Radhika Patel
Clinical Microbiology-2
To: Jane Coughanour
In-depth Report
April 28, 2013
Fungus and Related Disease Bread mold and mushrooms are among the most familiar examples of fungi organisms that grow in an irregular mass without roots, stems, or leaves. Fungi feed on other organisms, living or dead, and play an important role in helping dead plants and animals decay of the thousands of species of fungi, a few can cause human disease. These fungi cause a wide range of illnesses, from minor skin conditions to life-threatening diseases. They produce two kinds of infections: systemic and superficial. Systemic infections affect internal organs. They often start in the lungs, but in severe cases may spread to the blood, heart, brain, kidneys, liver, or other parts of the body. Superficial infections affect the surface of the body, the skin, the nails, and the hair. They most often occur in moist areas, such as between the toes, in the crotch, or in the mouth. Fungal diseases are called mycoses and those affecting humans can be divided into four groups based on the level of penetration into the body tissues. Superficial mycoses are caused by fungi that grow on the surface of the skin or hair. Cutaneous mycoses or dermatomycoses include such infections as athlete's foot and ringworm, where growth occurs only in the superficial layers of skin, nails, or hair. Subcutaneous mycoses penetrate below the skin to involve the subcutaneous, connective, and ne tissue. Systemic or deep mycoses are able to infect internal organs and become widely disseminated throughout the body. This type is often fatal.
How common are fungal diseases? Treating and caring for patients with fungal diseases is becoming an increasing economic burden. Estimated numbers of patients who will need expensive antifungal drugs for some of the life-threatening fungal illnesses are summarized here. Candidaemia infections occur can be predicted at around 300,000 worldwide per year with a mortality of 30-55%. Invasive aspergillosis can occur in different patients groups- so around 10% of new leukaemic cases will go on to develop invasive aspergillosis 30,000 per year. Of stem cell transplants - 54,000 are carried out in USA, UK, Europe and Japan anually, of which 5,400 will need treatment for aspergillus infection. In chronic obstructive pulmonary disease -1.2% of these will need antifungals for aspergillosis- 216,000 per year. Over 50% of invasive aspergillosis patients will die from their infection - even with treatment. In AIDS patients 1million contract cryptococcal meningitis resulting in 600,000 deaths - 70% of which are in sub-saharan Africa. Less fatal infections but which affect large numbers of people worldwide include cutaneous fungal infections, nail infections and athletes foot - affects some 1.5 billion people - or 25% of the world’s population. Tinea capitis -or hair infection- which is common in young children is predicted to affect some 200 million worldwide. An antifungal medication is a medication used to treat fungal infections such as athlete's foot, ringworm, candidiasis (thrush), serious systemic infections such as cryptococcal meningitis, and others. Such drugs are usually obtained by a doctor's prescription or for less serious infections of the nail and skin, over the counter. Apart from side-effects like liver-damage or affecting estrogen levels, many medicines can cause allergic reactions in some people including rashes. There are also many drug interactions and foods which must be avoided. Patients must read in detail the enclosed data sheet called a patient information leaflet (PIL) of the medicine. For example, the azole antifungal such as ketoconazole or itraconazole can be both substrates and inhibitors of the P-glycoprotein, which excretes toxins and drugs into the intestines. For detailed patient information leaflets and information on antifungal medication. The treatment of fungal infections can broadly be described in terms of three classes of antifungal drugs. The echinocandins, the azoles and the polyenes.
Fungal Diseases - Diagnosis Accurate diagnosis of fungal diseases is not straightforward. A new patient will be asked to give a history of the symptoms they have been experiencing. Depending on the history a number of laboratory tests may be ordered. These may well include the following tests. Newer more rapid molecular test are being developed to enhance the detection of different fungal species, many are still in the testing stage and research is needed to provide rapid and cost-effective diagnostic tests. Current methods for diagnosing fungal infections are slow and take too much time to process. The faster a positive diagnosis can be reached the better the outcome for the patient.
The FRT aims to support new ways of diagnosing fungal infections. The Aspergillus Website Resource contains detailed information for patients and their carers specifically about Aspergillus infections and their diagnosis. Much of this information is also applicable to other types of fungal infection. What are superficial fungal infections? Superficial fungal infections attack tissues on the surface of the body, which include the skin, nails, or hair. Some common examples are ringworm, athlete's foot, jock itch, and yeast infections. Candida yeast * infections are usually found on the skin, in the mouth, in the vagina, on the head of the penis, or around the nails. Superficial fungal infections are somewhat contagious and pass from person to person through direct contact or, less commonly, through clothes or contact with surfaces of other objects in the environment.
Skin infections Superficial fungal infections are often diagnosed on the basis of their appearance and their location on the body. Most skin infections respond well to topical antifungal creams, some of which are available over the counter, which means they do not require a doctor's prescription. Other skin infections, however, do not respond to such treatment. They require a doctor's attention and systemic treatment with prescription antifungal medications.
Candidiasis
Candida yeast infections are diagnosed by staining specimens of sputum or urine, or scrapings from the skin or the lining of the mouth or vagina, and by examining them under a microscope. People with vaginal yeast infections can be effectively treated with medications. Occasionally, repeated courses of treatment may be required.
What Are the Symptoms of Systemic Fungal Infections? Systemic fungal infections often are chronic and develop slowly, taking weeks or months to become a problem. Symptoms are sometimes similar to those of the common cold, but sometimes, especially in people with weakened immune systems, symptoms may be sudden and severe, requiring hospitalization. Symptoms may include cough, fever, chills, night sweats, anorexia weight loss, general fatigue, and depression.
If the infection spreads from the lungs to other organs, it may be particularly severe, especially if the patient has a weakened immune system. For example, cryptococcosis. may lead to meningitis which causes inflammation and swelling of the lining around the brain and spinal cord.
How Do Doctors Diagnose and Treat Systemic Fungal Infections?
Diagnosis
Diagnosing and treating systemic fungal infections can be a challenge for a doctor. Many of the symptoms are mild and vary greatly from person to person. Blood or skin tests exist for only a few of these infections and often are inconclusive or fail to find a fungus that really is there, a result called a false negative. Chest x-rays may show abnormalities in the lungs as fuzzy white spots on the black x-ray film, but the spots do not identify the specific cause. A diagnosis of systemic fungal infection usually is confirmed when a fungus is cultured, or grown, in a laboratory dish from a sample of the patient's sputum, bone marrow, urine, blood, cerebrospinal fluid, or other tissue.
Treatment
Treatment varies, depending on which fungus is causing the condition and how severe the symptoms are. Doctors usually prescribe antifungal medications, with drug therapy sometimes continuing for several weeks. In some cases, particularly if the immune system is weak, drug treatment may fail, or the doctor may recommend surgery to remove infected tissues.

Citation www.webmd.com Fungal infections in human body online article
News articles from Times of India

| | | |