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Candidiasis pneumonia, or invasive pulmonary candidiasis

Medical expert of the article

Pulmonologist
, medical expert
Last reviewed: 07.07.2025

Candidal pneumonia, or invasive pulmonary candidiasis, is usually a manifestation of acute disseminated candidiasis. Isolated candidal pneumonia develops very rarely, with aspiration of gastric contents or prolonged agranulocytosis.

Candidal pneumonia may be primary, for example, formed by aspiration of the pathogen into the lungs, or secondary, resulting from hematogenous dissemination of Candida spp from another source. Primary candidal pneumonia occurs very rarely, secondary lung damage is detected in 15-40% of patients with acute disseminated candidiasis.

It is fundamentally important to distinguish between candidal pneumonia with its characteristic high mortality rate and the much safer superficial candidiasis of the trachea and bronchi, as well as superficial colonization of the respiratory tract, which usually does not require treatment. At the same time, superficial candidiasis and colonization of the respiratory tract are often detected in patients with invasive candidiasis.

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Symptoms of pulmonary candidiasis

The most common clinical symptoms of candidal pneumonia are fever refractory to broad-spectrum antibiotics, cough, shortness of breath, chest pain, and hemoptysis. Candidal pneumonia often occurs without any obvious clinical manifestations, since patients are in a serious condition or are on artificial ventilation. On the other hand, such patients often have other signs of acute disseminated candidiasis, such as peritonitis, specific skin and subcutaneous tissue lesions, retinitis, kidney damage, etc.

Mortality rate for candidal pneumonia in different categories of patients ranges from 30 to 70%.

Diagnosis of pulmonary candidiasis

Diagnosis of candidal pneumonia is difficult. Clinical and radiological signs are nonspecific and do not allow to differentiate candidal pneumonia from bacterial or other mycotic. In CT of the lungs, foci with unclear contours are detected in 80-100% of patients, foci associated with blood vessels - 40-50%, alveolar infiltration - 60-80%, the "air bronchogram" symptom - 40-50%, "ground glass" infiltration - 20-30%, the "halo" symptom - 10%.

When performing chest X-ray, alveolar infiltration is detected in 60-80% of patients, foci with unclear contours - in 30-40%, the symptom of "air bronchogram" - in 5-10%. Despite this, chest CT is a more effective diagnostic method compared to X-ray, CT is often difficult to perform due to the severity of the patient's condition.

Detection of Candida spp by microscopy and culture of sputum or BAL is not considered a diagnostic criterion for candidal pneumonia; it usually indicates superficial colonization of the bronchi or pharynx. However, multifocal superficial colonization is a risk factor for the development of invasive candidiasis. The diagnosis is established by detecting Candida spp in a biopsy from the lesion. However, lung biopsy may be difficult due to the high risk of bleeding. The second diagnostic criterion is CT or radiographic signs of invasive pulmonary mycosis in patients with candidemia or acute disseminated candidiasis. Serological diagnostic methods have not been developed.

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Treatment of pulmonary candidiasis

The choice of drug depends on the type of pathogen and the patient's condition. The main drugs for the treatment of candidal pneumonia are voriconazole, caspofungin and amphotericin B. The duration of therapy is at least 2 weeks after the disappearance of signs of infection. An important condition for successful treatment is the elimination or reduction of risk factors (discontinuation or reduction of the dose of glucocorticoids, etc.).


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