[Fungal pneumonias: do they exist?]

Area of Science:

• Mycology
• Infectious Diseases
• Pulmonology

Context:

• Fungal infections, particularly fungal pneumonia, are often opportunistic, primarily affecting immunocompromised hosts.
• Pathogens such as Pneumocystis jirovecii, Coccidioides immitis, and Cryptococcus neoformans can cause severe respiratory illness.
• Current German guidelines for community-acquired pneumonia (CAP) and nosocomial pneumonia inadequately address fungal etiologies.

Purpose:

• To highlight the underrepresentation of fungal pathogens in current German pneumonia guidelines.
• To emphasize the importance of considering fungal infections in the differential diagnosis of severe pneumonia.
• To advocate for the inclusion of fungi in diagnostic considerations for pneumonia, especially in non-responsive cases.

Summary:

• Fungi are recognized opportunistic pathogens, with some species like Pneumocystis jirovecii predominantly infecting immunocompromised individuals.
• However, fungi such as Coccidioides immitis and Cryptococcus neoformans can also infect otherwise healthy individuals.
• German guidelines for community-acquired pneumonia do not mention fungi, and nosocomial pneumonia guidelines only briefly discuss Aspergillus spp. and Candida spp.

Impact:

• Inclusion of fungal pathogens in differential diagnosis for severe CAP, especially in patients with comorbidities unresponsive to antibacterial therapy.
• Potential revision of clinical guidelines to incorporate a broader range of fungal pneumonia etiologies.
• Improved patient outcomes through timely and accurate diagnosis and treatment of fungal pneumonias.