Candidal lung involvement
Candidal mycetomas have been reported rarely in the literature and are clearly not any more related to candidal pneumonia than aspergillomas are related to Aspergillus pneumonia. The recovery of Candida via protected brush or BAL specimens is common in patients receiving antimicrobial or corticosteroid therapy, as well as in diabetics, alcoholics, and HIV-infected patients. Therefore, the recovery of Candida from a bronchoscopy specimen, even with a protected tip, in a normal or compromised host with pulmonary infiltrates is not diagnostic of Candida pneumonia and should not be used as the basis for empiric anticandidal therapy. A Candida culture obtained via bronchial specimen should prompt the clinician to look for another explanation for the pulmonary infiltrates. Candidal lung involvement, even in systemic invasive disease, is rarely made antemortem. Therefore, if the diagnosis is made antemortem, the patient should be treated for systemic disease and not for an isolated pulmonary infection.
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Coccidioidomycosis
C immitiscauses the systemic illness coccidioidomycosis that is endemic in the southwestern United States. Approximately 60% of infected patients are asymptomatic while 40% will develop primary infection after an incubation period of 1 to 3 weeks. Most symptomatic patients with primary coccidioidomycosis develop a lower respiratory tract infection associated with a flu-like illness characterized by fever, chills, cough, malaise, anorexia, and night sweats. Erythema nodosum or erythema multiforme may occur. Chest radiographs are often abnormal with infiltrates, pleural effusions, or hilar adenopathy. Five percent of patients with primary disease have a residual pulmonary cavity or nodule, while 0.5% develop disseminated disease usually involving the meninges, bones, or joints.
In some patients, primary acute pneumonia may progress to chronic pulmonary coccidioidomycosis, a disease that closely mimics pulmonary tuberculosis. Most forms of acute pulmonary coccidioidomycosis are self-limited and require no therapy.