Endemic Fungi Presenting as Community-Acquired Pneumonia: A Review

Marwan M. Azar, Joshua Malo, Chadi A. Hage

Research output: Contribution to journalReview article


In endemic areas, dimorphic fungal infections due to Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides posadasii/immitis account for up to 30% of cases of community-acquired pneumonia. Because respiratory manifestations are often indistinguishable from common bacterial causes of pneumonia, the diagnosis of pulmonary histoplasmosis, blastomycosis, and coccidioidomycosis is often delayed and associated with antibiotics overuse. In addition to being highly endemic to certain regions of North America, dimorphic fungi have global significance due to established areas of endemicity in all six inhabited continents, an increasingly interconnected world of travelers and transported goods, and a changing epidemiology as a result of global heating and anthropomorphic land utilization. In this review, we discuss the epidemiology, pathogenesis, clinical presentation, diagnostic modalities, and treatment strategies for histoplasmosis, blastomycosis, and coccidioidomycosis.

Original languageEnglish (US)
Pages (from-to)522-537
Number of pages16
JournalSeminars in Respiratory and Critical Care Medicine
Issue number4
StatePublished - Aug 1 2020
Externally publishedYes


  • blastomycosis
  • coccidioidomycosis
  • community-acquired pneumonia
  • histoplasmosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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