Table 1.

Common fungal agents, characteristic growth patterns, associated pulmonary clinical syndromes, and risk factors for human pulmonary mycoses.

Agent of Lung Disease and Geographic Range	Infectious Propagule	Morphotype	Pulmonary Clinical Syndromes	Common Patient Populations
Aspergillosis Aspergillus fumigatus, A. flavus, A. niger, A. terreus, A. versicolor, A. ustus, A. lentulus, A. nidulans (chronic granulomatous disease)  Range: Ubiquitous	Airborne conidia (2–3 μm diameter)	Mold forms tissue-invasive hyphae	Pneumonia Tracheobronchitis (CNS dissemination) Chronic cavitaryaspergillosis (hyphae in pre-existing lung cavities) Allergenic disease Allergic bronchopulmonary aspergillosis (ABPA), extrinsic allergic alveolitis	Hematologic malignancy or aplastic anemia, hematopoietic cell transplant; lung and heart transplant, patients with severe COVID-19 or severe influenza, chronic granulomatous disease. Patients with structural lung damage, COPD, prior tuberculosis, bronchiectasis, sarcoidosis ABPA occurs primarily in patients with atopic asthma and cystic fibrosis
Mucormycosis (Rhizopus, Mucor,Rhizomucor, Lichtheimia spp.)  Range: Ubiquitous	Conidia (variable size based on species)	Mold	Pneumonia	Acute hematologic malignancy or bone marrow failure, hematopoietic cell transplant recipients; lung and heart transplant recipients, patients with severe COVID-19, diabetic ketoacidosis.
Cryptococcosis (Cryptococcus neoformans,C. gattii)  Range: C. neoformans: ubiquitous, C. gattii: Australia, Papua New Guinea,US Pacific Coast and British Columbia	Desiccated yeast cells	Encapsulated yeast (variable capsule size, rare Titan cells up to 100 μm diameter)	Pneumonia (CNS dissemination)	Patients with HIV/AIDS, patients on lymphodepleting therapies for hematologic malignancies.
Blastomycosis (Blastomyces dermatitidis)  Range: Eastern US and Canada; emergomycosis in Africa	Conidia (2–10 μm)	Dimorphic, 8–12 μm yeast with broad-based buds in tissue	Pneumonia (self-limiting to life-threatening disease, mucosal disease, skin)	Patients with HIV/AIDS, 50% of cases in immune competent patients; patients of Laotian ancestry in endemic area
Coccidioidomycosis (Coccidioides immitis, C. posadasii)  Range: CA, OR, WA, AZ, Mexico	Arthroconidia (3 × 5 μm, boxcar-shaped)	Dimorphic, 20–80 μm thick-walled spherules contain 2–5 μm yeast cells in tissue	Pneumonia (self-limiting to life-threatening disease, mucosal disease, CNS, erythema nodosum)	Patients with HIV/AIDS, patients on lymphodepleting therapies. Pregnant women, African-American and Filipino ancestry in endemic area
Histoplasmosis (Histoplasma capsulatum)  Range: OH and MS Valleys in US, Canada, Central and South America, sub-Saharan Africa, SE Asia, Australia	Conidia (microconida & macroconidia)	Dimorphic, Intracellular yeasts tissue; Hc var. capsulatum 2–4 μm; Hc var. duboisii 8–15 μm)	Pneumonia (self-limiting to life-threatening disease)	Patients with HIV/AIDS, patients on lymphodepleting therapies.
Paracoccidioidomycosis (Paracoccidioides brasiliensis)  Range: Central and South America (20th parallel north to 35th parallel south of equator)	Conidia	Dimorphic, yeast cells with multiple buds in tissue	Pneumonia (mucosal disease, skin)	Patients with HIV/AIDS, patients on lymphodepleting therapies.
Talaromycosis (Talaromyces marneffei)  Range: SE Asia	Conidia	Dimorphic, yeast cells in tissue	Pneumonia (mucosal disease)	Patients with HIV/AIDS, patients on lymphodepleting therapies.
Pneumocystosis (Pneumocystis jirovecii)  Range: Likely ubiquitous, non-culturable, no known reservoir outside of humans	Unknown	Trophozoites, Cysts	Pneumonia (characterized by hypoxemia)	Patients with HIV/AIDS, patients on lymphodepleting therapies.