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rare but important causes of pneumonia
fungal pneumonia in immunocompetent patients is very rare
2 main groups based on the immune response required to combat infection with
these organisms
- Histoplasma, blastomycosis, coccidioidomycosis, paracoccidioidomycosis
and cryptococcus require specific cell-mediated immunity for their control
and thus, diseases caused by these organisms can occur in otherwise
healthy individuals. Cause much more severe illnesss in patients with
impaired cell mediated immunity (eg patients infected with HIV and organ
transplant recipients). With the exception of cryptococcus these organisms
are rarely seen outside North America.
- Aspergillus
and mucor spores are killed by non-immune. Rarely result in clinical illness
in patients with normal neutrophil numbers and function.
- Candidiasis is effectively a combination of the 2 types of fungal
infection in that impaired cell-mediated immunity predisposes to mucosal
overgrowth with Candida but impaired phagocytic function or numbers is
usually required before deep invasion of tissues occurs.
Further reading
Rex,
J. H., Walsh, T. J., Sobel, J. D. et al. (2000). Practice guidelines for the
treatment of candidiasis. Infectious Diseases Society of America. Clin. Infect.
Dis. 30, 662-678.
Stevens, D.
A., Kan, V. L., Judson, M. A. et al. (2000). Practice guidelines for diseases
caused by Aspergillus. Clin. Infect. Dis 30, 696-709.
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