Introduction

Community-acquired fungal pneumonias are uncommon diseases but can cause substantial morbidity and even mortality. The endemic fungi Histoplasma capsulatum, Blastomyces dermatitidis, Coccidioides immitis and Paracoccidioides brasiliensis cause disease primarily in localised areas in North, Central, and South America, but the geographical distribution of these pathogens is actually quite widespread and cases are occasionally seen outside of the traditional endemic areas. Moreover, the global population is now so mobile that many individuals who reside in non-endemic areas come into contact with the endemic fungi while traveling for business or leisure activities. Other fungal respiratory tract pathogens including Cryptococcus neoformans and Sporothrix schenkii have worldwide distributions.

The patient with community-acquired fungal pneumonia often poses a significant diagnostic challenge because the clinical manifestations of the endemic and non-endemic pulmonary mycoses are varied and non-specific. The presentations of these forms of pneumonia often mimic bacterial pneumonia, tuberculosis, or malignancy. Thus, it is important for the clinician to have a high index of suspicion for fungal pneumonias in a variety of settings.

The diagnostic approach to the patient with suspected fungal pneumonia depends upon the specific aetiology under consideration in an individual case. Available diagnostic techniques include smears and cultures of clinical specimens and various serological tests. Although some forms of fungal pneumonia are self-limited, treatment is indicated in many cases. Treatment options for fungal pneumonia have expanded substantially with the availability of the azole antifungal compounds ketoconazole, fluconazole, and itraconazole.