I agree that it is extremely unlikely for a immune competent 13 month old child to have a Candidal infection into the lungs. Even if he were taking steroids. You can't make a diagnosis of a cause of pneumonia by the x-ray. If it were Candida, you would not expect nystatin, which works locally, and not absorbed by the gut, to work on infection in the lung. I would be extremely concerned about a Candidal infection in the lung, and would treat aggressively with fluconazole--if it were Candida, which I doubt. Probably much more likely viral. Jack Newman, MD, FRCPC