some of these difficult-to-treat pathogens. Surgical resection of diseased tissue and support of the host immune system are often required to optimize outcomes.
Insights
Invasive lung mold infections are rising, especially in immunocompromised patients, caused by environmental fungi. Diagnosis and treatment are challenging, often requiring specific antifungal agents and surgical intervention.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Pulmonology
Background:
- Invasive mold infections of the lung are increasing in incidence and diversity.
- Severely immunocompromised patients are vulnerable to unusual fungal pathogens.
- Some fungi can cause lung disease even in non-immunocompromised individuals.
Purpose of the Study:
- To review the challenges in diagnosing and treating invasive lung mold infections.
- To highlight emerging fungal pathogens and their clinical impact.
- To discuss current diagnostic and therapeutic strategies.
Main Methods:
- Review of current literature on invasive pulmonary mycoses.
- Analysis of diagnostic approaches including culture, histopathology, and molecular methods.
- Evaluation of antifungal susceptibility and treatment outcomes.
Main Results:
- Diagnosis relies on isolation and identification of fungi, often needing histopathology to confirm invasion.
- Imaging is nonspecific, and reliable serological biomarkers are lacking.
- Many rare molds show reduced susceptibility to antifungals, with voriconazole and posaconazole showing efficacy for some.
Conclusions:
- Optimal outcomes require accurate diagnosis, appropriate antifungal therapy (e.g., voriconazole, posaconazole), and often surgical resection.
- Support of the host immune system is crucial for managing these infections.
- Emerging fungal pathogens pose a significant threat, necessitating ongoing research and improved management strategies.
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