Antifungal Medication For Fungal Pneumonia

  • Batoul Salamah Bachelor’s degree in Pharmacy from Damascus University\Syria
  • Shazia Asim PhD Scholar (Pharmacology), University of Health Sciences Lahore, Pakistan

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Fungi are around us more than we think; they’re found profusely in nature, like yeasts, mushrooms, moulds, and other types. Although most fungi don’t cause any harm, some types of them can cause dangerous diseases in our bodies. One of these diseases is fungal pneumonia, and we’ll talk about everything related to this condition in addition to the suitable antifungal medication for it.1

What is fungal pneumonia2

Pneumonia, in general, is an infection in the lungs that can be caused by bacteria, viruses, or fungi. It leads to the inflammation of the lungs’ air sacs (alveoli), which, in turn, makes them filled with fluid or pus, and that makes it hard for oxygen to go into the bloodstream.

Pneumonia is an extremely dangerous condition and one of the leading causes of hospitalization for both adults and children. It can vary in severity according to many factors, like what germ caused it, the age of the patient, and their overall health.

What causes fungal pneumonia3

This infection isn’t contagious; it happens because of the inhalation of the fungal spores that can go to the lungs and harm them. It’s important to know that several types of these spores aren’t harmful to the human body unless the immune system is compromised.

Symptoms of fungal pneumonia

The symptoms could vary according to the fungus type and the overall health of the patient. Common symptoms are:

  • Cough with thick phlegm.
  • Fever and chills.
  • Shortness of breath.
  • Chest pain.
  • Nausea and vomiting.

Types of fungal pneumonia

The most three common types of fungal community-acquired pneumonia are:4

Valley fever (Coccidioidomycosis)

It’s caused by the fungus Coccidioides, which is common in the environment. However, most people who inhale its spores heal on their own unless there are specific situations like having a weakened immune system, pregnant women, people with diabetes, and Black and Filipino people.

It causes the general symptoms of pneumonia in addition to a rash.

To diagnose this condition, the healthcare providers ask about the travel history and the symptoms; they apply a physical examination; and they do blood tests. Sometimes, they might do imaging tests on the lungs.

Usually, the symptoms fade within a few months without the need for treatment, but in some cases, they might need antifungal medication (like fluconazole) to prevent the symptoms from getting worse and the severity of the condition from increasing.

Blastomycosis

It’s caused by the fungus Blastomyces, which lives commonly in the soil. Most people inhale its spores and get sick as well, unless there are some cases, like a weakened immune system or pregnancy.

It causes the general symptoms of pneumonia in addition to weight loss.

It is diagnosed the same way as Coccidioidomycosis.

The majority of patients who have this condition and/or show symptoms need antifungal treatment (usually itraconazole, and amphotericin B in severe cases).

Histoplasmosis

It’s caused by a fungus called Histoplasma, which is commonly found in soil that has large amounts of bird or bad droppings. As with the other two types, most people who inhale the spore don’t get sick unless they suffer from specific circumstances, like having a weakened immune system; it’s also more common in infants and adults aged 55 and older.

It causes the same symptoms as a general pneumonia. However, when one of the three types becomes severe, the symptoms might increase and spread to different organs in the body, like the central nervous system.

It’s diagnosed the same way as Coccidioidomycosis.

The symptoms might fade alone in some cases. However, severe Histoplasmosis needs antifungal medication (like itraconazole).

Other types of fungi are called opportunistic fungal organisms, which tend to cause pneumonia in people who have congenital or acquired defects in the immune system. Some examples of these fungi are Candida, Aspergillus, and Mucor species, and sometimes it’s hard to diagnose these types.5

Medication for fungal pneumonia

People with fungal pneumonia need antifungal medications. Following are few examples of antifungal drugs:

Azole antifungals6

This group of medicines contains an azole ring and works by damaging the fungal cell membrane, which leads to cell death.

The most commonly used azoles for treating fungal pneumonia are:

Fluconazole7

Dosage

It comes in two forms: oral and intravenous injections. The dosage for fungal pneumonia in adults is usually 400 mg/day. However, the optimal therapeutic dose and the duration of treatment haven’t been confirmed.

The absorption of fluconazole is not affected if it is taken with food.

Side effects

Common side effects

  • Diarrhea, and an upset stomach
  • Changes in the taste
  • Dizziness and nausea
  • Headache

Serious side effects

  • Seizures or convulsions
  • Liver injury (pain in the upper right side, loss of appetite, jaundice, and itching)
  •  Tachycardia 
  • Shortness of breath
  • Sudden dizziness
  • Skin rash or lesions

Warnings

It’s important to tell the doctor about any medical conditions the patients have or medications they are already   taking because some drugs can  interfere with the effectiveness of other drugs. Also, fluconazole can cause dangerous heart problems. For example, there might be some risks if the patients uses fluconazole with medicines for asthma, high blood pressure, heart problems, infections, cancer, malaria, HIV, or mental health conditions like psychosis.

Fluconazole  Shouldnt by taken during pregnancy

Voriconazole8

Dosage

It comes in two forms: oral and intravenous injection.

The loading dose of voriconazole in fungal pneumonia in adults is 6 mg/kg IV every 12 hours for the first 24 hours and then continues with a maintenance oral or IV dose that differs according to the cause of the fungal pneumonia.

The oral form t shouldn’t be taken with food

Side effects

Common side effects:

  • Flu-like symptoms, chills, and fever
  • Electrolyte imbalance
  • Stomach pain, nausea, vomiting, diarrhea, or constipation
  • Abnormal blood pressure and tachycardia
  • Kidney and liver problems
  • Bruising or bleeding
  • Vision changes, hallucinations, headache, and dizziness
  • Swelling in the hands or feet

Serious side effects:

  • Shortness of breath, pounding heartbeats, or slow pulse.
  • Unusual bleeding or bruising.
  • Sunburns.
  • Changes in  colour vision and vision problems.
  • Imbalance in the adrenal hormones (the increase causes sweating, acne, increased body hair, mood changes, muscle weakness, hunger, weight gain, swelling, missed menstrual periods, and sexual changes; while the decrease causes muscle or joint pain, skin discoloration, craving salty foods, stomach pain, and loss of appetite).

Warnings

It’s important to tell the doctor about any conditions the patients have or medications they take because some drugs can affect the effectiveness of other drugs. Voriconazole may cause transient changes in vision, hence it is important to protect the eyes from bright light. You should also avoid exposure to sunlight and tanning beds because voriconazole could cause a serious skin reaction that, sometimes, might lead to skin cancer.

Voriconazole.should be avoided during pregnancy. 

Itraconazole9

Dosage

It comes in two oral forms: capsules and liquid.

The dosage for Blastomycosis in adults usually starts with a loading dose of 200 mg twice a day for three days and continues with a 200 mg maintenance dose once a day.

The capsules should be taken with food, and the liquid should be taken on an empty stomach.

Side effects

Common side effects:

  • Changes in the menstrual  cycle
  • Erection  dysfunction
  • Headaches and dizziness
  • nausea, and vomiting
  • Swelling of feet
  • Constipation or diarrhea
  • Liver problems and fever
  • Increased blood pressure
  • Muscle or joint pain

Serious side effects:

  •  Tachycardia 
  • Loss of bladder control
  • Vision problems
  • Confusions
  • Low potassium
  • Pancreatitis and serious liver problems

Warnings

It’s important to tell the doctor about any conditions the patients have or medications they take because some drugs can affect the effectiveness of other drugs. Itraconazole can’t be taken if the patient suffers from congestive heart failure or serious kidney or liver problems.

Itraconazole  Should be avoided during pregnancy.

Echinocandins10

the drugs in this class are caspofungin, micafungin, and anidulafungin.

Mostly used aganist Candida and Aspergillus species.

Their main feature is their limited toxicity and minimal drug-drug interactions, which makes them an effective alternative when azoles and amphotericin B can’t be used.

They are only available as intravenous injections.

They have limited side effects compared to other antifungals, mostly infusion-related ones like rash, vasodilation, and rash, which disappear minutes after the end of the infusion. However, it’s recommended to monitor the liver’s functions.

The  high cost of these drugs is a major drawback.  

Amphotericin B11

It belongs to a group of antifungals called polyenes.

It comes as an intravenous infusion.

It’s a  broad-spectrum, most toxic antifungal that is used for severe and life-threatening cases. Common side effects: nausea, vomiting, muscle and joint pain, headaches, and flushing.

Serious side effects: nephrotoxicity,  convulsions, buildup of fluid in the lungs, low serum potassium, pale skin, blood in the stool, and jaundice.

Summary

To sum up, it is important to understand that fungi are widespread and they wait for any chance to invade our bodies. Furthermore, these organisms are dangerous and could lead to extremely grave conditions; therefore, it’s critical to take the right steps in treatment and never neglect our health. Fungal pneumonia is an infection of the lungs by fungi. It is most common in people with chronic health problems or weakened immune systems. This infection is not contagious; it happens because of the inhalation of the fungal spores. Its signs and syptoms include cough with thick phlegm, fever, chills. and shortness of breath. The most common types of fungal community-acquired penumonia are Valley fever, blastomycosis and Histoplasmosis. The major antifungal drugs used for fungal pneumonia are Azoles, Echinocandins and Amphotericin B. These drugs are effective but one should be careful about the toxicity of these drugs. 

References

  1. News. news. [cited 2023 Dec 17]. Physicians urged to consider fungal infections as possible cause for lung inflammation. Available from: https://health.ucdavis.edu/news/headlines/physicians-urged-to-consider-fungal-infections-as-possible-cause-for-lung-inflammation/2022/11
  2. Association AL. Learn about pneumonia [Internet]. [cited 2023 Dec 17]. Available from: https://www.lung.org/lung-health-diseases/lung-disease-lookup/pneumonia/learn-about-pneumonia
  3. What is fungal pneumonia? Learn about its symptoms, risk groups, occurrence, and management. The Times of India [Internet]. 2023 Nov 19 [cited 2023 Dec 17]; Available from: https://timesofindia.indiatimes.com/life-style/health-fitness/health-news/what-is-fungal-pneumonia-learn-about-its-symptoms-risk-groups-occurrence-and-management/articleshow/105309447.cms?from=mdr
  4. Community-acquired pneumonia | fungal diseases | cdc [Internet]. 2023 [cited 2023 Dec 17]. Available from: https://www.cdc.gov/fungal/diseases/community-acquired-pneumonia/index.html
  5. pneumonia: overview, risk factors, epidemiology of fungal pneumonia. 2023 Sep 14 [cited 2023 Dec 17]; Available from: https://emedicine.medscape.com/article/300341-overview?&icd=login_success_email_match_fpf
  6. Drugs.com [Internet]. [cited 2023 Dec 17]. List of azole antifungals for fungal pneumonia. Available from: https://www.drugs.com/drug-class/azole-antifungals.html
  7. Drugs.com [Internet]. [cited 2023 Dec 17]. Fluconazole uses, side effects & warnings. Available from: https://www.drugs.com/mtm/fluconazole.html
  8. Drugs.com [Internet]. [cited 2023 Dec 17]. Voriconazole oral/injection uses, side effects & warnings. Available from: https://www.drugs.com/mtm/voriconazole-oral-injection.html
  9. Drugs.com [Internet]. [cited 2023 Dec 17]. Itraconazole uses, side effects & warnings. Available from: https://www.drugs.com/mtm/itraconazole.html
  10. Medscape [Internet]. [cited 2023 Dec 17]. Echinocandins in the management of invasive fungal infections, part 1. Available from: https://www.medscape.com/viewarticle/545478
  11. Drugs.com [Internet]. [cited 2023 Dec 17]. Amphotericin b uses, side effects & warnings. Available from: https://www.drugs.com/mtm/amphotericin-b.html

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Batoul Salamah

Bachelor’s degree in Pharmacy from Damascus University\Syria
Associate’s degree in Health Sciences from the University Of the People\United States

Batoul has significant expertise in various domains of pharmacy. For instance, she worked in several community pharmacies, where she worked directly with patients. She worked as a senior pharmaceutical representative as well, where she worked directly with doctors and physicians. And currently, she’s working as a freelance medical writer, where she puts her humble expertise into helping people get the correct information about their health and how to take care of it.

my.klarity.health presents all health information in line with our terms and conditions. It is essential to understand that the medical information available on our platform is not intended to substitute the relationship between a patient and their physician or doctor, as well as any medical guidance they offer. Always consult with a healthcare professional before making any decisions based on the information found on our website.
Klarity is a citizen-centric health data management platform that enables citizens to securely access, control and share their own health data. Klarity Health Library aims to provide clear and evidence-based health and wellness related informative articles. 
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