Fungal (mycotic) pneumonia Fungal pneumonia is an infection of the lungs caused by fungi. The cause is endemic or opportunistic fungus or both. Immunocompetent patients generally respond well to antifungal therapy, but in immunocompromised patients, fungal pneumonia can have a mortality rate of up to 90%. Etiology Examples of well-defined fungal infections with pulmonary involvement: 1. Histoplasmosis, primary lung injury and hematogenous transmission. 2. Coccidioidomycosis, which usually begins as a self-limiting respiratory-associated infection (also known as “valley fever” or “San Joaquin fever”). 3, Pulmonary bacteriosis, Pneumocystis carinii pneumonia, which usually occurs in immunocompromised individuals, especially with AIDS. 4, sporotrichosis, mainly lymphodermal sporotrichosis, but can also involve the lungs. 5, Cryptococcosis, infection through inhalation of yeast contaminated dust, it can manifest as lung infection and disseminated cryptococcosis. 6, Aspergillosis, leading to invasive pulmonary aspergillosis, candidiasis, and rarely, pulmonary manifestations in immunocompromised patients. Pathophysiology With the inhalation of fungal spores, the fungi enter the lungs of the respirator. They can also reach the lungs by hematogenous dissemination of infection from other body parts. In addition, reactivation of latent infection can also cause fungal pneumonia. Once in the alveoli, the fungus wanders into the intercellular space and enters the adjacent alveoli through the alveolar junctions. The invasion of the fungus triggers the immune system to send white blood cells to attack the microorganisms (neutrophils) that have reached the lungs. The neutrophils engulf and kill the invading microorganisms and release cytokines, which in turn cause a full activation of the immune system, leading directly to fever, chills and fatigue – common symptoms in bacterial and fungal pneumonia. Neutrophils and fluid leaking from the peri-alveolar vessels diffuse the alveoli, leading to impaired oxygen transport. The diagnosis of fungal pneumonia can be arrived at by a variety of methods. The simplest and cheapest method is to take a culture of fungus from the patient’s respiratory tract body fluid. However this test is not only insensitive, but also time-consuming – a major drawback, as studies have shown that delayed diagnosis of fungal pneumonia is associated with high mortality. Microscopy is another method, but slow and inaccurate. Making up for these classic methods is antigen detection. This technique is extremely and obviously much faster, but may also lack sensitivity and specificity compared to the classical methods. There is also a molecular test based on real-time PCR technology, which originated from Myconostica, a leading British molecular diagnostics company. This test relies on DNA technology and is the most sensitive and specific for fungal detection, but is currently limited to detecting Pneumocystis carinii and Aspergillus. Fungal pneumonia may also be human-to-human in some places, such as dormitories. Fungal pneumonia cannot be detected by chest x-ray. Patients need to be hospitalized if necessary. TreatmentAntifungal medications are used to treat fungal pneumonia, sometimes requiring surgical debridement. Antifungal medicationsAntifungal medications are drugs used to treat fungal infections such as foot fungus, ringworm, candidiasis (thrush) , serious systemic infections such as cryptococcal meningitis and others. This type of drug is usually available through a doctor’s prescription or pharmacy. Adverse reactions In addition to side effects such as liver function impairment or effects on estrogen levels, many people using antifungal drugs can cause allergic reactions. For example, azole-based drugs are known to cause anaphylactic reactions. There are also many drug interactions.