Less Common Respiratory Conditions: Fungal Respiratory Infections

Coccidioidomycosis, histoplasmosis, and aspergillosis are all caused by inhaling a soil fungus. Most patients with coccidioidomycosis, which is endemic to California and Arizona, are asymptomatic, but 40% have influenzalike symptoms that frequently resolve without treatment. Rarely, coccidioidomycosis can disseminate. It typically is diagnosed with chest x-ray and antibody tests. Antifungal therapy is only needed for severe infections and individuals with extensive comorbidities. Histoplasmosis is endemic to central/eastern United States. Only 10% of cases are symptomatic, and they typically resolve without treatment. Severe illness can occur in immunocompromised individuals. Diagnosis typically is made with chest x-ray and urine/serum antigen tests. Antifungal therapy is indicated for mild infections that do not resolve and for those with more severe disease. Neither histoplasmosis nor coccidioidomycosis is spread from person to person. Aspergillosis also can be acquired in health care settings via person-to-person spread or contaminated medical devices. Aspergillus-related pulmonary disease includes an allergic syndrome, aspergillomas (fungus balls) in the lungs or sinuses, and chronic or invasive forms. The allergic syndrome is initially diagnosed with skin tests or immunoglobulin E levels and managed with steroids and antifungals. Aspergillomas and invasive disease are initially detected with x-rays and managed with antifungals.