Table 1.

Causal agents of respiratory mycosis.

Fungi	Disease	Source of Infection	Pathological Manifestations	Diagnosis	Antifungals
Endemic
Blastomyces dermatitidis	Blastomycosis	Soil	Mild flu-like symptoms; chronic cutaneous disease with subcutaneous lesions on the face and hands	Microscopic observation of sputum samples; urine antigen test; enzyme immunoassay	Amphotericin B, ketoconazole
Coccidioides immitis	Coccidioidomycosis (valley fever)	Soil	Granulomatous lesions on the face and nose; meningitis in severe cases	Serological tests	Amphotericin B
Histoplasma capsulatum	Histoplasmosis	Soils with bird or bat droppings	Fever, headache, and weakness with some chest discomfort	Chest X-ray; cultures grown on fungal selective media; direct fluorescence antibody and Giemsa staining	Amphotericin B, ketoconazole, itraconazole
Paracoccidioides sp.	Paracoccidioidomycosis	Soil near armadillo burrows	Adults: affects lungs and causes lesions in the mouth and throat; Children: swollen lymph nodes and skin lesions	Chest X-ray, biopsy for fungal culture or to be examined under the microscope and blood tests	Itraconazole and amphotericin B; trimethoprim/sulfamethoxazole
Talaromyces marneffei (formerly Penicillium marneffei)	Talaromycosis (formerly Penicilliosis)	Plants and farmed animals	Fever, weight loss, hepatosplenomegaly, lymphadenopathy, skin lesions	Microscopy, histology, and culture	Amphotericin B or voriconazole followed by itraconazole
Sporothrix schenckii	Sporotrichosis (rose gardener’s disease)	Soil, Sphagnum moss, rose bushes and hay	Cutaneous nodules that spread and break down into abscesses and ulcers, with rare pulmonary involvement	Culture	Itraconazole, amphotericin B
Opportunistic
Aspergillus fumigatus	Aspergillosis	Soils and organic debris	Asthma-like allergic reactions; shortness of breath, wheezing, coughing, runny nose and headaches	Chest X-ray; microscopic examination of tissue and respiratory fluid samples	Itraconazole, voriconazole
Candida spp.	Candidiasis	Skin and inside the body	Localized or diffuse pneumonia, nodular lesions, abscesses, and empyema	Isolation of the organism from lung tissue samples	Fluconazole (milder cases), amphotericin B deoxycholate, lipid formulations
Cryptococcus neoformans	Cryptococcosis	Soil, pigeon guano and tropical and subtropical trees	Fever, fatigue, and a dry cough; when spreading to the brain causes meningitis (headaches, sensitivity to light, and confusion)	Microscopic examination of lung tissues or cerebrospinal fluids	Amphotericin B combined with flucytosine followed by fluconazole for up to 6 months
Nonpigmented fungi (other than Aspergillus and Penicillium or Zygomycetes) *	Hyalohyphomycosis	Soil, water or on decomposing organic debris	Lesions from local cutaneous, subcutaneous, corneal, or nasal mucosal disease to disseminated disease involving multiple organs	Culture isolation and/or PCR	Surgical removal with or without azole antifungal therapy
Rhizopus spp. and Mucor spp.	Mucormycosis (formerly zygomycosis)	Throughout the environment	Fever, cough, chest pain, and shortness of breath	Tissue biopsy specimens	Amphotericin B and surgical debridement removal in superficial infections
Dark melanin-pigmented dematiaceous fungi **	Phaeohyphomycosis	Soil	Sinusitis, subcutaneous nodules or abscesses, keratitis, lung masses, osteomyelitis, mycotic arthritis, endocarditis, brain abscess, and disseminated infection	Examination using Masson-Fontana staining; culture to identify causative species	Surgery and/or itraconazole
Pneumocystis jirovecii	Pneumocystis pneumonia (PCP)	Person to person through the air	Fever, cough, and shortness of breath	Microscopic examination of tissue and fluid samples from the lungs	Trimethoprim-sulfamethoxazole combination

Includes: * Acremonium, Fusarium, Geotrichum, Paecilomyces, Pseudallescheria, Sagenomella, Phialosimplex, Geosmithia, Geomyces, and Scedosporium; ** Bipolaris, Cladophialophora, Cladosporium, Exophiala, Fonsecaea, Phialophora, Ochronosis, Rhinocladiella, and Wangiella.