Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- exposição a esporos fúngicos
- fatores de risco que comprometem as defesas do hospedeiro
- febre
- cefaleia
- dispneia
- tosse seca ou não produtiva
- dor torácica pleurítica
- anorexia
- tosse produtiva
Other diagnostic factors
- dor abdominal
- fadiga
- mal-estar
- artralgias
- perda de peso
- hepatoesplenomegalia
- estertores dispersos à ausculta torácica
- sopro tubário à ausculta torácica
- murmúrio vesicular diminuído à ausculta torácica
- hemoptise
- sintomas tipo meningite
- lesões cutâneas
- sintomas gastrointestinais
- síndrome tipo sepse
Risk factors
- exposição ao fungo
- enfisema
- Infecção pelo vírus da imunodeficiência humana (HIV)
- tratamento com antagonistas do fator de necrose tumoral (TNF)-alfa
- tratamento com corticosteroides
- tratamento com outros imunossupressores e agentes biológicos
- imunodeficiência primária (especialmente aquelas associadas ao comprometimento das células T)
- transplante de células-tronco e de órgão sólido
- doença do enxerto contra o hospedeiro
Diagnostic investigations
1st investigations to order
- radiografia torácica
- cultura
- teste de antígeno
- sorologia (teste de precipitina [imunodifusão])
- sorologia (ensaio de fixação de complemento)
- sorologia (imunoensaio enzimático)
- TC do tórax
- Hemograma completo
- TFHs
Investigations to consider
- biópsia tecidual
Treatment algorithm
doença pulmonar assintomática (não gestante)
doença pulmonar sintomática (não gestante)
doença pulmonar crônica (não gestantes)
doença disseminada (não gestantes)
granuloma mediastinal (não gestantes)
fibrose mediastinal (não gestantes)
broncolitíase (não gestantes)
pericardite (não gestantes)
síndrome reumatológica (não gestantes)
meningoencefalite (não gestantes)
gestante
Contributors
Authors
David L. Goldman, MD
Associate Professor
Pediatric Infectious Diseases
The Children's Hospital at Montefiore
Bronx
NY
Disclosures
DLG declares that he has no competing interests.
Philip Lee, Pharm D
Clinical Pharmacist for Pediatric Infectious Disease
The Children’s Hospital at Montefiore
Bronx
New York
Disclosures
PL declares that he has no competing interests.
Acknowledgements
Dr David L. Goldman and Dr Philip Lee would like to gratefully acknowledge Dr Zainab A. Malik, a previous contributor to this topic.
Peer reviewers
Kassem Hammoud, MD
Associate Professor
Division of Infectious Diseases
University of Kansas Health System
Kansas City
MI
Disclosures
KH declares that he has no competing interests.
Adriana M. Rauseo, MD
Assistant Professor of Medicine
Division of Infectious Diseases
Department of Internal Medicine
Washington University in St Louis
St Louis
MI
Disclosures
AMR declares that she has no competing interests.
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Infectious Diseases Society of America. IDSA 2025 guideline update on the treatment of asymptomatic histoplasma pulmonary nodules (histoplasmomas) and mild or moderate acute pulmonary histoplasmosis in adults, children, and pregnant people. Mar 2025 [internet publication].Full text
Thompson GR 3rd, Le T, Chindamporn A, et al. Global guideline for the diagnosis and management of the endemic mycoses: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology. Lancet Infect Dis. 2021 Dec;21(12):e364-74.Full text Abstract
National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and the Infectious Diseases Society of America. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: histoplasmosis. Oct 2024 [internet publication].Full text
Hage CA, Carmona EM, Epelbaum O, et al. Microbiological laboratory testing in the diagnosis of fungal infections in pulmonary and critical care practice. An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2019 Sep 1;200(5):535-50.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Pneumonia adquirida na comunidade
- Pneumonia por Pneumocystis jirovecii (PCP)
- Tuberculose pulmonar
More DifferentialsGuidelines
- IDSA 2025 guideline update on the treatment of asymptomatic histoplasma pulmonary nodules (histoplasmomas) and mild or moderate acute pulmonary histoplasmosis in adults, children, and pregnant people
- Testing algorithms for fungal pneumonias
More Guidelines
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer