Abstract
Objectives:Fungal pneumonia in the immune competent host is a rarity with few reported cases in the literature. We present a series of 7 cases of recurrent fungal pneumonia in association with allergic fungal rhinosinusitis and gastroesophageal reflux disease (GERD). We hypothesised that recurrent infection may have been transported from the infected paranasal sinuses into the lung by GERD as the process was terminated by surgical fundoplication in 2 of these patients.Methods:Patients were recruited into the study if they were immune competent and had recurrent fungal pneumonia and GERD. Allergic fungal rhinosinusitis was proven by biopsy. GERD was investigated by a scintigraphic test that assessed local oesophageal disease, lung aspiration and head and neck involvement with a hybrid gamma camera and X-ray computed tomography.Results:All patients were shown to have GERD with 5/7 showing paranasal sinus contamination and 7/7 showing laryngopharyngeal involvement and 6/7 lung aspiration. One patient had characteristics strongly predictive of aspiration. Fundoplication led to cessation of fungal lung infection in two patients.Conclusion:Recurrent fungal pneumonia in the immune competent host should raise the possibility of re-infection from the paranasal sinuses, especially in patients with GERD.
Highlights
The Aspergillus species of fungus is widespread and generally acquired by inhalation of airborne spores
This paper presents 7 patients with recurrent pulmonary infections who are distinguished from most previous reports in terms of a connection between recurrent fungal pneumonia and allergic fungal sinusitis with polyposis
Consecutive patients with fungal pneumonia were referred to a single Nuclear Medicine practice as part of a large research study to evaluate extra-oesophageal manifestations of gastroesophageal reflux disease (GERD) over a period of 3 years
Summary
The Aspergillus species of fungus is widespread and generally acquired by inhalation of airborne spores. The immunocompetence of the host is a critical factor in the establishment of invasive infection. Infection may occur in the immunocompetent host, as has been described by a number of authors [1,2,3]. Such cases have been described since 1959 [4]. These cases include patients with chronic fungal infections of the maxillary sinuses, mediastinum, lymph nodes and direct pulmonary involvement. In that series 9 of 18 patients had allergic fungal sinusitis with polyposis with a background of chronic rhinosinusitis
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