Nursing Guide to Fungal Pneumonia: Nursing Diagnosis, Interventions, & Care Plans

Fungal pneumonia, caused by different fungi, mainly affects people with weakened immune systems, including those with HIV/AIDS, organ transplants, or who receive immunosuppressive therapy. Healthy individuals can also contract fungal pneumonia, particularly if they live in or travel to areas where specific fungi are endemic. Symptoms include cough, fever, chest pain, and difficulty breathing, which can resemble pneumonia, complicating diagnosis. 

The most common fungi causing fungal pneumonia are Histoplasma capsulatum, Coccidioides immitis, Blastomyces dermatitidis, and Aspergillus species. Management involves antifungal therapy and supportive care, with treatment tailored to the specific fungal pathogen. Early diagnosis and proper management are crucial to prevent severe complications. 

Etiology and epidemiology 

Fungal pneumonia occurs when fungal spores are inhaled and infect the lungs. The infection can remain localized or disseminate, especially in immunocompromised individuals. Different fungi cause infections in specific geographical regions: 

• Histoplasmosis: This is caused by Histoplasma capsulatum, found in soil contaminated with bird or bat droppings, primarily in the Ohio and Mississippi River valleys in the U.S. 
• Coccidioidomycosis (Valley fever): This is caused by Coccidioides immitis, common in desert regions like the southwestern U.S. and parts of Central and South America. 
• Blastomycosis: This is caused by Blastomyces dermatitidis, found in moist soil and decaying wood in areas surrounding the Great Lakes and the southeastern U.S. 
• Aspergillosis: This is caused by Aspergillus species, this type of pneumonia often occurs in patients with weakened immune systems or underlying lung diseases. 

Fungal pneumonia is more likely to affect: 

• Immunocompromised individuals (e.g., those with HIV/AIDS, cancer, or post-organ transplantation) 
• People with chronic lung diseases like chronic obstructive pulmonary disease (COPD) 
• Individuals on long-term corticosteroid or immunosuppressive therapy 
• Travelers to or residents in areas where specific fungi are endemic 

ICD-10 code for fungal pneumonia 

• ICD-10 code for fungal pneumonia: B44.9 (Aspergillosis, unspecified) 

Fungal Pneumonia Diagnosis 

Diagnosing fungal pneumonia can be challenging because its symptoms mimic other types of pneumonia. Diagnosis is based on clinical history, exposure risk, and laboratory tests. 

Common fungal pneumonia symptoms 

• Cough (dry or productive) 
• Fever 
• Pleuritic chest pain 
• Shortness of breath 
• Fatigue and malaise 
• Hemoptysis (in severe cases, especially with Aspergillus) 

Diagnostic tests 

• Chest X-ray or CT scan: This may show nodules, consolidations, or cavitations in the lungs. 
• Sputum culture: This can identify fungal pathogens in the respiratory secretions. 
• Serologic tests: This is useful for detecting antibodies against fungi such as Histoplasma or Coccidioides. 
• Fungal antigen tests: This can detect fungal antigens in blood or urine for infections like histoplasmosis and aspergillosis. 
• Bronchoscopy with biopsy: This is used when imaging and cultures are inconclusive, allowing direct sampling of lung tissue. 

Differential diagnosis includes bacterial, viral, and mycobacterial pneumonias, which often present similarly but require different treatment approaches. 

Management 

Treatment for fungal pneumonia is primarily based on the type of fungus and the patient’s immune status. Antifungal therapy is the mainstay of treatment, with the goal of eradicating infection and preventing dissemination. 

Fungal pneumonia treatment options 

• Antifungal therapy: 
• Itraconazole: The first-line treatment for mild to moderate Histoplasma and Blastomyces infections. 
• Amphotericin B: This is often used in severe cases of fungal pneumonia or when the patient is immunocompromised. It’s effective against a wide range of fungal infections but can be nephrotoxic. 
• Voriconazole: This is considered first-line treatment for Aspergillus infections. 
• Fluconazole: This is often used for treating Coccidioides infections in mild cases or for maintenance therapy after initial treatment with more potent antifungals. 
• Supportive care: 
• Oxygen therapy: This is used for patients with respiratory distress or hypoxia. 
• Analgesics/antipyretics: This is used for pain and fever management. 
• IV fluids: This helps to maintain hydration, especially in patients with high fever or who are unable to maintain oral intake. 

Preventive measures 

• Environmental precautions: High-risk patient populations, such as those with weaker immune systems, should avoid areas with high fungal exposure, such as construction sites or caves. 
• Prophylactic antifungal therapy: This may be used in immunocompromised patients to prevent fungal infections. 
• Vaccinations: While vaccines aren’t available yet for most fungal infections, ongoing research is exploring the development of fungal vaccines, particularly for endemic fungi like Coccidioides. 

Fungal Pneumonia nursing care plan 

Nursing considerations 

Nurses caring for patients with fungal pneumonia should focus on supporting respiratory function, monitoring for complications, and educating patients and caregivers on infection control and treatment adherence. 

Assessment 

• Respiratory status: Monitor for increased work of breathing, hypoxia, or signs of respiratory failure. 
• Vital signs: Track temperature, respiratory rate, heart rate, and oxygen saturation closely. 
• Lung sounds: Auscultate for crackles, wheezing, or diminished breath sounds. 
• Neurological status: Assess for changes in mental status, especially in immunocompromised patients, as fungal infections can disseminate to the brain. 
• Pain level: Evaluate and manage pleuritic chest pain. 

Nursing diagnosis/risk for 

• Impaired gas exchange related to inflammation and infection in the lungs 
• Ineffective airway clearance related to mucus production and cough 
• Risk for impaired skin integrity related to prolonged immobility and respiratory distress 
• Knowledge deficit related to the unfamiliarity with fungal infections and treatment plan 

Interventions 

• Oxygen therapy: Administer supplemental oxygen as needed to maintain oxygen saturation above 92%. 
• Medication administration: Ensure timely administration of prescribed antifungal medications, monitoring for side effects (e.g., renal toxicity from amphotericin B). 
• Airway clearance: Encourage deep breathing and coughing exercises or use chest physiotherapy as needed. 
• Monitor for complications: Watch for signs of disseminated infection, such as skin lesions or neurological symptoms. 
• Positioning: Elevate the head of the bed to promote better lung expansion and ease breathing. 
• Infection control: Maintain strict infection control measures, especially in immunocompromised patients, to prevent hospital-acquired infections. 

Expected outcomes 

• The patient will maintain effective respiratory function with oxygen saturation within normal limits (SpO2 > 92%). 
• The patient will demonstrate improved airway clearance and reduced cough. 
• The patient will verbalize an understanding of the treatment plan, including the importance of completing the antifungal therapy. 
• The patient will show no signs of disseminated fungal infection. 

Individual/caregiver education 

Education helps ensure that patients and caregivers understand the treatment regimen, preventive measures, and when to seek further care.  Consider the following when providing patient education: 

• Antifungal adherence: Stress the importance of completing the full course of antifungal therapy, even if symptoms improve, to prevent recurrence. 
• Symptom monitoring: Teach patients and caregivers to monitor for worsening symptoms, such as difficulty breathing, increased cough, or confusion. 
• Environmental precautions: Advise immunocompromised patients to avoid activities or areas with high fungal exposure (e.g., soil, construction sites, bird or bat habitats). 
• Follow-up care: Ensure patients understand the need for follow-up appointments, especially for monitoring response to treatment and potential side effects. 

References 

1. Centers for Disease Control and Prevention. (2023). Fungal infections. Retrieved from https://www.cdc.gov/fungal/index.html 
2. ICD-10 Data. (2023). B44.9 - Aspergillosis, unspecified. Retrieved from https://www.icd10data.com/ICD10CM/Codes/B00-B99/B40-B49/B44-/B44.9