How do you consider sending fungal studies in a patient with pneumonia?

This is a very good question. One that I’ve meant to look up for a while, so thank you for prompting me to do so. I agree with Dr. @Dr. First Last's answer (he is also my division chief!), but wanted to expand further. The articles I found most helpful are cited below.

When to suspect a fungal pneumo...

I almost never send them for an immunocompetent patient with pneumonia as part of my initial workup. If the patient is not getting better with antibiotics, it may be reasonable to send them, especially if the patient has exposure to endemic mycoses (such as Histoplasma in the Mississippi River Valle...

In endemic areas for cocci, and if there is a history of travel (including driving through the San Joaquin Valley), cocci testing is wise. Stay tuned for the SAnds-PPC study results on cocci presenting as CAP breakdown.