Pulmonary fungal infections: Making the diagnosis
Since endemic mycoses can be contracted during a brief travel exposure, it is important to inquire about travel when a patient presents with symptoms of a respiratory infection. Most patients with blastomycosis present in the chronic phase, with cough, weight loss, hemoptysis, and pleurisy; the chest radiograph typically shows lobar consolidation. The diagnostic workup includes sputum examination and culture and serologic testing. Patients who have cryptococcosis are often immunocompromised and may be asymptomatic or present with pulmonary nodules or pneumonia with hemoptysis and pleural effusions. Diagnosis may include a serum Cryptococcus antigen test, with positive results prompting a lumbar puncture and blood cultures. Patients with semi-invasive aspergillosis may have upper lobe interstitial infiltrates with pleural thickening or a fungus ball. The diagnosis involves isolation of Aspergillus species from sputum, bronchoalveolar lavage fluid, or biopsy samples and exclusion of other causes of pneumonia.
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