322 Ch 321. Pulmonary Fungal Infections

Pulmonary fungal infections 分 opportunistic (Pneumocystis jirovecii, Candida, Aspergillus, mucormycosis, Cryptococcus, Scedosporium) 與 endemic / geographic (Histoplasma, Coccidioides, Blastomyces, Paracoccidioides, Talaromyces marneffei)；Pneumocystis jirovecii pneumonia (PCP) = HIV / 免疫抑制者最常見 fungal lung infection；TMP-SMX 為治療 + 預防 (CD4 < 200)；invasive pulmonary aspergillosis (IPA) = 嗜中性球缺乏 / 移植 / 免疫抑制 / COVID-19 (CAPA) / influenza (IAPA) 重要併發症；isavuconazole / voriconazole 為 first-line；mucormycosis = DM ketoacidosis / iron overload；amphotericin B + 手術；endemic mycoses 多 self-limited 在 immunocompetent，severe disease 需 antifungals；台灣 talaromyces marneffei (SE Asia AIDS-associated) + PCP, aspergillosis, cryptococcosis 都是重要 ID；2024 antifungal landscape：rezafungin (longer-acting echinocandin)、ibrexafungerp (oral glucan synthase)、olorofim (orotomide for resistant Aspergillus)、fosmanogepix (broad including endemic)。