Definition

Pulmonary mycosis is an inflammation of the lungs (pneumonia) caused by fungi. Typically, pneumonia is caused by bacteria or viruses, but fungi can also be the cause, although it is relatively rare. Pulmonary mycosis generally occurs in individuals with weakened immune systems. Fungi can enter and thrive in various parts of the body without causing any disease, or conversely, they can cause a variety of symptoms.

Causes

The causes of pulmonary mycosis can be opportunistic fungi or pathogenic fungi. Opportunistic fungi are fungi that can only cause disease when there are problems with the human immune system, either due to congenital abnormalities or acquired conditions. Examples of opportunistic fungi are Candida, Aspergillus, and Mucor. Meanwhile, pathogenic fungi are fungi that can infect humans regardless of the strength of the human immune system. Typically, these fungi are predominantly found in certain places worldwide, resulting in endemic infections (localized to a particular area). Examples of pathogenic fungi include Histoplasma capsulatum, Coccidioides immitis, Blastomyces dermatitidis, Paracoccidioides brasiliensis, Sporothrix schenckii, and Cryptococcus neoformans.

The most common cause of pulmonary mycosis is Aspergillus fungi. Moreover, this fungal infection has a relatively high mortality rate, around 50-85%. The cause of death often is not pulmonary mycosis, but rather fungal infections that have spread throughout the body. The second most common cause of pulmonary mycosis is Mucor fungi, which primarily affect individuals with weakened immune systems. This fungal infection also commonly occurs in individuals with uncontrolled diabetes mellitus and excess iron in the body.

Risk Factor

The risk factors for pulmonary mycosis vary but involve the human body, infectious agents, and the environment. Human body-related risk factors include problems with the immune system, which can be caused by congenital or acquired conditions. Examples of such conditions are individuals receiving immunosuppressive therapy after organ transplantation, individuals with blood cancer (leukemia) and lymphoma, end-stage liver disease, and long-term corticosteroid use (e.g., in autoimmune diseases such as lupus and rheumatoid arthritis). Additionally, other human body-related risk factors may include a history of asthma and cystic fibrosis (a disease that causes excessive mucus in the respiratory tract).

Meanwhile, risk factors related to infectious agents and the environment include occupations involving high exposure to birds, bats, rodents, or animal excrement. Farmers, workers in nurseries, gardeners, and landscapers are also at high risk of fungal infections when working with soil. Moreover, individuals who have nearly drowned in a source of water contaminated with fungi have a higher risk of fungal infection (e.g., victims of the 2004 Aceh tsunami).

Symptoms

Pulmonary mycosis may present with the following symptoms:

• Fever
• Cough, usually non-productive
• Chest pain, especially when breathing in, or dull pain
• Shortness of breath
• Swelling in the neck or chest due to enlarged lymph nodes
• Coughing up blood
• Joint pain or inflammation, redness and swelling throughout the body, inflammation of the heart lining
• Allergic reactions such as fever, coughing up blood or with sputum, or worsening asthma
• Inflammation of the brain and brain membranes

Usually, fever becomes the predominant symptom found in individuals with weakened immune systems.

Diagnosis

The diagnosis of pulmonary mycosis usually begins with questions about the patient's history and direct examination of the patient. These questions and examinations can lead the doctor to consider the possibility of fungal infection, especially if the patient has HIV/AIDS, a history of organ transplantation, is receiving corticosteroid therapy  or long-term immunosuppression, malignancy/cancer, diabetes mellitus, or end-stage liver disease. The doctor may also find extrapulmonary symptoms that may indicate pulmonary mycosis.

Pulmonary mycosis has a relatively high mortality rate despite ongoing antifungal therapy. Therefore, establishing a diagnosis needs to be done quickly. Unfortunately, the examination capable of confirming the diagnosis definitively is culture (cultivation of fungi from sputum or body tissue samples), which can take a long time. The use of examinations such as complete blood count and sputum or lung tissue examinations can help determine the presence of fungal infection rapidly but requires adequate facilities. Blood and urine cultures can also be performed if the fungal infection has spread throughout the body. Other examinations may include rapid fungal antibody tests, polymerase chain reaction (PCR) to search for fungal genetic material, or other chemical tests related to fungi. Fluid examination near the brain is also usually performed to look for fungal infections that have spread to the brain.

Meanwhile, various imaging examinations can be performed. X-rays can be used to identify various signs of fungal infection in relatively small healthcare facilities. In adequately equipped healthcare facilities, computed tomography scans (CT scans) can be performed rapidly to detect fungal infections so that therapy can be initiated before culture results are available. Findings on imaging may indicate a tendency towards certain fungal infections, but a definitive diagnosis can only be made through culture.

Management

The success of pulmonary mycosis management depends greatly on the extent of fungal infection and the individual's immune status. In healthy individuals with mild pulmonary mycosis, the infection may resolve on its own. If the immune system is compromised and the infection is extensive, the risk of death will be higher. Therefore, in individuals with weakened immune systems, several measures need to be taken to boost the immune system. For example, if someone is undergoing cancer chemotherapy or bone marrow transplantation, they will be given medications to increase the number of immune cells. Meanwhile, individuals undergoing corticosteroid therapy or other immunosuppressive therapy may need to stop or reduce medication intake for a period of time. If someone is known to be infected with Candida fungi, infected or contaminated catheters need to be removed from the body.

Moreover, management will involve antifungal therapy. The administration of antifungals depends greatly on the likely species of fungi infecting the individual and the extent of fungal infection. If someone recovers from a fungal infection but needs to continue immunosuppressive therapy or chemotherapy, antifungal therapy may be administered to prevent fungal reinfection.

Surgery may also be performed in cases of Aspergillus infection. This surgery is performed to prevent recurrent Aspergillus fungal infections if the patient requires further immunosuppressive therapy. Additionally, surgery is also performed to prevent severe bleeding usually caused by lung injury near major blood vessels. Apart from Aspergillus fungal infection, surgery may also be performed for Sporothrix fungal infections.

Complications

Complications of pulmonary mycosis are diverse. Pulmonary mycosis can cause bleeding in the form of coughing up blood due to lung injuries near major blood vessels. Moreover, fungal infections can spread to other parts of the body, especially the brain, heart, and kidneys. This spread can occur rapidly and have fatal consequences. Death can also result from pulmonary mycosis, particularly in those with compromised immune systems.

Prevention

Prevention of pulmonary mycosis can be achieved by using personal protective equipment when working with soil or animals. In healthy individuals, fungal infections are often acquired from soil or animal excrement. Additionally, other preventive measures can be taken by preventing HIV/AIDS, for example, by avoiding risky behaviors, tattooing, and sharing syringes. If you have been diagnosed with HIV/AIDS, you need to take medication regularly to control the virus and maintain your immune system. To prevent liver disease, you can avoid alcohol consumption, improper eating habits, and sharing syringes. If you have been diagnosed with diabetes mellitus, you need to take medication, consume nutritious foods, maintain an ideal body weight, and exercise regularly to help control your blood sugar levels.

If you are taking immunosuppressive drugs or undergoing chemotherapy, you can use masks to prevent inhaling fungi.

When to See a Doctor?

Jika Anda memiliki asma atau fibrosis kistik, sebaiknya Anda mengunjungi dokter jika Anda merasakan perubahan bernapas. Perubahan ini dapat berupa gejala sesak yang memberat, batuk, dan sebagainya. Mikosis paru belum tentu menjadi penyebab, namun, masalah-masalah ini sebaiknya dievaluasi dan ditangani segera.

Jika Anda memiliki penyakit terkait imun tubuh atau sedang dalam kemoterapi, Anda dapat segera ke dokter apabila mengalami demam yang tidak dapat dijelaskan, sesak napas, serta batuk berdarah.