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Mycotic Infections of the Lung

Matthew A. Steliga, MD, FACS, Ryan Dare, MD

Key Points

  • Several organisms can cause mycotic lung infections, with varied clinical presentations ranging from the asymptomatic patient with a subclinical infection to the immunocompromised patient with a life-threatening invasive opportunistic fungal infection.
  • A heightened index of suspicion is essential when confronted with patients with pulmonary symptoms, especially those with refractory or atypical infections. Patients who are malnourished, debilitated, diabetic, or receiving intensive or long courses of antibiotic therapy are at increased risk of mycotic infections. Patients with blood dyscrasias, lymphatic malignancies such as Hodgkin’s disease or immunosupressed also are at increased risk.
  • Respiratory tract symptoms such as fever, cough, sputum production, hemoptysis, or pleuritic pain usually provide the indication for a conventional chest radiograph and computed tomography. Imaging is necessary for delineating pulmonary mediastinal or pleural involvement.
  • A confirmed diagnosis of fungal infection can be made only after the demonstration of the presence of the organism in body exudates or tissues. Stronger proof is provided by growth in culture; however, the mere recognition of the organisms in smears, fresh mounts, or tissue sections has usually been sufficient for diagnosis.
  • Occasionally, fungi can spread to the lungs hematogenously from another source, but the presence of fungi in the lung results most frequently from inhalation of fungal organisms. In the vast majority of patients, asymptomatic or mild pulmonary infection clears spontaneously without significant debility. In cases of systemic fungal infection, the portal of entry again, with rare exception, is the airway.

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Last updated: August 27, 2024