What is the associated morbidity and mortality in fungal pneumonia?

Updated: Jun 21, 2019
  • Author: Romeo A Mandanas, MD, FACP; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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The endemic fungal pneumonias are generally self-limited in healthy hosts. C immitis is the most virulent, yet 90% of patients recover without treatment. However, patients with fungal pneumonias may develop chronic pulmonary complications (eg, cavitation, pleural effusions, bronchopleural fistulas) or extrapulmonary complications. In patients with AIDS, the mortality rate is as high as 70%.

Aspergillosis represents the leading cause of invasive pulmonary lung infection and death among patients who are neutropenic (from either leukemia chemotherapy or bone marrow transplantation) with a mortality rate of 50-85%. More often, in the case of aspergillosis and candidal infections or meningoencephalitis in the case of cryptococcosis, the cause of mortality in patients who are immunocompromised is disseminated fungal disease. [12]

Mucormycosis represents the second most common cause of fungal pneumonia, accounting for approximately 10% of all invasive pulmonary infections in immunosuppressed patients and resulting in significant morbidity and mortality. Patients with hematologic malignancies are at highest risk, but uncontrolled diabetes mellitus and iron overload are important predisposing factors. [1] Rhizopus, Mucor, Absidia (Lichtheimia), and Rhizomucor species are the most commonly implicated. [1, 5]

P boydii or its asexual form, S apiospermum, is now considered an emerging pathogen causing pneumonia and disseminated infections in the same immunocompromised hosts as aspergillosis. Scedosporium species (including prolificans) are inherently resistant to amphotericin B and echinocandins, and infections carry high mortality rates, especially in the persistently profound neutropenic patient. [13]

The mortality rate for untreated disseminated histoplasmosis is 80%, but, with treatment, the rate is reduced to 25%.

Candida albicans and Candida glabrata are ubiquitous commensals of humans and can be found especially in the oral cavity and gastrointestinal tract of most healthy humans. On the other hand, they are also the most pathogenic yeasts. [14] Among the Candida species, C albicans and C glabrata rank as the two most frequently isolated organisms. [14] Despite the frequent isolation of Candida species from respiratory samples in nonneutropenic patients, the organisms are not considered causes of pneumonia regardless of the species isolated. [15] Pneumonia from Candida species is exceptional in nonneutropenic patients. [15]

Sporothrix schenckii is the etiological agent of sporotrichosis, a chronic fungal infection that most frequently affects cutaneous and subcutaneous tissues and adjacent lymphatics. [10] However, extracutaneous forms have been described with no history of traumatic injuries, making the diagnosis difficult. [10] Pulmonary presentation is rare and may be caused by the dymorphic fungus S schenckii and even more rarely by other Sporothrix species. Lately, recognition of this condition has increased as more cases have been reported. [16] In immunocompromised patients, disseminated sporotrichosis may be associated with significant morbidity and, possibly, mortality.

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