Mycosis

Last updated
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, organ transplant, [6] COVID-19, [8] tuberculosis
Diagnostic method Based on symptoms, culture, microscopic examination [6]
Treatment Antifungals [3]
FrequencyCommon [9]
Deaths1.7 million (2020) [10]

Mycoses, also known as fungal infections, [3] are infections caused by disease causing fungi, and are traditionally divided into superficial, subcutaneous, and systemic. [5] [6] They include common tinea of the skin, yeast infections such as candidiasis and pityriasis versicolor, and several other opportunistic fungal infections such as systemic candidiasis, aspergillosis and mucormycosis, which are more severe. [1] [7] Signs and symptoms range widely. [3] There is usually a rash with superficial infections. [2] Fungal infections within the skin or under the skin may present with a lump and skin changes. [3] Pneumonia-like symptoms or meningitis may occur with deeper infections. [2]

Contents

Fungi that cause infections in people include yeasts, molds and fungi that are able to exist as both a mold and yeast. [3] Candida is the most common cause of fungal infection in people, particularly as oral thrush or vaginal yeast infection, often following taking antibiotics. [3] Fungal infections occur 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] Fungal infections are more likely in people with weak immune systems. [11] This includes people with illnesses such as HIV/AIDS, and people taking medicines such as steroids or cancer treatments. [11]

Diagnosis is generally based on signs and symptoms, microscopy, culture, sometimes requiring a biopsy and the aid of medical imaging. [6] Some superficial infections of the skin can appear similar to other skin conditions such as eczema and lichen planus. [7] Treatment is generally with antifungal medicines, usually in the form of a cream or by mouth or injection, depending on the specific infection and its extent. [12] 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. [9] An estimated 1.7 million deaths from fungal disease were reported in 2020. [10] Several, including sporotrichosis, chromoblastomycosis and mycetoma are neglected. [13]

A wide range of fungal infections occur in other animals, and some can be transmitted from animals to people. [14]

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]

Classification

Mycoses are traditionally divided into superficial, subcutaneous, or systemic, where infection is deep, more widespread and involving internal body organs. [3] [9] They can affect the nails, vagina, skin and mouth. [15] Some types such as blastomycosis, cryptococcus, coccidioidomycosis and histoplasmosis, affect people who live or visit certain parts of the world. [15] Others such as aspergillosis, pneumocystis pneumonia, candidiasis, mucormycosis and talaromycosis, tend to affect people who are unable to fight infection themselves. [15] 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 ]

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. [11] This includes people with illnesses such as HIV/AIDS, and people taking medicines such as steroids or cancer treatments. [11] People with diabetes also tend to develop fungal infections. [16] Very young and very old people, also, are groups at risk. [17] [ dead link ]

Individuals being treated with antibiotics are at higher risk of fungal infections. [18]

Children whose immune systems are not functioning properly (such as children with cancer) are at risk of invasive fungal infections. [19]

COVID-19

During the COVID-19 pandemic some fungal infections have been associated with COVID-19. [8] [20] [21] Fungal infections can mimic COVID-19, occur at the same time as COVID-19 and more serious fungal infections can complicate COVID-19. [8] A fungal infection may occur after antibiotics for a bacterial infection which has occurred following COVID-19. [22] The most common serious fungal infections in people with COVID-19 include aspergillosis and invasive candidiasis. [23] COVID-19–associated mucormycosis is generally less common, but in 2021 was noted to be significantly more prevalent in India. [8] [24]

Mechanism

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

Diagnosis

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. [25]

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 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. [12] Pneumocystosis does not respond to anti-fungals is treated with co-trimoxazole. [26] Sometimes, infected tissue needs to be surgically cut away. [3]

Epidemiology

Worldwide, every year fungal infections affect more than one billion people. [9] An estimated 1.6 million deaths from fungal disease were reported in 2017. [27] The figure has been rising, with an estimated 1.7 million deaths from fungal disease reported in 2020. [10] Fungal infections also constitute a significant cause of illness and mortality in children. [28]

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. [29]

History

In 500BC, an apparent account of ulcers in the mouth by Hippocrates may have been thrush. [30] The Hungarian microscopist based in Paris David Gruby first reported that human disease could be caused by fungi in the early 1840s. [30]

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. [31]

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. [14]

See also

Related Research Articles

Candidiasis fungal infection due to any type of Candida

Candidiasis is a fungal infection due to any type of 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 along with other symptoms depending on the parts involved.

Coccidioidomycosis Fungal infection

Coccidioidomycosis, commonly known as cocci, Valley fever, as well as California fever, desert rheumatism, or San Joaquin Valley fever, is a mammalian fungal disease caused by Coccidioides immitis or Coccidioides posadasii. Coccidioidomycosis is endemic in certain parts of the United States in Arizona, California, Nevada, New Mexico, Texas, Utah, and northern Mexico.

Tinea versicolor Medical condition

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 circumstances, such as a warm and humid environment, although the exact conditions that cause initiation of the disease process are poorly understood.

Blastomycosis Medical condition

Blastomycosis is a fungal infection caused by inhaling Blastomyces dermatitidis spores. If it involves only the lungs, it is called pulmonary blastomycosis. Only about half of people with the disease have symptoms, which can include fever, cough, night sweats, muscle pains, weight loss, chest pain, and feeling tired. These symptoms usually develop between three weeks and three months after breathing in the spores. In those with weak immune systems, the disease can spread to other areas of the body, including the skin and bones.

Athletes foot Skin infection caused by fungus

Athlete's foot, known medically as tinea pedis, is a common skin infection of the feet caused by fungus. Signs and symptoms often include itching, scaling, cracking and redness. In rare cases the skin may blister. Athlete's foot fungus may infect any part of the foot, but most often grows between the toes. The next most common area is the bottom of the foot. The same fungus may also affect the nails or the hands. It is a member of the group of diseases known as tinea.

Dermatophytosis Fungal infection of the skin

Dermatophytosis, also known as ringworm, is a fungal infection of the skin. 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. Multiple areas can be affected at a given time.

Onychomycosis Medical condition

Onychomycosis, also known as tinea unguium, is a fungal infection of the nail. Symptoms may include white or yellow nail discoloration, thickening of the nail, and separation of the nail from the nail bed. Toenails or fingernails may be affected, but it is more common for toenails to be affected. Complications may include cellulitis of the lower leg. A number of different types of fungus can cause onychomycosis, including dermatophytes and Fusarium. Risk factors include athlete's foot, other nail diseases, exposure to someone with the condition, peripheral vascular disease, and poor immune function. The diagnosis is generally suspected based on the appearance and confirmed by laboratory testing.

Fungal pneumonia 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.

Talaromycosis is a fungal infection that presents with painless skin lesions of face and neck, fever, anaemia, large lymph glands and liver.

Aspergillosis Medical condition

Aspergillosis is a fungal infection of usually the lungs, caused by the genus Aspergillus, a common mold that is breathed in frequently from the air around, but does not usually affect most people. It generally occurs in people with lung diseases such as asthma, cystic fibrosis or tuberculosis, or those who have had a stem cell or organ transplant, and those who cannot fight infection because of medications they take such as steroids and some cancer treatments. Rarely, it can affect skin.

Paracoccidioidomycosis Medical condition

Paracoccidioidomycosis (PCM) is an acute to chronic fungal infection caused by fungi in the genus Paracoccidioides, including Paracoccidioides brasiliensis and Paracoccidioides lutzii. It is endemic to Central and South America, and is considered to be a neglected endemic mycosis, a type of neglected tropical disease.

<i>Malassezia furfur</i> Species of fungus

Malassezia furfur is a species of yeast that is naturally found on the skin surfaces of humans and some other mammals. It is associated with a variety of dermatological conditions caused by fungal infections, notably seborrhoeic dermatitis and tinea versicolor. As an opportunistic pathogen, it has further been associated with dandruff, malassezia folliculitis, pityriasis versicolor (alba), and malassezia intertrigo, as well as catheter-related fungemia and pneumonia in patients receiving hematopoietic transplants. The fungus can also affect other animals, including dogs.

<i>Histoplasma capsulatum</i> Species of fungus

Histoplasma capsulatum is a species of dimorphic fungus. Its sexual form is called Ajellomyces capsulatus. It can cause pulmonary and disseminated histoplasmosis.

Dimorphic fungus

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

Clotrimazole 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, pityriasis 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.

Mucormycosis Fungal infection

Mucormycosis, also known as black fungus, is a serious fungal infection, usually in people who are immunocompromised. Symptoms depend on where in the body the infection occurs. It most commonly infects the nose, sinuses, eye, 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.

Histoplasma duboisii is a saprotrophic fungus responsible for the invasive infection known as African histoplasmosis. This species is a close relative of Histoplasma capsulatum, the agent of classical histoplasmosis, and the two occur in similar habitats. Histoplasma duboisii is restricted to continental Africa and Madagascar, although scattered reports have arisen from other places usually in individuals with an African travel history. Like, H. capsulatum, H. duboisii is dimorphic – growing as a filamentous fungus at ambient temperature and a yeast at body temperature. It differs morphologically from H. capsulatum by the typical production of a large-celled yeast form. Both agents cause similar forms of disease, although H. duboisii predominantly causes cutaneous and subcutaneous disease in humans and non-human primates. The agent responds to many antifungal drug therapies used to treat serious fungal diseases.

Edouard Drouhet was a physician, biologist, and medical mycologist who played a key role in understanding how anti-fungal agents such as ketoconazole and amphotericin-B can be used as therapeutic treatments in humans with superficial or deep-seated mycoses.

Emmonsiosis, also known as emergomycosis, is a systemic fungal infection that can affect the lungs, generally always affects the skin and can become widespread. The lesions in the skin look like small red bumps and patches with a dip, ulcer and dead tissue in the centre.

References

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