Fungal pneumonia

Concurrent puimonary conditions Atovaquone is not effective therapy for concurrent pulmonary conditions such as bacterial, viral, or fungal pneumonia or mycobacterial diseases. Clinical deterioration in patients may be due to infections with other pathogens, as well as progressive PCP. 

Unlabeled Uses Treatment of coccidioidomycosis, cryptococcosis, fungal pneumonia, onychomycosis, ringworm of the hand, septicemia... 

Unlabeled Uses Suppression of histoplasmosis treatment of disseminated sporotrichosis, fungal pneumonia and septicemia, or ringworm of the hand... 

Unlabeled Uses S(/stemic Treatment of fungal pneumonia, prostate cancer, septicemia... 

Yamada H, Kotaki H, Takahashi T. Recommendations for the treatment of fungal pneumonias. Expert Opin Pharmacother. 2003 4 1241-1258. 

An unexplained change in the pattern of microbial causes of pneumonia has been noted in liver transplant patients taking tacrolimus, with an unexpectedly high incidence of Legionella and fungal pneumonia, the latter being involved in all deaths directly due to pneumonia (93). 

DM is a 55-year-old man who has been on chronic digoxin therapy for CHF for 3 years. He is currently undergoing treatment with amphotericin B for a fungal pneumonia. Today he complains of dizziness and nausea. Cr 0.8 mg/dl, weight 70 kg. What is the most likely reason for his digoxin toxicity ... 

Bacterial and fungal pneumonias are treated with antimicrobials (see chapter 12) and with bronchodilators, antipyretics, analgesics, expectorants and mucolytics, and cough suppressants. 

Fungal pneumonia is most likely in the immunocompromized as an oppormnistic infection with aspergillus or histoplasma and can be treated with amphotericin, itraconazole or voriconazole. Amphotericin has to be given intravenously and is toxic to the kidneys itraconazole is given orally or by intravenous infusion and can produce liver toxicity and heart failure voriconazole is given orally or by intravenous infusion and can be toxic to both liver and kidneys. 

Pneumonia can result from infection by bacteria, viruses or fungi. Bacterial pneumonia is treated with antibiotics viral pneumonia may not need specific drug treatment, but in serious cases antiviral drugs can be used. Fungal pneumonia usually only occurs in immunocompromized patients and must be treated with oral antifungal drugs. 

A 59-year-old man with acute myeloid leukemia developed fungal pneumonia after unrelated donor stem cell transplantation and was given posaconazole then voriconazole 200 mg bd, and soon after began working outside and developed photodistributed, macular erythema on the head, neck, and upper chest [51 ]. 

Characterization 366 Bacterial Pneumonia 367 Fungal Pneumonia 367 Pneumocystis Jiroveci Pneumonia (PcP) 369 Tuberculosis 369 Viral Pneumonia 370 Non-Infectious Disease 370 Graft vs Host Disease 370 Radiation Toxicity 37J Drug Toxicity 371 Pulmonary Congestion 372 Leukemic Infiltration 372 Pulmonary Hemorrhage 372... 

Fig. 27.3a-d. The small ill-defined nodule in the right upper lobe (c) of the 34 year-old neutropenic AML patient was even retrospectively not visible at chest X-ray done at the same day (a,b). Amphotericin B treatment was started due to suspicion of fungal pneumonia however, the nodule size increased dur-... 

Fig. 27.6a-d. Fungal pneumonia in HRCT (a), T2w (b), non-enhanced Tlw GE MRI (c) and after Gd application performed the same day (d). Lesion contrast is similar in CT and contrast enhanced MRI (Ullmann AU, personal communications)... 

There are other useful patterns in the identification of fungal pneumonia distribution along the broncho-vascular bundle resulting in the feeding vessel sign with an angiotropic location. 

In pancytopenia, pulmonary bleeding occurs spontaneously, after interventions (e.g. BAL), or during haema-tological reconstitution after fungal pneumonia (Heus-SEL et al. 1997). 

Chanock S (1993) Evolving risk factors for infectious complications of cancer. Hematol Oncol Clin North Am 7 771-793 Conces DJ (1998) Bacterial pneumonia in immunocompromised patients. J Thoracic Imaging 13 261-270 Conces DJ (1999) Noninfectious lung disease in immunocompromised patients. J Thoracic Imaging 14 9-24 Davies SF (1994) Fungal pneumonia. Med Clin North Am 78 1049-1065... 

Heussel CP, Ulhnann AJ, Kauczor H-U (2000a) Fungal pneumonia. Radiologe 40 518-529... 

Bag R (2003) Fungal pneumonias in transplant recipients. Curr Opin Pulm Med 9 193-198... 

Conces DJ Jr, Stockberger SM, Tarver RD, Wheat LJ (1993) Disseminated histoplasmosis in AIDS findings on chest radiographs. AJR Am J Roentgenol 160 15-19 Connolly JE Jr, McAdams HP, Erasmus JJ, Rosado-de-Chris-tenson ML (1999) Opportunistic fungal pneumonia. J Thorac Imaging 14 51-62... 

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