Pulmonary endemic mycoses

Abstract

While rare, the likelihood of encountering a case of a pulmonary endemic mycosis (PEM) in the UK is increasing. Diagnosis may be challenging, often leading to considerable delay to appropriate treatment. Clinical suspicion must be present for respiratory disease, particularly in the immunocompromised or in those not responding to empiric treatment approaches, and an extended travel history should be obtained. This article summarises the epidemiology of PEM, key clinical features, diagnostic strategies and management.

Keywords: Endemic mycoses; Fungi; Immunocompromised; Infection; Pulmonary.

Fig 1

Radiological images from a patient with pulmonary histoplasmosis. (a) Chest X-Ray and (b) computed tomography. The radiological appearance mimicks that of miliary tuberculosis.

Fig 2

The organisms causing occidioidomycosis and paracoccidioidomycosis. (a) Coccidioides immitis in the environmental mould form. X 400 magnification, lactofuchsin stain. Thick-walled, barrel-shaped arthroconidia with thin-walled empty cells between, forming in mature hyphae. Infectious arthroconidia are released when the thin-walled empty cells rupture. (b) Paracoccidioides brasiliensis in the yeast phase. X 400 magnification, lactofuchsin stain. Characteristic ship's wheel appearance of a mother cell with multiple synchronously budding daughter cells.