ABSTRACT
Fungal respiratory disease causes significant mortality and morbidity.1,2 With increasing use of immunosuppressive therapeutics and an aging population with chronic disease, the incidence of fungal infections continues to rise.3 Pulmonary complication is the most frequent cause of morbidity and mortality following fungal infection in the immunocompromised state.2,4 In this chapter, we review the spectrum of respiratory fungal disease. Largely, this constitutes invasive fungal infection in the setting of systemic immunocompromise; however, the prevalence of chronic semi-invasive disease is rising with better recognition. The diagnosis of fungal infection remains challenging due to the low sensitivity of conventional cultural and microscopic methods, and consensus international recommendations utilizing clinical, microbiological, and radiological criteria are currently utilized.5 Histological confirmation remains the gold standard in themajority of respiratory fungal infections; however, this is often impractical and associated with considerable risk. Nevertheless, delay in diagnosis is associated with poor outcome, and advances in novel diagnostics and therapeutics for invasive fungal diagnostics are discussed alongside research into the role of immunotherapy. Lastly, the emergence of novel fungal pathogens and fungal resistance causing significant morbidity are reviewed alongside the respiratory complications of endemic mycoses.
