Fungal infection

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Mycosis
Other namesMycoses, [1] fungal disease, [2] fungal infection [3]
ICD-10CM codes: Mycoses B35-B49 [4]
Pulmonary aspergillosis.jpg
Micrograph showing a mycosis (aspergillosis). The Aspergillus (which is spaghetti-like) is seen in the center and surrounded by inflammatory cells and necrotic debris. H&E stain.
Specialty Infectious Diseases [5]
TypesSystemic, superficial, subcutaneous [3]
Causes Pathogenic fungus: dermatophytes, yeasts, molds [6] [7]
Risk factors Immunodeficiency, cancer treatment, large surface area wounds/burns, [8] [9] organ transplant, [6] COVID-19, [10] tuberculosis
Diagnostic method Based on symptoms, culture, microscopic examination [6]
Treatment Antifungals [3]
FrequencyCommon [11]
Deaths1.7 million (2020) [12]

Fungal infection, also known as mycosis, is a disease caused by fungi. [5] [13] Different types are traditionally divided according to the part of the body affected; superficial, subcutaneous, and systemic. [3] [6] Superficial fungal infections include common tinea of the skin, such as tinea of the body, groin, hands, feet and beard, and yeast infections such as pityriasis versicolor. [7] Subcutaneous types include eumycetoma and chromoblastomycosis, which generally affect tissues in and beneath the skin. [1] [7] Systemic fungal infections are more serious and include cryptococcosis, histoplasmosis, pneumocystis pneumonia, aspergillosis and mucormycosis. [3] Signs and symptoms range widely. [3] There is usually a rash with superficial infection. [2] Fungal infection within the skin or under the skin may present with a lump and skin changes. [3] Pneumonia-like symptoms or meningitis may occur with a deeper or systemic infection. [2]

Contents

Fungi are everywhere, but only some cause disease. [13] Fungal infection occurs after spores are either breathed in, come into contact with skin or enter the body through the skin such as via a cut, wound or injection. [3] It is more likely to occur in people with a weak immune system. [14] This includes people with illnesses such as HIV/AIDS, and people taking medicines such as steroids or cancer treatments. [14] Fungi that cause infections in people include yeasts, molds and fungi that are able to exist as both a mold and yeast. [3] The yeast Candida albicans can live in people without producing symptoms, and is able to cause both superficial mild candidiasis in healthy people, such as oral thrush or vaginal yeast infection, and severe systemic candidiasis in those who cannot fight infection themselves. [3]

Diagnosis is generally based on signs and symptoms, microscopy, culture, sometimes requiring a biopsy and the aid of medical imaging. [6] Some superficial fungal infections of the skin can appear similar to other skin conditions such as eczema and lichen planus. [7] Treatment is generally performed using antifungal medicines, usually in the form of a cream or by mouth or injection, depending on the specific infection and its extent. [15] Some require surgically cutting out infected tissue. [3]

Fungal infections have a world-wide distribution and are common, affecting more than one billion people every year. [11] An estimated 1.7 million deaths from fungal disease were reported in 2020. [12] Several, including sporotrichosis, chromoblastomycosis and mycetoma are neglected. [16]

A wide range of fungal infections occur in other animals, and some can be transmitted from animals to people. [17]

Classification

Mycoses are traditionally divided into superficial, subcutaneous, or systemic, where infection is deep, more widespread and involving internal body organs. [3] [11] They can affect the nails, vagina, skin and mouth. [18] Some types such as blastomycosis, cryptococcus, coccidioidomycosis and histoplasmosis, affect people who live in or visit certain parts of the world. [18] Others such as aspergillosis, pneumocystis pneumonia, candidiasis, mucormycosis and talaromycosis, tend to affect people who are unable to fight infection themselves. [18] Mycoses might not always conform strictly to the three divisions of superficial, subcutaneous and systemic. [3] Some superficial fungal infections can cause systemic infections in people who are immunocompromised. [3] Some subcutaneous fungal infections can invade into deeper structures, resulting in systemic disease. [3] Candida albicans can live in people without producing symptoms, and is able to cause both mild candidiasis in healthy people and severe invasive candidiasis in those who cannot fight infection themselves. [3] [7]

ICD-11 codes

ICD-11 codes include: [5]

Superficial mycoses

Superficial mycoses include candidiasis in healthy people, common tinea of the skin, such as tinea of the body, groin, hands, feet and beard, and malassezia infections such as pityriasis versicolor. [3] [7]

Subcutaneous

Eumycetoma Madura foot..JPG
Eumycetoma

Subcutaneous fungal infections include sporotrichosis, chromoblastomycosis, and eumycetoma. [3]

Systemic

Systemic fungal infections include histoplasmosis, cryptococcosis, coccidioidomycosis, blastomycosis, mucormycosis, aspergillosis, pneumocystis pneumonia and systemic candidiasis. [3]

Systemic mycoses due to primary pathogens originate normally in the lungs and may spread to other organ systems. Organisms that cause systemic mycoses are inherently virulent.[ further explanation needed ].[ citation needed ] Systemic mycoses due to opportunistic pathogens are infections of people with immune deficiencies who would otherwise not be infected. Examples of immunocompromised conditions include AIDS, alteration of normal flora by antibiotics, immunosuppressive therapy, and metastatic cancer. Examples of opportunistic mycoses include Candidiasis, Cryptococcosis and Aspergillosis.[ citation needed ]

Signs and symptoms

Most common mild mycoses often present with a rash. [2] Infections within the skin or under the skin may present with a lump and skin changes. [3] Less common deeper fungal infections may present with pneumonia like symptoms or meningitis. [2]

Causes

Mycoses are caused by certain fungi; yeasts, molds and some fungi that can exist as both a mold and yeast. [3] [6] They are everywhere and infection occurs after spores are either breathed in, come into contact with skin or enter the body through the skin such as via a cut, wound or injection. [3] Candida albicans is the most common cause of fungal infection in people, particularly as oral or vaginal thrush, often following taking antibiotics. [3]

Risk factors

Fungal infections are more likely in people with weak immune systems. [14] This includes people with illnesses such as HIV/AIDS, and people taking medicines such as steroids or cancer treatments. [14] People with diabetes also tend to develop fungal infections. [19] Very young and very old people, also, are groups at risk. [20]

Individuals being treated with antibiotics are at higher risk of fungal infections. [21]

Children whose immune systems are not functioning properly (such as children with cancer) are at risk of invasive fungal infections. [22]

COVID-19

During the COVID-19 pandemic some fungal infections have been associated with COVID-19. [10] [23] [24] Fungal infections can mimic COVID-19, occur at the same time as COVID-19 and more serious fungal infections can complicate COVID-19. [10] A fungal infection may occur after antibiotics for a bacterial infection which has occurred following COVID-19. [25] The most common serious fungal infections in people with COVID-19 include aspergillosis and invasive candidiasis. [26] COVID-19–associated mucormycosis is generally less common, but in 2021 was noted to be significantly more prevalent in India. [10] [27]

Mechanism

Fungal infections occur after spores are either breathed in, come into contact with skin or enter the body through a wound. [3]

Diagnosis

Workup algorithm of fungal infection at a microbiology lab at a New England community hospital. Mycology algorithm.png
Workup algorithm of fungal infection at a microbiology lab at a New England community hospital.

Diagnosis is generally by signs and symptoms, microscopy, biopsy, culture and sometimes with the aid of medical imaging. [6]

Differential diagnosis

Some tinea and candidiasis infections of the skin can appear similar to eczema and lichen planus. [7] Pityriasis versicolor can look like seborrheic dermatitis, pityriasis rosea, pityriasis alba and vitiligo. [7]

Some fungal infections such as coccidioidomycosis, histoplasmosis, and blastomycosis can present with fever, cough, and shortness of breath, thereby resembling COVID-19. [28]

Prevention

Keeping the skin clean and dry, as well as maintaining good hygiene, will help larger topical mycoses. Because some fungal infections are contagious, it is important to wash hands after touching other people or animals. Sports clothing should also be washed after use.[ clarification needed ][ citation needed ]

Treatment

Treatment depends on the type of fungal infection, and usually requires topical or systemic antifungal medicines. [15] Pneumocystosis that does not respond to anti-fungals is treated with co-trimoxazole. [29] Sometimes, infected tissue needs to be surgically cut away. [3]

Epidemiology

Worldwide, every year fungal infections affect more than one billion people. [11] An estimated 1.6 million deaths from fungal disease were reported in 2017. [30] The figure has been rising, with an estimated 1.7 million deaths from fungal disease reported in 2020. [12] Fungal infections also constitute a significant cause of illness and mortality in children. [31]

According to the Global Action Fund for Fungal Infections, every year there are over 10 million cases of fungal asthma, around 3 million cases of long-term aspergillosis of lungs, 1 million cases of blindness due to fungal keratitis, more than 200,000 cases of meningitis due to cryptococcus, 700,000 cases of invasive candidiasis, 500,000 cases of pneumocystosis of lungs, 250,000 cases of invasive aspergillosis, and 100,000 cases of histoplasmosis. [32]

History

In 500BC, an apparent account of ulcers in the mouth by Hippocrates may have been thrush. [33] The Hungarian microscopist based in Paris David Gruby first reported that human disease could be caused by fungi in the early 1840s. [33]

SARS 2003

During the 2003 SARS outbreak, fungal infections were reported in 14.8–33% of people affected by SARS, and it was the cause of death in 25–73.7% of people with SARS. [34]

Other animals

A wide range of fungal infections occur in other animals, and some can be transmitted from animals to people, such as Microsporum canis from cats. [17]

See also

Related Research Articles

<span class="mw-page-title-main">Candidiasis</span> Fungal infection due to any type of Candida

Candidiasis is a fungal infection due to any species of the genus Candida. When it affects the mouth, in some countries it is commonly called thrush. Signs and symptoms include white patches on the tongue or other areas of the mouth and throat. Other symptoms may include soreness and problems swallowing. When it affects the vagina, it may be referred to as a yeast infection or thrush. Signs and symptoms include genital itching, burning, and sometimes a white "cottage cheese-like" discharge from the vagina. Yeast infections of the penis are less common and typically present with an itchy rash. Very rarely, yeast infections may become invasive, spreading to other parts of the body. This may result in fevers, among other symptoms.

<span class="mw-page-title-main">Histoplasmosis</span> Fungal infection of the lungs

Histoplasmosis is a fungal infection caused by Histoplasma capsulatum. Symptoms of this infection vary greatly, but the disease affects primarily the lungs. Occasionally, other organs are affected; called disseminated histoplasmosis, it can be fatal if left untreated.

<span class="mw-page-title-main">Tinea versicolor</span> Skin disease

Tinea versicolor is a condition characterized by a skin eruption on the trunk and proximal extremities. The majority of tinea versicolor is caused by the fungus Malassezia globosa, although Malassezia furfur is responsible for a small number of cases. These yeasts are normally found on the human skin and become troublesome only under certain conditions, such as a warm and humid environment, although the exact conditions that cause initiation of the disease process are poorly understood.

<span class="mw-page-title-main">Fluconazole</span> Antifungal medication

Fluconazole is an antifungal medication used for a number of fungal infections. This includes candidiasis, blastomycosis, coccidioidomycosis, cryptococcosis, histoplasmosis, dermatophytosis, and tinea versicolor. It is also used to prevent candidiasis in those who are at high risk such as following organ transplantation, low birth weight babies, and those with low blood neutrophil counts. It is given either by mouth or by injection into a vein.

<span class="mw-page-title-main">Blastomycosis</span> Medical condition

Blastomycosis, also known as Gilchrist's disease, is a fungal infection, typically of the lungs, which can spread to brain, stomach, intestine and skin, where it appears as crusting purplish warty plaques with a roundish bumpy edge and central depression. Around half of people with the disease have symptoms, which can include fever, cough, night sweats, muscle pains, weight loss, chest pain, and fatigue. Symptoms usually develop between three weeks and three months after breathing in the spores. In 25% to 40% of cases, the infection also spreads to other parts of the body, such as the skin, bones or central nervous system. Although blastomycosis is especially dangerous for those with weak immune systems, most people diagnosed with blastomycosis have healthy immune systems.

<span class="mw-page-title-main">Chromoblastomycosis</span> Medical condition

Chromoblastomycosis is a long-term fungal infection of the skin and subcutaneous tissue.

<span class="mw-page-title-main">Dermatophytosis</span> Fungal infection of the skin

Dermatophytosis, also known as tinea and ringworm, is a fungal infection of the skin, that may affect skin, hair, and nails. Typically it results in a red, itchy, scaly, circular rash. Hair loss may occur in the area affected. Symptoms begin four to fourteen days after exposure. The types of dermatophytosis are typically named for area of the body that they affect. Multiple areas can be affected at a given time.

<span class="mw-page-title-main">Fungal pneumonia</span> Infection of the lungs by fungi

Fungal pneumonia is an infection of the lungs by fungi. It can be caused by either endemic or opportunistic fungi or a combination of both. Case mortality in fungal pneumonias can be as high as 90% in immunocompromised patients, though immunocompetent patients generally respond well to anti-fungal therapy.

<span class="mw-page-title-main">Sporotrichosis</span> Medical condition

Sporotrichosis, also known as rose handler's disease, is a fungal infection that may be localised to skin, lungs, bone and joint, or become systemic. It presents with firm painless nodules that later ulcerate. Following initial exposure to Sporothrix schenckii, the disease typically progresses over a period of a week to several months. Serious complications may develop in people who have a weakened immune system.

Talaromycosis is a fungal infection that presents with painless skin lesions of the face and neck, as well as an associated fever, anaemia, and enlargement of the lymph glands and liver.

Fever of unknown origin (FUO) refers to a condition in which the patient has an elevated temperature (fever) for which no cause can be found despite investigations by one or more qualified physicians. If the cause is found, it is usually a diagnosis of exclusion, eliminating all possibilities until only the correct explanation remains.

<span class="mw-page-title-main">Paracoccidioidomycosis</span> Medical condition

Paracoccidioidomycosis (PCM), also known as South American blastomycosis, is a fungal infection that can occur as a mouth and skin type, lymphangitic type, multi-organ involvement type (particularly lungs), or mixed type. If there are mouth ulcers or skin lesions, the disease is likely to be widespread. There may be no symptoms, or it may present with fever, sepsis, weight loss, large glands, or a large liver and spleen.

<span class="mw-page-title-main">Tinea nigra</span> Medical condition

Tinea nigra, also known as superficial phaeohyphomycosis and Tinea nigra palmaris et plantaris, is a superficial fungal infection, a type of phaeohyphomycosis rather than a tinea, that causes usually a single 1–5 cm dark brown-black, non-scaly, flat, painless patch on the palms of the hands and the soles of the feet of healthy people. There may be multiple spots. The macules occasionally extend to the fingers, toes, and nails, and may be reported on the chest, neck, or genital area. Tinea nigra infections can present with multiple macules that can be mottled or velvety in appearance, and may be oval or irregular in shape. The macules can be anywhere from a few mm to several cm in size.

<span class="mw-page-title-main">Dimorphic fungus</span> Fungi that can exist as mold or yeast

A dimorphic fungus is a fungus that can exist in the form of both mold and yeast. As this is usually brought about by a change in temperature, this fungus type is also described as a thermally dimorphic fungus. An example is Talaromyces marneffei, a human pathogen that grows as a mold at room temperature, and as a yeast at human body temperature.

<span class="mw-page-title-main">Clotrimazole</span> Chemical compound

Clotrimazole, sold under the brand name Lotrimin, among others, is an antifungal medication. It is used to treat vaginal yeast infections, oral thrush, diaper rash, tinea versicolor, and types of ringworm including athlete's foot and jock itch. It can be taken by mouth or applied as a cream to the skin or in the vagina.

<span class="mw-page-title-main">Mucormycosis</span> Fungal infection

Mucormycosis, also known as black fungus, is a severe fungal infection that comes under fulminant fungal sinusitis, usually in people who are immunocompromised. It is curable only when diagnosed early. Symptoms depend on where in the body the infection occurs. It most commonly infects the nose, sinuses, eyes and brain resulting in a runny nose, one-sided facial swelling and pain, headache, fever, blurred vision, bulging or displacement of the eye (proptosis), and tissue death. Other forms of disease may infect the lungs, stomach and intestines, and skin. The fatality rate is about 54%.

Two feet-one hand syndrome (TFOHS), is a long-term fungal condition where athlete's foot or fungal toe nail infections in both feet is associated with tinea manuum in one hand. Often the feet are affected for several years before symptoms of a diffuse scaling rash on the palm of one hand appear, which is when most affected people then seek medical help.

Topical antifungaldrugs are used to treat fungal infections on the skin, scalp, nails, vagina or inside the mouth. These medications come as creams, gels, lotions, ointments, powders, shampoos, tinctures and sprays. Most antifungal drugs induce fungal cell death by destroying the cell wall of the fungus. These drugs inhibit the production of ergosterol, which is a fundamental component of the fungal cell membrane and wall.

<span class="mw-page-title-main">Libero Ajello</span> American mycologist (1916–2004)

Libero Ajello was an American mycologist. He cofounded and was first president of the International Society of Human and Animal Mycology (ISHAM). He was the head of the Division of Mycotic Diseases at the Communicable Disease Center (CDC), and editor of the ISHAM Journal Medical Mycology for several years. As one of the first researchers to investigate histoplasmosis and coccidioidomycosis in the United States, he and made valuable contributions to the comprehensive field of veterinary and human fungal disease diagnosis.

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