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Previously, several authors have also reported the occurrence of invasive pulmonary aspergillosis in COPD patients, with a very high mortality rate [20-24]. On the whole, data related to TBFI in non-neutropenic patients hospitalized in the ICU are lacking. In the present study, histopathology showed yeast-like pseudohyphae among the necrotic cells and the surface epithelium, acute inflammatory cell infiltration, and fibrin in the bronchial Selleckchem BMS777607 and tracheal mucosa. Blood vessel invasion by fungi was not found in any of our cases. In a review that evaluated the distribution of fungal species in TBFI, Aspergillus species (53%) and Coccidioides immitis (16%) were reported to be the most frequent. The patients in this review were mostly immunocompromised, and the percentage of Candida was very low (6%) [12]. In contrast, in our study, the Candida isolates were responsible for 90.5% of all TBFIs, whereas Aspergillus species were responsible for only 9.5%. We were unable to subclassify the Candida isolates, because of inadequate laboratory resources. When whitish plaques were detected on bronchoscopic RVX-208 examination, TBFI was confirmed histopathologically in more than half of the cases. Consequently, the detection of whitish plaques by FB should alert the treating clinician to the presence of an invasive fungal disease, according to our data. In a prospective and post-mortem study performed in critically ill and non-neutropenic patients, various factors, such as antibiotic use, duration of antibiotic treatment, mechanical ventilation period, age, acute respiratory distress syndrome, parenteral nutrition, and gender, did not affect Candida isolation from the lungs Neratinib solubility dmso [25]. According to our data, antifungal treatment is strictly indicated when whitish tracheobronchial plaques are detected on bronchoscopic examination, as TBFI was confirmed histopathologically in a couple of days in more than half (54%) of the cases. In this study, TBFIs caused by non-albicans types of Candida constituted three-quarters of all biopsy-proven Candida infections. Non-albicans Candida species are known to have higher resistance to fluconazole [26-29]. The treating clinician should also bear in mind that an early start of rational antifungals in invasive fungal disease has a profound impact on mortality [6, 29]. In the present study, we did not have antifungal susceptibility test results. Meersseman et�al. [31] showed that, in 77 pneumonia patients in whom tracheal lavage revealed Candida, no Candida could be histologically detected post-mortem. No autopsies were performed on our patients, and fungal pneumonia was not evaluated with lung biopsy. Wood et�al. [31] performed a study in a level? trauma ICU, where they included 62 patients whose BAL fluid was positive for Candida. They suggested that isolation of Candida from BAL fluid in quantities below the diagnostic threshold for ventilator-associated pneumonia in this population does not require antifungal therapy.