Rare and Emerging Fungal Pulmonary Infections

Jay B. Varkey, MD; John R. Perfect, MD

Disclosures

Semin Respir Crit Care Med. 2008;29(2):121-131. 

In This Article

Endemic Mycoses

In the area of dimorphic fungi producing rare and emerging pulmonary infections there are three infections to consider. Pulmonary adiaspiromycosis is caused by Emmonsia crescens, which can produce adiospores at 37 to 40°C that resemble spherules. It produces pulmonary disease in small rodents and occasionally in humans. Infection can range from asymptomatic in its presentation to invasive/disseminated infection in immunocom-promised hosts. It has responded to treatment with several antifungal agents, but it is important to realize that in many patients there has been spontaneous recovery with no treatment. Thus it is important to judge host immunity and degree of symptoms prior to starting any antifungal therapy.[69,70]

The other two endemic mycoses considered rare and/or emerging are sporotrichosis and penicilliosis (Penicillium marneffei). Pulmonary sporotrichosis has a chronic, insidious presentation and favors immunosup-pressed hosts such as those with a history of alcohol abuse. The treatment is not clearly defined but it is likely to be a combination of polyene for initial treatment followed by an azole such as itraconazole, with or without surgery. These infections can be quite refractory to both medical and surgical intervention.[71]Penicillium marneffei primarily causes pulmonary disease in Southeast Asia and in particular with concomitant human immunodeficiency virus infection. It presents in a sub-acute manner and can respond to treatment with azoles or polyenes. Immune reconstitution with highly active antiretroviral therapy (HAART) is critical for success.[72]

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