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Jun 09, 2023

Fungal Pneumonia: Causes, Symptoms, Treatment, and More

Mark Gurarie is a freelance writer, editor, and adjunct lecturer of writing

Mark Gurarie is a freelance writer, editor, and adjunct lecturer of writing composition at George Washington University.

John Carew, MD, is board-certified in otolaryngology and is an adjunct assistant professor at New York University Medical Center.

Fungal pneumonia is a non-contagious lung infection caused by fungal spores. It happens when the spores mix with the air and are inhaled, or when an inactive infection is reactivated. Fungal pneumonia symptoms are those of the flu: coughing, headache, thick mucus, fever, and chest pain.

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Several fungi cause fungal pneumonia, the three most common ones being Pneumocystis, Cryptococcus, and Aspergillus. These fungi are found in the air, soil, and clinical environments like hospitals.

Fungal pneumonia tends to affect people with weaker immune systems, such as adults over the age of 65, children under the age of 2, and people with certain chronic diseases like human immunodeficiency virus (HIV/AIDs) or cancer.

Antifungal medications can cure this kind of infection. But if it is not treated, fungal pneumonia becomes very serious and can be deadly.

This article goes over what fungal pneumonia is, including its symptoms, treatments, and complications.

Because the most common symptoms of fungal pneumonia are similar to those of viral or bacterial lung infections, diagnosis—and proper treatment—can be delayed. Those symptoms are:

Age can play a part in the type and severity of symptoms in people with fungal pneumonia, including:

If you’ve been sick with respiratory symptoms and think you could have pneumonia, it's very important that you seek medical care.

Call your provider if you have:

You should also call your provider if you think you could have been exposed to a fungus that could cause fungal pneumonia, especially if you are at risk because of your age or weak immune system. Read on for some of the possible places you may encounter such fungi.

Pneumonia can become a medical emergency. Call 911 or go to your nearest emergency room if you or a loved one has:

Primarily, fungal pneumonia develops when fungal spores are inhaled. Each form of this disease arises from a corresponding type of fungus that often are native to specific regions. These fungi include:

In addition to these are opportunistic fungal infections, those present in any indoor or outdoor setting, including clinical or hospital environments, called hospital-acquired infections (HAIs). Most common among these are Candida, Aspergillus, and Pneumocystis jirovecii, the latter two of which cause pneumonia.

Overall, these infections are rare in healthy adults and tend to infect people with compromised immunity. These include:

In addition, immunity can be affected by a number of preexisting heart or lung conditions, including:

As noted, there are several types of fungal pneumonia, and while they largely align, symptoms can vary slightly among them. Pneumonia types are categorized based on the fungus that causes the infection.

Deriving from the yeast-like Pneumocystis jirovecii fungi, pneumocystis pneumonia causes severe dry cough, fever, and chest pains. It typically impacts those with vulnerable immune systems, like cancer patients and those with HIV, or people who have had a bone marrow transplant or take high doses of corticosteroids.

Since this fungal pneumonia most often arises in already very sick, immunocompromised people, this condition can be very difficult to take on. Treatment may be oral medication or daily IV (intravenous) injections for three weeks. While outcomes are improving, this type of pneumonia is still a major cause of death among HIV/AIDs patients.

Also known as coccidioidomycosis, valley fever arises from exposure to Coccidioides fungi from soil in the U.S. Southwest and parts of Central America and South America. It usually affects people 60 and older and those exposed to dusty environments, such as farmworkers and construction workers.

Symptoms of this fungal infection—fever, cough, headache, rash, and muscle and joint pain—mimic other illnesses, making diagnosis challenging.

The outlook for people with this condition is brighter than for those with other fungal pneumonia. While treatment is extensive—lasting up to six months—most people respond well to it and recover fully. Long-term infections and nerve damage can linger, and untreated cases can be dangerous.

Caused by the Histoplasma fungus of the central and eastern United States, histoplasmosis causes fatigue, fever, and coughing, as well as other typical pneumonia symptoms. Arising three to 17 days after exposure, many cases resolve on their own, though some cases can become advanced and severe.

In the worst cases, infections spread from the lungs to other parts of the body, such as the spinal cord and brain.

Courses of treatment—taking medications—can last from three to 12 months. Severe cases of this pneumonia can be deadly, and histoplasmosis has a mortality rate of about 4% six months after hospitalization.

This pneumonia is due to exposure to Cryptococcus neoformans, which is found in rotting wood and bird droppings in natural environments. As with other infections, cryptococcus only occurs in people with already weak immune systems, with most healthy individuals being able to fend off this disease.

Typical pneumonia symptoms accompany cases of cryptococcus. If untreated, it can progress to an infection of the brain or spinal cord called cryptococcal meningitis.

Antifungal medication for this condition is taken for at least six months, with fatality estimated to be about 12%. Like pneumocystis pneumonia, this infection was once a major cause of death among HIV/AIDS patients, though these numbers have gone down as therapies improve.

Among the most prevalent airborne fungi is Aspergillus, a mold found in many indoor and outdoor environments. The resulting infection, aspergillosis, is often acquired in the hospital setting in patients with severe immunodeficiency. This type, along with cryptococcus and some others, is associated with late-stage HIV/AIDS cases.

In addition to pneumonia symptoms, this type of infection can cause masses known as "fungal balls" (aspergilloma) to grow in the lungs. It can also spread to other organs.

While milder forms of aspergillosis are easily treated and managed with drug therapy, severe cases can be dangerous. Since immunocompromised people are affected, this condition can become deadly. For instance, the one-year survival rate for those with this condition after an organ transplant is about 59%.

One of the main challenges of fungal pneumonia is that it's a disease that resembles others. Many people delay seeking medical attention, assuming they have a cold or flu. In addition, determining the exact cause requires lab assessment of cultures found in mucus and/or fluid from the lungs.

Diagnosis is made through the following tests:

In severe cases, additional tests may be needed, including:

Fungal pneumonia is primarily treated with antifungal medications. Specific dosages and methods of administration vary based on the individual case and type of infection. Medications indicated include:

In severe cases, oxygen therapy to restore oxygen levels and breathing exercises to loosen mucus and strengthen the lungs might be ordered. In general, the duration of treatment for fungal pneumonia can last up to year.

In very advanced cases of cryptococcus, valley fever, and aspergillosis, fungal growths called mycetomas can form in the lungs and need to be surgically removed. This delicate work is undertaken only if previous therapies haven't yielded results.

If fungal pneumonia progresses, a number of potentially very dangerous complications arise:

If the infection spreads from the lungs to the bloodstream, other parts of the body become vulnerable. This leads to a number of serious conditions, including:

Advanced cases of fungal pneumonia of all forms also can lead to mycetomas in the lungs. Aspergilloma, the development of mycetomas as a result of Aspergillus infection, is the most common form, but valley fever, histoplasmosis, and cryptococcus can all cause these growths.

There are steps you can take to prevent fungal pneumonia. These are even more important if you have a weak immune system:

Fungal pneumonia happens when you breathe in spores for different kinds of fungus. It causes flu-like symptoms and is more likely to infect people who have weak immune systems.

It's not contagious, but fungal pneumonia can be a serious illness if it's not diagnosed and treated.

You can't always prevent pneumonia, but there are steps you can take to reduce your risk. Staying healthy, protecting yourself if you're in an environment where fungi could live, and getting care if you're feeling ill will help you avoid serious complications.

The most common causes of fungal pneumonia in the environment are coccidioides, histoplasmosis, cryptoccous neoformans, and blastomyces.

Candida, aspergillum, and pneumocystis jirovecii are common causes of hospital-acquired fungal pneumonia.

Fungal pneumonia can feel like the flu or other types of pneumonia. It causes symptoms like fever, cough, and pain when you breathe.

How long it takes to treat fungal pneumonia depends on the cause and how serious the infection is. A few weeks of medication can clear up the infection in some people, but more severe cases may take months to recover from.

Fungal pneumonia can be very serious, partly because it often occurs in people who have weak immune systems. People can develop complications ranging from fluid in their lungs to an infection that spreads to their brains. In some cases, fungal pneumonia can be fatal.

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By Mark GurarieMark Gurarie is a freelance writer, editor, and adjunct lecturer of writing composition at George Washington University.