Pulmonary mycoses: a clinical perspective

Pulmonary mycoses encompass a broad spectrum of pathogens, including filamentous moulds, dimorphic fungi and fungi with predominantly yeast-like growth forms. Susceptibility is driven by defects in T-helper (Th)1/Th17 immunity, neutrophil dysfunction and barrier disruption. Clinical presentation varies widely, ranging from asymptomatic colonisation to rapidly progressive, life-threatening disease, depending on host immune status and pathogen type. Radiological findings, particularly on high-resolution computed tomography, often provide critical diagnostic clues but are rarely pathognomonic. Although histopathological evidence remains the gold standard, advancements in complementary diagnostics are increasingly being integrated into clinical workflows. Broad-range fungal markers such as (1→3)-β-d-glucan can guide diagnosis, while both culture- and nonculture-based tests are warranted for further pathogen identification, each offering unique advantages and constraints. Management emphasises prompt, guideline-concordant therapy. Emerging antifungal agents and host-directed immunotherapeutic approaches offer promise against resistant or refractory disease. This review synthesises current knowledge on species-specific epidemiology, clinical manifestations, radiological features, diagnostic methods and therapeutic options for pulmonary mycoses, highlighting practical considerations for clinicians managing these complex diseases.