Experts Warn of Spread of Lung Infection-Causing Fungi

Risk of histoplasmosis, blastomycosis, and coccidioidomycosis—also known as Valley fever—may increase in the United States, according to research published in the Annals of Internal Medicine.

Considered endemic fungal diseases (found in a distinct geographical location), researchers warn that climate changes could propel the disease-causing fungi beyond their traditional hot spot.

"These 3 fungal diseases usually inhabit specific US regions conducive to their survival," said George Thompson, professor at the UC Davis School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, and the Department of Medical Microbiology and Immunology, in a recent press release. "Recently, we are finding more cases of these diseases outside their known areas, taking clinicians and patients by surprise."

These disease-causing fungi can cause lung infections but are commonly misdiagnosed. Considered a rising threat in the community, late diagnoses and delayed treatment may worsen or prolong treatment outcomes. Common symptoms of fungal infection may include fever, chills, cough, night sweats, fatigue, and pneumonia-mimicking lung infections that mimic viral and bacterial infection.

Fungi—which include yeasts, molds, mushrooms, and other living organisms—are abundant in nature and generally harmless. The trouble arises with those that cause disease (mycoses) in humans, which are now identified by the World Health Organization (WHO) as pathogens. The WHO created a list of the worst fungal priority pathogens or those that cause infections that are resistant to drug treatment.

"The organisms are probably much more widespread than we originally thought. There is an increasing likelihood that clinicians who are not familiar with these organisms will encounter them during their daily practice," Thompson said in the press release.

Fungal lung infections are not widely recognized. While Valley fever causes approximately 20%

of California’s and Arizona’s pneumonia cases, diagnosis can take upwards of 3 weeks following symptoms. Often misdiagnosed as bacterial infections, fungal infections are treated with antibiotics that can cause antibiotic resistance and not treat the root cause.

Further, leading references, such as the American Thoracic Society and Infectious Diseases Society of America, do not recommend testing or treatment for endemic mycosis, which could lead to further ineffective treatments.

To combat endemic mycoses, authors suggest a 5-step multifaceted identification, treatment, and educational approach that includes: 1) national surveillance and disease reporting of endemic mycoses in both humans and animals, 2) educational efforts for patients and providers, 3) inclusion of endemic mycoses in future pneumonia guidelines, 4) development of point-of-care diagnostic tools, and 5) exploration of a pan-endemic mycoses vaccine to prevent infection.

"The organisms are probably much more widespread than we originally thought. There is an increasing likelihood that clinicians who are not familiar with these organisms will encounter them during their daily practice," Thompson said.

Reference

University of California – Davis Health. Physicians urged to consider fungal infections as possible cause for lung inflammation. Science Daily. News Release. November 21, 2022. Accessed on December 16, 2022. https://www.sciencedaily.com/releases/2022/11/221121213544.htm