When someone has pneumonia, the first line of treatment is almost always antibiotics. After all, most pneumonia cases are bacterial and respond well to antibiotics. But what happens when the infection refuses to clear up despite several rounds of medication?
According to Dr Neha Mishra, Consultant, Infectious Diseases, Manipal Hospital, Bengaluru, that’s when doctors must consider a less-discussed but serious possibility: fungal pneumonia. “A subset of patients who do not improve despite adequate antibiotic cover needs further evaluation for non-resolution. This clinical non-response often indicates an alternative cause, most notably, fungal pneumonia,” she explains.
Understanding fungal pneumonia
Unlike bacterial or viral pneumonia, fungal pneumonia is not contagious. It occurs when spores from the environment, found in soil, decaying leaves, or construction dust, enter the lungs. Healthy individuals usually clear these spores without issue, but in people with weakened immunity, such as those with diabetes, cancer, chronic lung disease, or those on long-term steroids or immunosuppressants, these spores can invade lung tissue and cause infection.
Common culprits include Aspergillus, Histoplasma, and Mucor species. The symptoms, fever, cough, breathlessness, or chest pain, often mimic bacterial pneumonia, making diagnosis tricky. Because of this, fungal infections are often detected late, when they have already advanced and may become life-threatening.
Why antibiotics don’t help
Dr Mishra explains that persistent pneumonia that fails to respond to antibiotics “must not be dismissed as slow recovery.” Instead, it’s a red flag that something else may be going on. Continuing antibiotics in such cases doesn’t help and can even delay the right treatment.
When bacterial causes are ruled out, doctors look at advanced diagnostic tools like molecular testing, culture, and fungal biomarkers to confirm or rule out fungal infection. This step is critical because fungal pneumonia requires specific antifungal therapy, not antibacterial drugs.
The treatment path
The good news? Once correctly identified, fungal pneumonia is usually treatable. Treatment depends upon the fungus involved and the extent of infection. Most physicians use specific antifungal medicines under strict supervision because these drugs are known to interact with several other medications and also affect liver and kidney functions.
Dr Mishra emphasises that “patients who are immunocompromised must be under close medical monitoring. Early diagnosis and initiation of antifungal therapy can significantly reduce complications and improve outcomes.”
Why awareness matters
As more people are being treated with immunosuppressant medications for chronic illnesses and cancers, the incidence of fungal infections is rising globally. Climate change and construction-related dust exposure are also increasing the spread of spores in the environment.
This makes awareness essential for both doctors and patients. People recovering from infections, or those whose pneumonia seems to “linger,” should consult a specialist rather than relying on repeated antibiotic courses. As Dr Mishra puts it, “greater awareness, timely diagnosis, and appropriate antifungal therapy are vital to improving patient outcomes and reducing mortality.
Also read: Can air purifiers really prevent pneumonia? Here’s what the doctor says
