Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Infection occurs after inhalation of sporangiospores, germination in a hyphal form• Pulmonary infection occurs in immunocompromised persons, follows a fulminant pattern• Distinct clinical syndromes:-Rhinocerebral infection: Direct extension in CNS from paranasal sinus infection-Cutaneous infection: Burn patients-GI infection: Children with protein-calorie malnutrition-Disseminated infection: Uremic patients receiving deferoxamine therapy +++ Epidemiology + • Pulmonary fungal infections are rising due to widespread use of broad-spectrum antibiotics, immunosuppressive drugs, and HIV infection• Occur anywhere in world, some with characteristic endemic areas• Rhizopus arrhizus (most common), absidia species, rhizomucor species-Infection occurs in patients with diabetes, leukemia, immunosuppression-Common in decaying fruit, vegetables, soil, and manure +++ Symptoms and Signs + • Pulmonary infection: Fever, cough, pleuritic chest pain, hemoptysis +++ Imaging Findings + • Chest film: 3 distinct patterns1. Limited disease with involvement of single lobe2. Diffuse or disseminated disease3. Endobronchial disease with obstruction and secondary bacterial infection• Chest CT scan: Characteristic halo sign, ring enhancement, and air-crescent sign + • Demonstrating organism in symptomatic patients• No skin or serologic test• Fungi grow in culture as broad irregular nonseptate hyphae branch at 90-degree angles• Diagnosis most commonly made by histology• Sine qua non: Hyphal vascular invasion between internal elastic membrane and media of blood vessels causing thrombosis and infarction + • Chest x-ray• Chest CT scan• Sputum microscopy and culture + • Amphotericin B is standard treatment• Small group of patients have limited disease: Aggressive surgical resection + amphotericin B • Endobronchial form: Successful treatment with transbronchoscopic resection using laser therapy +++ Prognosis + • Mortality is 90% despite best treatment; death from fungal sepsis, pulmonary dysfunction, and hemoptysis• Those surgically treatable: Mortality 50%• Endobronchial treatment is generally successful +++ References ++Piarrouz R et al: Assessment of preemptive treatment to prevent severe candidiasis in critically ill surgical patients. Crit Care Med 2004;32:2443. ++Walsh TJ et al: Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever. NEJM 2002;346:225. [PubMed: 11807146] Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth