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Chapter 16. Fungal Infections in Pulmonary Medicine

Andrew F Shorr, MD, MPH, FCCP
DOI: 10.1378/pulm.26.16
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Sections

Objectives 
  • Review the epidemiology of and risk factors for mold and yeast infections.

  • Illustrate the clinical syndromes associated with different mold pathogens.

  • Describe newer diagnostic approaches for aspergillosis and candidemia.

  • Review new treatment options and guidelines for yeast and mold infections.

Synopsis 

Fungal infections comprise processes including both mold and yeast. Although Aspergillus accounts for the major concern with respect to mold, other organisms cause important human disease. Specifically, mucormycosis, histoplasmosis, blastomycosis, and coccidioidomycosis represent examples of mold that cause a range of potential illnesses. The clinical manifestations of mold infection vary based on the species involved and the host's immune status. Aspergillus and mucormycosis may be difficult to distinguish clinically but mucromycosis remains much less common. Diagnostically, all mold are challenging and the role for invasive techniques is controversial. Historically, amphotericin served as the primary therapeutic agent. Now alternative options exist. However, the specific preferred treatment varies based on the particular mold in question. In terms of yeast, these pathogens mainly result in bloodstream infection (BSI) and sepsis. In the ICU, BSIs due to yeast often complicate the use of central venous catheters. Many other variables can predispose to candidal BSIs and include prior exposure to broad spectrum antibiotics, corticosteroids, and/or total parentral nutrition. Candida albicans continue to be the most common specific yeast species encountered. Other species, however, are increasing in frequency, and several of these are not presumptively susceptible to fluconazole. For both yeast and mold, recent research has focused on novel diagnostic strategies using serum assays. These, however, continue to have limitations. Finally, there are new guidelines from professional societies addressing infections caused by yeast and mold.

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