Last reviewed: 7 Jan 2023
Last updated: 24 Mar 2022
Summary
Definition
History and exam
Key diagnostic factors
- exposure to fungal spores
- risk factors that impair host defenses
- fever
- headache
- dyspnea
- dry or nonproductive cough
- pleuritic chest pain
- anorexia
- productive cough
More key diagnostic factors
Other diagnostic factors
- abdominal pain
- fatigue
- malaise
- arthralgias
- weight loss
- hepatosplenomegaly
- scattered crackles on chest auscultation
- bronchial breathing on chest auscultation
- distant breath sounds on chest auscultation
- hemoptysis
- meningitis-like symptoms
- skin lesions
- gastrointestinal symptoms
- sepsis-like syndrome
Other diagnostic factors
Risk factors
- exposure to fungus
- emphysema
- HIV infection
- treatment with tumor necrosis factor (TNF)-alpha antagonists
- treatment with corticosteroids
- treatment with immunosuppressants
- neutropenia
- stem cell and solid organ transplant
- graft-versus-host disease
More risk factors
Diagnostic investigations
1st investigations to order
- chest x-ray
- culture of pulmonary secretions
- antigen testing
- immunodiffusion precipitin test
- complement fixation assay
- serology (enzyme immunoassay)
- CT scan of chest
- CBC
- LFTs
More 1st investigations to order
Investigations to consider
- tissue biopsy
More investigations to consider
Treatment algorithm
ACUTE
latent asymptomatic disease (nonpregnant)
acute pulmonary disease: <4 weeks (nonpregnant)
acute pulmonary disease: >4 weeks (nonpregnant)
chronic pulmonary disease (nonpregnant)
disseminated disease (nonpregnant)
mediastinal granuloma (nonpregnant)
mediastinal fibrosis (nonpregnant)
broncholithiasis (nonpregnant)
pericarditis (nonpregnant)
rheumatologic syndrome (nonpregnant)
meningoencephalitis (nonpregnant)
pregnant
Contributors
Authors
Zainab A. Malik, MD, MS, FAAP
Consultant
Pediatrics and Pediatric Infectious Diseases
Mediclinic City Hospital
Dubai
United Arab Emirates
Disclosures
ZAM has received speakers' honoraria from Merck-MSD.
David L. Goldman, MD
Associate Professor
Pediatric Infectious Diseases
The Children's Hospital at Montefiore
New York
NY
Disclosures
DLG declares that he has no competing interests.
Peer reviewers
Paul Roberts, MD
Assistant Professor
Family Medicine
Mayo Clinic
Jacksonville
FL
Disclosures
PR declares that he has no competing interests.
Janak Koirala, MD
Associate Professor of Medicine
Division of Infectious Diseases
Department of Internal Medicine
Southern Illinois University School of Medicine
Springfield
IL
Disclosures
JK declares that he has no competing interests.
Differentials
- Community-acquired pneumonia
- Pneumocystis jirovecii pneumonia (PCP)
- Pulmonary tuberculosis
More DifferentialsGuidelines
- Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV
- Global guideline for the diagnosis and management of the endemic mycoses
More GuidelinesLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer