Endemic pulmonary fungal diseases in immunocompetent patients: an emphasis on thoracic imaging

Abstract

Introduction: Systemic endemic mycoses are prevalent in specific geographical areas of the world and are responsible for high rates of morbidity and mortality in these populations, and in immigrants and travelers returning from endemic regions. The most common fungal infections that can affect the lungs of immunocompetent patients include histoplasmosis, coccidioidomycosis, paracoccidioidomycosis, blastomycosis, sporotrichosis, aspergillosis, and cryptococcosis. Diagnosis and management of these diseases remain challenging, especially in non-endemic areas due to the lack of experience. Therefore, recognition of the various radiologic manifestations of pulmonary fungal infections associated with patients' clinical and epidemiologic history is imperative for narrowing the differential diagnosis. Areas covered: This review discusses the clinical and radiological findings of the main endemic fungal diseases affecting the lungs in immunocompetent patients. Specific topics discussed are their etiology, epidemiology, pathogenesis, clinical manifestations, methods of diagnosis, pathology and main imaging findings, especially in computed tomography. Expert commentary: Imaging plays an important role in the diagnosis and management of pulmonary fungal infection and may reveal useful signs. Although definitive diagnosis cannot be made based on imaging features alone, the use of a combination of epidemiologic, clinical and imaging findings may permit the formulation of an adequate differential diagnosis.

Status of pulmonary fungal pathogens among individuals with clinical features of pulmonary tuberculosis at Mbarara University Teaching Hospital in Southwestern Uganda

“…13 However, in many parts of the world endemic pulmonary mycoses, particularly the deep seated ones, are also prevalent and, just like TB, are also responsible for high rates of morbidity and mortality in an array of patient populations’. 14 , 15 – 17 The challenge has always been that in addition to the fact that both entities present with similar symptoms, patients with a history of suffering from TB have proven prone to certain opportunistic fungal infections such as Aspergillus . For instance, chronic aspergillosis commonly complicates treated pulmonary tuberculosis with residual cavitation.…”

Coccidioidomicosis. Reporte de 3 casos

“…En ninguno encontramos derrames pleurales. Los hallazgos radiológicos no son específicos y pueden incluir consolidaciones del parénquima pulmonar que tienden a ser unilateral, adenopatía hiliar, infiltrados lobares, derrame pleural, nódulos, cavidades, bronquiectasias y calcificaciones (2,9) . La diabetes se presentó en dos de los tres pacientes.…”

“…A los tres pacientes se les sometió a biopsia pulmonar abierta por mini-toracotomía, obteniendo tejido pulmonar adecuado para llegar al diagnóstico histopatológico, demostrando en todos ellos la presencia de las esférulas. La identificación histológica de las endosporas conteniendo las esférulas usualmente dentro de los granulomas no caseosos es diagnóstico de coccidioidomicosis (1,2,9) Conclusión.…”

Coccidioidomycosis in a reference center in Northeast Brazil: clinical/epidemiological profile and most common radiological findings

“…Imaging tests play an important role in the differential diagnosis of coccidioidomycosis and evaluation of pulmonary involvement extension. In acute phases of the disease, the most common findings in chest radiographs are segmental or parenchymal lobar consolidation (75% of cases) 15,18 . However, the radiological presentations may vary, ranging from alveolar or reticulonodular infiltrates with or without pleural effusion to multiple cavities.…”

“…Pleural effusion occurs in approximately 15%-20% of cases and is usually characterized by pulmonary parenchymal involvement 18 . In our case series, 13.8% of the patients presented with pleural effusion on admission.…”