Here Are the Most Common Types of Fungal Infections

Are you suffering from a skin condition and unsure whether it’s a rash or a fungal infection? Here are a few of the most common fungal infections and what you need to know about them.

What are the Most Common Types of Fungal Infections

Ringworm

Ringworm doesn’t exactly sound like it’s a fungal infection, but fortunately this condition has nothing to do with actual worms. The truth is that it’s named for the shape of the rash, which looks like a ring with a raised, worm-like border. The most telling symptom of this fungal skin infection, as you might have already guessed, is its unique rash pattern. Unfortunately, ringworm is a relatively contagious fungal infection, as well. This condition is most commonly spread via direct contact with infected people or animals, so if you suspect you have ringworm it’s important to contact anyone you’ve recently been in contact with so you can all get proper treatment. In addition, you should avoid contact with others after you’ve been diagnosed. For fungal infection treatment, you’ll typically use topical antifungal products. Over-the-counter options are available for ringworm treatment, but it’s always safest to consult with your doctor and follow their recommended treatment program for best results.

Athlete’s Foot

As the name suggests, this is a fungal foot infection. The type of fungi that cause this condition live on dead tissue. Some common places you’ll find them is on the hair, toenails, and outermost layers of your skin. This fungus also grows best in warm, moist environments like socks and showers. And while fungal infection symptoms for athlete’s food tend to vary from person to person, some of the most common include blisters, itching or burning sensations, peeling and scaly skin on the feet, and skin that’s broken down. This fungal skin infection most commonly occurs for people who wear tight shoes, people who don’t change out of dirty or sweaty socks, and people who make frequent use of public baths and pools. Athlete’s foot may also develop in a few different ways. Interdigital athlete’s foot is the most common and occurs between the toes. Moccasin and vesicular athlete’s foot are a bit less common and both typically start on the soles of your feet.

Yeast Infections

Yeast infections can occur in a number of different locations on your body, but yeast infections on the skin are quite common. This type of fungal skin infection is caused by an overgrowth of a fungus called candida. Fortunately, yeast infections are not contagious. Like athlete’s foot, this fungal infection most commonly occurs in warm, moist areas. As we mentioned earlier, yeast infections can form in a number of places! Some of the most common areas where yeast infections occur include your underarms and groin. The most common fungal infection symptoms for this condition when it occurs on your skin include patches that ooze clear liquid, itching and burning sensations, and pimple-like bumps. Like ringworm, topical antifungal treatments are necessary to rid yourself of this fungal infection. In more severe cases, you may need to take oral antifungal medication to aid in your fungal infection treatment plan.

Fungal infections are fairly common, and there are plenty of treatment options available. If you suspect you’re suffering from a fungal infection, don’t hesitate to make an appointment with a member of our team at North Pacific Dermatology today.

Fungal Infections – Types of Fungal Infections

Treatment of fungal infections begins with seeking regular medical care throughout your life. Regular medical care allows your health care professional to assess your risks of developing fungal infections and promptly order diagnostic testing for fungal infections and underlying conditions as needed. These measures greatly increase the chances of diagnosing and treating underlying causes of fungal infections in their earliest stages.

Fungal infection treatment includes:

• Antiseptic mouth washes for oral thrush

• Diagnosing and treating any underlying diseases, such as HIV/AIDS and diabetes. Treating the high blood sugar levels of diabetes may resolve a current infection and is critical to minimizing the risk of developing recurrent fungal infections.

• Eating yogurt or taking acidophilus supplements, which can help to correct the abnormal balance of microorganisms in the mouth and digestive tract

• Medications, including prescription topical or oral antifungal medications such as fluconazole

In many cases, oral fungal infections (oral thrush) in infants can disappear within two weeks and may need no treatment other than watching the progress of the mouth lesions. Because oral thrush may be painful in the mouth and affect feedings, the pediatrician should still be notified if symptoms appear in an infant.

What are the possible complications of fungal infections?

Complications of fungal infections can be serious for people with weakened immune systems, such as those with HIV/AIDS or those taking steroid medications or on chemotherapy. In these cases, fungal infections can spread throughout the body, causing fungal infections in vital organs, such as the heart and the brain. This can result in critical, life-threatening complications, such as:

• Abscess formation

• Endocarditis

• Meningitis

• Nephritis

• Organ failure

• Transplant rejection

Seek prompt medical care if you are experiencing symptoms of fungal infections and you have diabetes or HIV/AIDS, are being treating with chemotherapy, or are taking steroid medications.

Cutaneous Fungal Infections

US Pharm. 2015;40(4):35-39.

ABSTRACT: Cutaneous fungal infections are commonly caused by dermatophytes. The prevalent dermatophytic infections in the United States include tinea pedis, tinea corporis, tinea cruris, tinea capitis, and tinea unguium. Persons most susceptible to fungal skin infections include immunodeficient or immunosuppressed patients, obese individuals, patients with impaired circulation, and those who are exposed to prolonged moisture or have poor hygiene. Tinea pedis, tinea corporis, and tinea cruris typically are treated topically, unless the infection is extensive, severe, or recalcitrant. Tinea unguium responds best to oral therapy, and tinea capitis must be treated with oral antifungal therapy, since topical agents cannot penetrate the hair shaft. Treatment may last for several weeks to months, making patient adherence an important factor in therapy selection.

Cutaneous fungal infections are superficial infections typically involving the skin, hair, and nails.¹ Most commonly, these fungal infections are caused by dermatophytes, but they can also be caused by nondermatophyte fungi and yeast (Candida species).^1-4 The term dermatophyte refers to a fungal organism that causes tinea, a fungal infection.⁵ Thus, dermatophytoses are known as tinea infections, which are further classified by the region of the body infected (e.g., tinea pedis, tinea capitis).^1-4

Dermatophytoses are limited to the stratum corneum, nails, and hair shafts because they require keratin for growth.^3,4,6 The prevalent dermatophytic infections in the United States include tinea pedis (foot), tinea corporis (body), tinea cruris (groin), tinea capitis (scalp), and tinea unguium (nail). In the U.S., there are three dermatophyte genera that cause infections: Microsporum, Epidermophyton, and Trichophyton. Trichophyton is the most prevalent genus, accounting for approximately 80% of dermatophytic infections in the U.S.^4,6 The most common mode of transmission of dermatophytes is by direct contact with other people (anthropophilic organisms), but transmission also occurs via contact with animals (zoophilic organisms), the soil (geophilic organisms), and fomites.⁴ Individuals most susceptible to fungal skin infections include those who are obese, immunodeficient, or immunosuppressed or have impaired circulation.¹ Fungal infections are also more likely to occur with prolonged exposure to sweaty clothes or bedding, poor hygiene, and residence in warm, humid climates.^1,2

The classic appearance of a cutaneous tinea infection is a central clearing surrounded by an active border of redness and scaling, which gives rise to the more common name, ringworm.^2,4 One key point in recognizing a cutaneous fungal infection is the location; tinea infections have no mucosal involvement, since dermatophytes invade only keratinized tissue. ⁴ Despite having a classic appearance, tinea infections may be similar in appearance to many other dermatologic conditions and are often misdiagnosed and, therefore, mistreated.² This article will guide pharmacists to recognize the most common fungal infections, understand the most effective treatment options, and provide counseling for treatment and prevention.

Types of Dermatophytoses

Tinea Pedis: Tinea pedis is the most prevalent cutaneous fungal infection.^1,2 Frequently referred to as athlete’s foot, it affects approximately 26.5 million Americans per year.¹ It is estimated that approximately 70% of people will have tinea pedis during their lifetime.

Four clinically accepted variants of tinea pedis exist; however, they sometimes overlap. The most common variant is intertriginous, which is characterized by fissuring, scaling, or maceration of the interdigital areas; foul odor; itching; and a stinging sensation.¹ The infection often involves the lateral toe webs and may spread to the sole or instep of the foot. Warm, humid conditions may aggravate the area. The second variant is a chronic papulosquamous type that often occurs on both feet. Mild inflammation and dispersed scaling of the skin on the soles of the feet are characteristic of this type. The third variant is composed of small vesicles or vesicopustules on the instep and plantar surface. Scaling of the skin in this area, as well as the toe webs, is observed. The fourth variant involves macerated, denuded, weeping ulcerations on the sole of the foot. Odor is common with this type. This variant is often complicated by opportunistic gram-negative bacteria. Differential diagnosis includes eczema, contact dermatitis, psoriasis, and pitted keratolysis.²

Adults typically have an increased risk of tinea pedis compared with children, owing to increased exposure opportunities.¹ Persons who use public pools or bathing facilities are at increased risk.^1-3,7 Individuals who participate in high-impact activities that cause chronic trauma to the foot and those who wear occlusive footwear are also at increased risk.^1,2 Treatment with topical agents is the preferred therapy.^5,7 Systemic antifungal agents may be required for failed treatment with topical agents, extensive disease, or an immunocompromised state.⁵

Tinea Corporis: Also called ringworm, tinea corporis may present in multiple ways and on multiple areas of the body.^1,2 Lesions frequently manifest as small, circular, erythematous, scaly spaces.^1-3,5 Central clearing occurs as the borders spread and vesicles or pustules develop. Tinea corporis may occur on any body part, depending upon the type of dermatophyte infection. Zoophilic dermatophytes frequently infect areas of exposed skin, whereas anthropophilic dermatophytes infect occluded areas or sites of trauma. Differential diagnosis includes eczema, psoriasis, and seborrheic dermatitis.⁵

Tinea Cruris: Tinea cruris, or jock itch, occurs on the medial and upper area of the thighs and groin area and is more common in males than in females.¹ The scrotum itself often is not affected.^5,8 Signs of excessive moisture, pruritus, and burning are often present.² Risk factors for tinea cruris include infection with tinea pedis, obesity, diabetes, and immunodeficiency. Differential diagnosis includes candidiasis, intertrigo, erythrasma, psoriasis, and seborrheic dermatitis.²

Tinea Capitis: Tinea capitis is also called ringworm of the scalp. The incidence of this form is not known; however, it occurs most frequently in children exposed through contact with other children or pets.^2,3 Three types of tinea capitis exist: black dot, gray patch, and favus.^5,8Trichophyton tonsurans frequently causes black dot tinea capitis and is the predominant variant observed in the U.S.^2,5,8 Gray patch tinea capitis occurs in epidemic and endemic forms; however, the epidemic form is no longer documented in the U.S. The endemic form, which is caused by Microsporum canis, is often spread by cats and dogs. Favus, which rarely occurs in the U.S., is characterized by spores, air spaces, and fragmented hyphae, and occurs more frequently in Eastern Europe and Asia.⁹

Black dot tinea capitis is often asymptomatic initially. An erythematous, scaling patch on the scalp enlarges over time, and alopecia occurs.³ Hairs within the patches break, and a black dot (caused by detritus within the follicular opening) appears.^5,10 If black dot tinea capitis is left untreated, the alopecia and scarring may be permanent.^3,10 On occasion, the lesion may change and become elevated, tender, highly inflamed nodules known as kerion. Kerion formation is due to an immune response to the fungus. Lymphadenopathy may occur with kerion. Gray patch tinea capitis presents as circular patches of alopecia with prominent scaling.¹⁰ Kerion formation may occur with gray patch tinea capitis infection.

Tinea capitis must be treated with systemic antifungal agents, since topicals cannot penetrate the hair shaft.^5,10 Adjunctive treatment with antifungal shampoos may be recommended. Asymptomatic carriers of dermatophytes may be a source of reinfection. Sharing of fomites such as hats, combs, and brushes should be avoided.⁵ Differential diagnosis includes alopecia areata, atopic dermatitis, bacterial infection, psoriasis, and seborrheic dermatitis.⁵

Tinea Unguium: This disorder, also known as onychomycosis, is caused most frequently by dermatophytes, but nondermatophytes and Candida species also can cause it.⁷ Annually, more than 2.5 million people in the U.S. are treated for tinea unguium. Affected nails often become thick, rough, yellow, opaque, and brittle.^1,2,5 The nail may separate from the nail bed, and the dermis surrounding the infected nail may be hyperkeratotic.⁷ Risk factors include diabetes, trauma, family history, tinea pedis, smoking, extended periods of water exposure, and immunodeficiency. Differential diagnosis includes psoriasis, eczema, lichen planus, and trauma.^2,5 Treatment requires oral therapy for an extended period, at least 6 to 12 weeks, depending upon the location of the infection.^5,7 Failure rates with oral therapy typically are high, and topical treatment generally is not effective.

Tinea Incognito: Tinea incognito is a dermatophyte infection that is modified because of treatment with a corticosteroid.^2,3 Margins may be lost, and the area may be more widespread. Tinea incognito requires a thorough patient history and should be considered when a corticosteroid has been used to treat a rash that appeared to have cleared, but returned unresolved.

Candida Yeast Infections

Candida is part of normal body flora, but it is also a common cause of yeast infections.³ When the normal balance of flora is disturbed, an acute infection may occur. Risk factors include antibiotics, corticosteroids, diabetes, obesity, immunosuppression, and immunodeficiency.^2,3 Additionally, Candida thrives in warm, moist conditions.² An infection often presents as red lesions with accompanying satellite papules and pustules. Common areas of infection are the mouth and genital region. Differential diagnosis includes tinea corporis.

Treatment of Fungal Skin Infections

Topical Therapy: Tinea pedis, tinea corporis, and tinea cruris generally respond well to topical therapy.¹ Many of these treatments are available as nonprescription formulations. Commonly used topical therapies are described in TABLE 1.^1,11 Topical agents are available as ointments, creams, powders, and aerosols, and are well-tolerated overall. Rare cases of mild skin irritation, burning, itching, or dryness have been reported.¹ Drug-drug interactions are unlikely with topical therapy.

Multiple combination products incorporating an antifungal plus a corticosteroid are available. Combination therapy with antifungals and corticosteroids is not currently recommended in clinical guidelines.¹² Clinical cure rates have been demonstrated for combination therapy; however, the quality of the studies was poor owing to imprecision and bias, and relapse rates could not be assessed.

Patient adherence may be affected by the product chosen. Therefore, the selection of a drug or product should be made based on the patient’s daily habits and activities, as well as patient-specific characteristics such as concomitant disease states, age, and drug sensitivities.

Oral Therapy: Oral therapy can be recommended for the treatment of tinea pedis, tinea corporis, and tinea cruris if the infection is extensive, severe, or recalcitrant.⁶ See TABLE 2. However, tinea capitis must be treated with oral antifungal therapy, since topical agents do not penetrate the hair shaft, and tinea unguium responds better to oral therapy than to topical treatment.^5,6

There are currently two FDA-approved pediatric treatment options for tinea capitis: griseofulvin and terbinafine.^5,6,13 Griseofulvin is available as a suspension and as ultramicrosize tablets, but the tablets may be preferred, given the bitter taste of the suspension.¹³ For griseofulvin, there is some discrepancy regarding treatment duration for tinea capitis. Manufacturer labeling recommends 4 to 6 weeks, but other sources advise 6 to 12 weeks, and possibly up to 16 weeks.¹³ The American Academy of Pediatrics recommends that griseofulvin be continued for 2 weeks after clinical resolution of the infection.¹⁴ In 2007, terbinafine was approved to treat tinea capitis in patients aged 4 years and older.¹³ Terbinafine is dosed according to weight and is given once daily for 6 weeks. Off-label uses of itraconazole syrup (5 mg/kg for 4 weeks) and fluconazole (6 mg/kg daily for 3-6 weeks or 6 mg/kg once weekly) are alternative therapies.^3,5 Because of increasing resistance to griseofulvin, alternative regimens may be preferred for the treatment of tinea capitis; however, griseofulvin remains the drug of choice for kerion and when the etiologic agent is a Microsporum species.⁵

There are several different oral treatment approaches for onychomycosis. Oral griseofulvin, terbinafine, itraconazole, or fluconazole may be useful, but dosages and treatment duration vary according to the location of the infection (e.g., toenails or fingernails).⁶ These antifungal therapies may be effective only if the onychomycosis is caused by dermatophytes; if Candida is the etiologic agent, the infection may be resistant to oral antifungal therapy. Fluconazole is not approved for the treatment of onychomycosis, but pulse dosing may be used off-label (150-300 mg once a week for 3-6 months for fingernails or 6-12 months for toenails). Some researchers believe that oral antifungal therapy should be continued past the recommended treatment duration, at least until the infected nail is replaced by normal growth; however, this may take up to 9 to 12 months.^5,6

The use of the oral antifungal agents is not without side effects or significant drug interactions.¹³ Common adverse effects of griseofulvin include rash, headache, nausea and vomiting, and photosensitivity; additionally, long-term use of griseofulvin may result in hepatotoxicity. Notable drug interactions with griseofulvin include barbiturates, alcohol, cyclosporine, oral contraceptives, aspirin, and warfarin. Adverse effects of itraconazole include diarrhea, rhinitis, dyspepsia, pruritus, and hypertension. Notable drug interactions with itraconazole include terfenadine, astemizole, diazepam, oral triazolam, oral midazolam, cisapride, and hydroxymethyl glutaryl coenzyme A reductase inhibitors. Fluconazole may cause nausea and vomiting, rash, abdominal pain, and changes in taste. Like itraconazole, fluconazole has many drug interactions and should also be avoided in patients with renal impairment or hepatic disease. All oral antifungals require routine liver function tests.

Nonpharmacologic Therapy: Good skin care, including regular bathing and complete drying of the skin, is essential for preventing fungal skin infections. Prolonged exposure of the affected area(s) to moisture should be avoided. To prevent the recurrence of tinea pedis, walking barefoot in areas such as public bathrooms, locker rooms, and showers should be avoided. Affected individuals should also consider nonocclusive shoes, absorbent socks, and powder to control the moisture content.

When tinea capitis is confirmed, all contaminated combs, brushes, hats, and bedding should be cleaned. Diagnosed children may return to school once treatment of tinea capitis has begun; however, the sharing of grooming utensils, hats, and bedding should be avoided for at least 14 days.⁵

Conclusion

Proper identification and treatment of fungal skin infections remains a growing health concern. Pharmacists should refer patients with suspected tinea infections to their primary care provider for diagnosis confirmation, and then work in collaboration to effectively manage the infection with pharmacologic and nonpharmacologic treatment recommendations. Pharmacists are well positioned to encourage proper use of and adherence to lengthy treatment regimens. Since patient adherence may be affected by product selection, the pharmacist should consider patient characteristics and lifestyle to ensure that the appropriate product and formulation is chosen.

REFERENCES

1. Newton GD, Popovich NG. Fungal skin infections. In: Krinsky DL, Berardi RR, Ferreri SP, et al, eds. Handbook of Nonprescription Drugs. 17th ed. Washington DC: American Pharmacists Association; 2012:757-771.
2. Goldstein AO, Smith KM, Ives TJ, Goldstein B. Mycotic infections. Effective management of conditions involving the skin, hair, and nails. Geriatrics. 2000;55(5):40-52,45-47,51-52.
3. Robinson J. Fungal skin infections in children. Nurs Stand. 2012;27:52-54,56,58.
4. Hainer BL. Dermatophyte infections. Am Fam Physician. 2003;67:101-108.
5. Ely JW, Rosenfeld S, Seabury Stone M. Diagnosis and management of tinea infections. Am Fam Physician. 2014;90:702-710.
6. Vander Straten MR, Hossain MA, Ghannoum MA. Cutaneous infections: dermatophytosis, onychomycosis, and tinea versicolor. Infect Dis Clin North Am. 2003;17:87-112.
7. Flint WW, Cain JD. Nail and skin disorders of the foot. Med Clin North Am. 2014;98:213-225.
8. Hawkins DM, Smidt AC. Superficial fungal infections in children. Pediatr Clin North Am. 2014;61:443-455.
9. Drake LA, Dinehart SM, Farmer ER, et al. Guidelines of care for superficial mycotic infections of the skin: tinea capitis and tinea barbae. J Am Acad Dermatol. 1996;34:290-294.
10. Fuller LC, Child FJ, Midgley G, Higgins EM. Diagnosis and management of scalp ringworm. BMJ. 2003;326:539-541.
11. Clinical Pharmacology [online database]. Tampa, FL: Elsevier/Gold Standard; 2014.
12. El-Gohary M, van Zuuren EJ, Fedorowicz Z, et al. Topical antifungal treatments for tinea cruris and tinea corporis. Cochrane Database Syst Rev. 2014;(8):CD009992.
13. Lexicomp Online [online database]. Hudson, OH: Wolters Kluwer Health; 2015.
14. Tinea capitis. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009:662.

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Fungal Skin Infections: Symptoms and Treatments

Types of fungal skin infections

There are several different types of fungal infection that can affect your skin and nails.

Athlete’s foot

This is a really common infection. Around seven in 10 people have athlete’s foot (tinea pedis) at some point in their lives. It’s caused by a fungus that grows in the skin between your toes and on the soles of your feet. It grows easily here because the area gets moist when your feet sweat.

The skin between your toes can become itchy, flaky and red, with painful cracks, or fissures. The sole of your foot can also become itchy, thickened and scaly. You might get blisters too.

Athlete’s foot is more likely if your footwear makes your feet sweaty and you’re in a warm, humid environment. You can catch it by walking barefoot on damp, contaminated floors such as in communal bathing or swimming areas. After scratching the affected area, you can spread the infection to other parts of your body.

Nail infections

Fungal nail infections can affect any part of your nails. Toenails are much more likely to be affected than fingernails. The infection causes nails to discolour and become rough and crumbly. Your nail may also get thicker.

You’re more likely to get a fungal nail infection if you have other fungal infections, such as athlete’s foot. They’re also more common if you’re older, have another medical condition such as psoriasis or diabetes or if you bite your nails.

Ringworm

Despite its name, ringworm is an infection with a fungus not a worm. It gets its name because it often causes a ring-shaped rash. Ringworm infections are very common and can affect different parts of your body.

Ringworm on your body

This is most common on parts of your body that are exposed, such as your arms, legs or trunk. It causes a red, scaly, ring-shaped rash. You can catch ringworm by touching somebody who already has it or by touching contaminated items such as clothing or bedding. Animals, including cats and dogs, can also carry the ringworm fungus.

Ringworm in your groin

Ringworm in your groin causes an itchy, red rash in your groin and around the top of your legs. Also called ‘jock itch’, it’s more common in men. You’re more likely to get it if:

• your skin in this area often gets warm and damp
• you’re very overweight
• you often wear tight clothing
• you have diabetes

You’re most likely to get ringworm in your groin if you have other fungal infections. For example, about half of people who are affected also have athlete’s foot. You can spread it to other parts of your body by scratching. You can also pass it to others by direct contact or by sharing towels or clothing.

Ringworm on your scalp

You can get this at any age, but it mostly affects children. Scaly patches develop on your scalp and may be itchy. In some people, the patches become inflamed and red and have pus-filled spots. You may also develop a pus-filled area on your scalp; this is called a ‘kerion’.

You can get ringworm on your scalp by sharing a contaminated hairbrush or clothing used by somebody with the infection.

Candida (yeast) infections

Candida is a yeast, which is a kind of fungus. It may live harmlessly inside your digestive system or vagina. But if conditions are right, candida can multiply and start to cause symptoms. These yeast infections most often appear around your genitals (vagina or penis), in your mouth or where you have folds of skin. A common name for candida infections is ‘thrush’.

Thrush makes the affected area sore and itchy. The skin is usually red and moist, and small pus-filled spots may appear. In women, vaginal thrush can cause itchiness and a white discharge. Thrush in the mouth most often affects babies and older people (particularly if you have false teeth or a medical condition that lowers your resistance to infection). It appears as white patches, which leave a red mark if you rub them off.

Pityriasis versicolor

This is caused by a type of yeast called Malassezia, which usually lives harmlessly on the skin. It typically affects teenagers and young adults. Pityriasis versicolor causes patches of scaly, discoloured skin that are sometimes mildly itchy. It most commonly appears on your back, chest or upper arms but it can be in other areas. Patches can be pink, brown or red, or may be paler than the surrounding skin. You may notice this especially after being in the sun because the affected area doesn’t tan as much as the rest of your skin.

A Creeping Public Health Threat

Fungal infections most often present themselves as minor annoyances: a gross toenail, itchy ringworm, or perhaps a more pesky mucosal infection such as thrush in the mouth and vaginal yeast infections. These superficial infections affect an estimated 15% of the world’s population and can present meaningful lifestyle hurdles, but are rarely life threatening. However, invasive fungal infections are collectively responsible for killing up to 1.5 million people each year, making this infection category one of the most deadly among communicable diseases, along with lower respiratory infections, tuberculosis and diarrheal diseases.

Despite the high mortality rates of invasive fungal infections (upwards of 50%), experts estimate that 80% of those patients might be saved with appropriate diagnostics and treatments. But diagnosing fungal infections is difficult, in part because of their nonspecific symptoms. Many patients are misdiagnosed with bacterial and/or viral infections, delaying appropriate treatment. Fungi are also rapidly becoming resistant to the current arsenal of  antifungal agents. Improvements are needed to make progress in these areas, but the question remains: why have fungal infections become more frequent?

Fungal infections were considered rare until the mid-20th century. They were considered diseases of the “immunocompromised and the unlucky,” a statement that succinctly describes the two types of fungal pathogens,  opportunistic and primary. Opportunistic fungi only cause invasive infections in those who are immunodeficient, while primary fungi are those capable of causing invasive disease in healthy individuals. Increased numbers of invasive infections by both groups of fungal pathogens have been fueled with technological advances that improved medical care and led to increasing global travel.

Increasing Opportunities for Opportunistic Fungi

In the mid-to-late 1900s, significant medical advances began extending and improving the lives of many people with previously fatal health conditions, such as liver failure, cancer and premature birth. But organ transplants, chemotherapy and radiation result in patients that are immunocompromised for brief or extended periods of time. An increasing immunocompromised patient population, as well as the spread of human immunodeficiency virus (HIV) in the 1980s, has greatly increased the incidence of fatal fungal infections around the world. Infections by Candida spp. yeasts (common members of the human microbiome) account for 50–60% of all fungal infections following organ transplants, and together, four fungal infections (cryptococcal meningitis, pneumocystis pneumonia, disseminated histoplasmosis and chronic pulmonary aspergillosis) account for nearly 50% of all AIDS-related deaths.

Pneumocystis jirovecii (formerly called P. carinii) was the most common opportunistic pathogen from 2008-2010.

Source: CDC/ Dr. Russell K. Brynes

For instance, Pneumocystis jirovecii pneumonia (PCP), a previously rare disease, became a defining diagnosis for HIV/AIDS patients, reaching a global incidence rate of 4.9 per 100 person-years in 1995. With the introduction of anti-HIV therapies, the incidence rate of PCP dropped to 0.3 per 100 person-years in just three years (1998), though it remained the most common opportunistic infection in the U.S. from 2008 – 2010. More recently, Cryptococcus neoformans was estimated to cause more than 1 million cases of meningitis and more than 600,000 deaths in 2009, primarily in HIV-positive patients, though experts expect that number to have dropped as a result of increased screening and improved medical therapies. Unfortunately, in 2016, an estimated 16.7 million HIV-positive individuals didn’t have access to anti-HIV therapies, putting them at increased risk of invasive fungal infections.

Patients undergoing surgery, chemotherapy or other invasive procedures are given prophylactic treatments to prevent infections. Although this strategy helps prevent bacterial and viral infections, it can also increase a patient’s susceptibility to fungal infections. For example, patients undergoing bone marrow transplants are often prescribed the antiviral ganciclovir for 4 or more weeks to prevent cytomegalovirus infections. Unfortunately, ganciclovir use also correlates with invasive aspergillosis; each additional week of use (past week 4), increases the infection risk by 40%. Similarly, anti-yeast treatments increase the risk of mycelial infections (such as aspergillosis) from 18 to 29%.

Aspergillus spp. can cause pneumonia, invasive disease and a progressive allergic lung disease, particularly in asthmatics and those with cystic fibrosis. A French study examining a national hospital database found a 4.4% yearly increase in invasive aspergillosis from 2001– 2010. Similar increases have been reported in other studies. Aspergillosis infections have a high mortality rate of about 50% with timely diagnosis and treatment on time, otherwise the mortality rate is 80%.

While the fungi discussed above are the most common opportunistic fungal infections in immunocompromised patients, these may only be a drop in the bucket compared to the total number of potential opportunistic fungi. One expert suggests that more than 400 different fungal species may be responsible for opportunistic infections, though most may have only been encountered once or twice. Regardless of the infecting fungal species, the increasing number of patients living with compromised immune systems, whether because of age, HIV status, cancer or organ transplants, has contributed to the increasing number of invasive fungal infections.

The Spread of Primary Fungal Pathogens

Primary fungal pathogens include species such as Blastomyces dermatitidis, Histoplasma capsulatum, Coccidioidis immitis, Paracoccidioidis brasiliensis and Penicillium marneffei. Interestingly, many of these primary fungal pathogens alter their cell shape (or morphology) during human infection, switching between circular yeast and elongated hyphae based on either temperature or host-associated molecules.

Histoplasma capsulatum isolated from the environment has a hyphal morphology, as seen here.

Source: CDC/ Dr. Russell K. Brynes

Most thermally dimorphic fungi grow in the soil as branching mycelial networks up to 25ºC. If disturbed and inhaled into the lungs, the hyphae convert to single-cell yeasts at the higher temperature (37ºC) to cause pneumonia and disseminate through the bloodstream. Thermal dimorphs can infect both healthy and immunocompromised humans, as well as other mammals (e.g., dogs, cats and armadillos) and include the fungal species that cause blastomycosis, histoplasmosis, coccidioidomycosis, paracoccidioidomycosis and sporotrichosis.

The transition to the yeast morphology is accompanied by the up-regulation of a suite of virulence factors that promote adhesion, growth in and lysis of macrophages, and to impair the immune response. Non-thermally dimorphic fungi, on the other hand, tend to infect plants and insects, with the transition between forms triggered by oxygen levels, nitrogen sources, pheromones and quorum-sensing molecules.

Many of these primary fungal pathogens have historically held to geographic boundaries, with species endemic to particular areas. For instance, the thermal dimorph H. capsulatum is the most common transplant-related endemic mycosis in the U.S., with the Midwest recording 6.1 cases per 100,000 person-years between 1999–2008. It is also the most common opportunistic infection of HIV-positive patients in Latin America. But histoplasmosis has now been described in China, India, Central and Western Africa, and Madagascar.

While the mycelial survival and growth of H. capsulatum (and other thermal dimorphs) in the soil contributes to some migration, it certainly doesn’t explain crossing entire oceans. Humans routinely do so, however. Not only has increasing global travel allowed endemic fungi to spread wherever humans and their property may go, but climate change has increased the area where traveling fungi may successfully take root. Both of these factors increase the number of people who might be counted as “unlucky.”

Unfortunately, when it comes to combating the increasing number of invasive fungal infections, we’re fighting an uphill battle. In addition to problematic diagnostics and treatments, getting a true picture of the global burden of invasive fungal infections is difficult because surveillance is almost nonexistent for many fungal infections in many parts of the globe. Even in the U.S., the most widely reportable fungal infection is coccidioidomycosis (also known as Valley fever, the incidence rate of which has increased from 5.3 per 100,000 people years in 1993 to 42.6 in 2011), and it is only reported by 23 states. The lack of reliable data complicates (and delays) coordinated responses to an increasing public health threat.

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Fungal infections worldwide are becoming resistant to drugs and more deadly

Say “fungus” and most people in the world would probably visualize a mushroom.

But this fascinating and beautiful group of microbes has offered the world more than just foods like edible mushrooms. Fungi are also a source of antibiotics – for example, penicillin from Penicillium – as well as the yeasts and other fermentation agents that make bread rise, give cheese its flavor and put the alcohol in wine and beer.

Many people may also not realize that some fungi can cause disease. However, athlete’s foot, thrush, ringworm and other ailments are caused by fungi, and some are serious risks to health and life. That’s why the rise of antifungal resistance is a problem that needs more widespread attention – one equal to the better-recognized crises of multidrug-resistant microbes like the bacteria that cause tuberculosis.

I’ve worked in public health and medical laboratories for over three decades, specializing in public health and clinical microbiology, antimicrobial resistance and accurate science communication and health literacy. I’ve been paying close attention to the growing resistance of a pathogenic fungus called Candida auris to limited and commonly used anti-fungal agents. Since fungi have traditionally not caused major diseases, the emergence of drug-resistant fungi that can cause serious illness rarely receives funding for medical research.

But the facts suggest that this needs to change.

What’s a fungus?

Fungi-caused ailments are treated with specifically anti-fungal medications because these organisms are such a unique form of life.

Fungi are spore-producing organisms, including molds, yeast, mushrooms and toadstools. Among their unique characteristics, fungi feed on organic matter by decomposing it, rather than ingesting it like animals do, or absorbing nutrients through roots, as plants do. Unlike bacteria, which have simple prokaryotic cells, or cells without a true nucleus, fungi have complex eukaryotic cells cells, which do have a nucleus surrounded by a membrane like animals and plants. In the multi-level taxonomy, or naming system, that biologists use to classify life forms, fungi are in their own kingdom under the domain of Eukarya.

Most fungal infections worldwide are caused by a genus of fungi called Candida, particularly the species called Candida albicans. But there are others, including Candida auris, which was first identified from an external ear canal discharge in 2009 in Japan, and given its name for the Latin term for ear, “auris.”

Candida normally lives on the skin and inside the body, such as in the mouth, throat, gut and vagina, without causing any problems. It exists as a yeast and is thought of as normal flora, or the microbes that are part of humans. Only if our bodies are immuno-compromised do these fungi become opportunistic and cause disease. That is what’s happening worldwide with multidrug-resistant C. auris.

What is the concern about

Candida auris?

Infections by C. auris , sometimes called fungemia, have been reported in 30 or more countries, including the United States. They are often found in the blood, urine, sputum, ear discharge, cerebrospinal fluid and soft tissue, and occur in people of all ages. According to the U.S. Centers for Disease Control, the mortality rate in the U.S. has been reported to be between 30% to 60% in many patients who had other serious illnesses. In a 2018 overview of research to date about the global spread of the fungus, researchers estimated mortality rates of 30% to 70% in C. auris outbreaks among critically ill patients in intensive care.

Research data shows that risk factors include recent surgery, diabetes and broad-spectrum antibiotic and antifungal use. People who are immuno-compromised are at greater risk than those with healthy immune systems.

In this 2019 interview, Dr. Rodney E. Rohde talks about the global scope of antimicrobial resistance with the Association for the Health Care Environment.

C. auris can be difficult to identify with conventional microbiological culture techniques, which leads to frequent mis-identification and under recognition. This yeast is also known for its tenacity to easily colonize the human body and environment, including medical devices. People in nursing homes and patients who have lines and tubes that go into their bodies – like breathing tubes, feeding tubes and central venous catheters – seem to be at highest risk.

The Centers for Disease Control and Prevention have set C. auris infections at an “urgent” threat level because 90% are resistant to at least one antifungal, 30% to two antifungals, and some are resistant to all three available classes of antifungals. This multidrug resistance has led to outbreaks in health care settings, especially hospitals and nursing homes, that are extremely difficult to control.

COVID-19 and

C. auris: An even deadlier combination

For hospitalized COVID-19 patients, antimicrobial-resistant infections may be a particularly devastating risk of hospitalization. The mechanical ventilators often used to treat serious COVID-19 are breeding grounds and highways for entry of environmental microbes like C. auris. Further, according to a September 2020 paper authored by researchers Anuradha Chowdhary and Amit Sharma, hospitals in India treating COVID-19 have detected C. auris on surfaces including “bed rails, IV poles, beds, air conditioner ducts, windows and hospital floors.” The researchers termed the fungus a “lurking scourge” amid the COVID-19 pandemic.

The same researchers reported in a November 2020 publication that of 596 COVID-19-confirmed patients in a New Delhi ICU from April 2020 to July 2020, 420 patients required mechanical ventilation. Fifteen of these patients were infected with candidemia fungal disease and eight of those infected (53%) died. Ten of the 15 patients were infected with C. auris; six of them died (60%).

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What next?

With the options for effective antifungals narrowing, the CDC is recommending a focus on stopping C. auris infections before they start. These steps include better hand hygiene and improving infection prevention and control in medical care settings, judicious and thoughtful use of antimicrobial medications, and stronger regulation limiting the over-the-counter availability of antibiotics.

In December of 2019 news emerged of a novel virus, SARS-CoV-2. Since then, most of us have been watching the terrifying headlines about the global pandemic, which has killed millions. But while we have been isolating ourselves in lockdown or quarantine, or just remaining physically distant from one another, the multidrug-resistant microbes of the world – including C. auris – have not.

Fungal Skin Infections: Types, Symptoms, and Treatments

Are Fungal Infections Serious?

Fungal skin infection and fungal nail infection are gross and itchy, but they are not usually serious. Fungal infections like athlete’s foot, ringworm, and jock itch are easy to pick up and transmit to others. Healthy people do not usually experience a spread of fungus beyond the surface of the skin, so they are easy to treat. If you spend a lot of time at the gym or public pool, follow these steps to guard against fungal infections.

Ringworm

Tinea, or ringworm, is an organism that may cause fungal infection on the scalp, fungal infections on the face, or infections on other areas of the body. Ringworm creates a characteristic fungal infection skin rash that is circular, raised, red, and itchy. People usually pick up ringworm from other people, pets, or contaminated items that carry the organism. Keep your skin clean and dry to help prevent ringworm. Avoid sharing personal items, including towels, hair brushes, and combs to avoid spreading the infection. Ringworm is easily transmissible.

Athlete’s Foot

Athlete’s foot is a type of fungal infection on the feet. It results in cracked, itching, burning, and peeling between the toes. The infection is caused by a type of ringworm often found in locker rooms, gyms, pool areas, towels, and shoes. Always wear shower shoes when you are in communal showers or pool areas. Wash and dry your feet thoroughly every day. Air out your shoes and let them dry before wearing them again. Put on clean socks daily.

Jock Itch

Jock itch is a fungal infection on the groin. This red, itchy, raised rash can affect both men and women. Jock itch is caused by a type of ringworm fungus. You’re more likely to get it when you are sweating and in humid weather. Exercising in workout clothes causes the hot, humid conditions where jock itch flourishes. Minimize the risk of jock itch by keeping your groin area clean and dry. Wear fresh clothes and underwear daily. Steer clear of tight clothing.

Nail Fungus

Toenail fungal infection is very common. It appears as thick, yellowish, brittle toenails, although fingernails can be affected as well. Take the same precautions to avoid toenail fungus as you do to avoid other types of fungal infections. Keep hands and feet clean and dry. Wear clean socks and change them daily. Wear flip flops when you are in locker rooms, at the pool, and in communal shower areas. Choose wide-toed shoes. Do not share personal items like towels, grooming tools, razors, and nail clippers.

Caring for Gym Clothes

Minimize the risk of fungal infections by taking good care of your workout wear. Sweaty gym clothes are the perfect breeding ground for fungi and bacteria to grow. Wash workout wear right after you exercise. If you won’t get to the laundry immediately, at least hang wet clothes up to air out. Turn clothes inside out before loading them into the washing machine to make the dirtiest parts of garments easier to clean. Add baking soda to the washer to help deodorize clothes. Add vinegar to the rinse cycle to further cut down on odors. Put on clean workout clothes before every workout.

Preventing Fungal Infections at Home

What causes a fungal infection? You need the presence of a fungi, but you also need the environmental conditions that allow the infection to take hold and flourish. Minimize the risk of fungal infections at home by keep your skin clean and dry. Allow your sneakers and footwear to air out and dry before you wear them again. Put on clean socks and underwear daily. Go barefoot or wear sandals often to allow your feet to air out.

Staying Safe in the Gym and Locker Room

Gyms and locker rooms are common areas where it is easy to pick up fungal skin infections or fungal nail infections. Reduce your risk of picking up an infection by wearing clean, loose-fitting workout clothes to keep skin dry. Wear sandals or flip flops around pools, communal showers, and locker rooms. Wash your hands frequently and wash or sanitize them right after you work out. Disinfect exercise equipment before and after use. Shower right after you work out and throw your workout gear into the washer. If you won’t do laundry immediately, hang up and damp garments to dry them out. If you have a cut or wound, keep it clean and covered and stay out of saunas, hot tubs, and steam rooms until it has healed.

Treating Fungal Infections

If you need fungal infection treatment, talk to your doctor. Some skin conditions looks like fungal infections, but they have a different underlying cause and require different treatment. Mild fungal infections may be treated easily with topical medication. If you have a severe or persistent infection, you may need prescription antifungals.

Can Fungal Infections Lead to Serious Illness?

Fungal skin infections and fungal nail infections are annoying, but they are rarely serious. They usually just cause itching and irritation. If fungal skin infections are severe or worrisome to you, see your doctor for an evaluation and treatment.

90,000 Fungal diseases, description of the disease on the Medihost.ru portal

Fungal diseases (mycoses) – a large group of diseases, the cause of which is the defeat of the body by pathogenic fungi. Roughly similar signs of all mycoses – skin inflammation, peeling, the formation of secondary elements – scales, crusts. Skin changes are accompanied by itching, changes in the structure of the skin and its derivatives.

Often, due to itching, the patient combs the affected areas, thereby seeding with fungi other parts of the body.Moreover, if the skin is damaged, a secondary infection is possible.

Classification

The following types of fungal diseases are distinguished:

1. Dermatophytosis is a chronic fungal infection in which the epidermis is mainly affected. Examples of specific diseases are mycosis of the feet, trichophytosis, favus, microsporia.
2. Keratomycosis is a low-contagious group of diseases, the stratum corneum is affected without the involvement of skin appendages in the process. Examples are erythrasma, pityriasis versicolor, actinomycosis.
3. Candidiasis is a more serious group of fungal diseases. Candidal fungi affect not only the skin, but also the mucous membrane, internal organs. Fungi of the genus Candida are saprophytes and become disease only under certain conditions.

Symptoms

Each group of fungal diseases is characterized by its own set of symptoms. Thus, all keratoses are characterized by the formation of flaky spots of various sizes, brownish-pinkish spots.Favorite location – back, shoulders, neck. The provoking factor in the development of keratoses is increased sweating. The spots have jagged scalloped edges, they can merge, forming large lesions.

Those people who have hypersalivation are more susceptible to the development of skin candidiasis. For the development of candidiasis, two conditions are necessary – moderately warm temperature and humidity. Favorite places of localization are folds of the skin, the corners of the mouth (candidiasis seizures), skin for which proper hygienic care is not carried out.

Provoking factor – eating sweets, pastries, food that contains fast carbohydrates. The affected skin is brightly hyperemic, covered with a white bloom over the entire surface, detachment of the epidermis and erosion are possible along the edges. As a rule, the boundaries of the lesion are clear.

Dermatophytosis are characterized by a varied clinical picture. With trichophytosis, the scalp is affected, manifested by increased hair fragility, peeling of the skin. Provoking factors – hypovitaminosis, endocrine system disorders.

Microsporia affects mainly smooth skin. The rashes are in the form of intersecting rings of various elements of the rash – bubbles, crusts, vesicles, nodules. Itching with this disease is absent.

Favus of the skin is a disease of moderate contagiousness. The most susceptible to favus are women and children. Fungi affect the skin, hair, nails, and sometimes internal organs. A prolonged course can lead to baldness, there is a tendency to family foci of the disease.

Many other types of fungi affect the skin and nails of the feet and hands, accompanied by itching, burning, changes in the structure of the skin – thickening, cracking.The nails become brittle and brittle, yellow in color, sometimes the nail peels off.

Diagnostics

Most fungal diseases can be diagnosed by the appearance and nature of the rash, symptoms. However, the diagnosis can be finally confirmed only on the basis of determining the pathogen from a biopsy of the affected area.

Treatment

Long repeated courses of antimycotic drugs are used to treat fungal diseases. Also, the cause of the development of mycoses is identified – the underlying disease and therapy is carried out.Including are prescribed immunostimulating drugs, diet therapy, physiotherapy treatment with ultraviolet light. For the prevention of relapse, it is recommended to diagnose and prophylactically treat all family members of the patient.

signs, causes and how to treat them?

The disease, which is known as a fungal infection of the nails, belongs to a type of mycoses and is called onychomycosis in the medical literature. This is one of the most common diseases of the skin appendages in the world – according to statistics, 5% of adults on the planet suffer from various fungal nail diseases.Among people over 60 years old, this figure is much higher and reaches 30% [1].

What types of fungal pathogens spread to the nails? What symptoms to look for? How should fungal nail diseases be treated? Answers to these and other important questions can be found in our article.

Types of fungal diseases

Currently, scientists have identified more than 50 species of fungi that can cause fungal diseases of the nails.They are divided into three main groups: dermatomycetes (dermatophytes), yeast-like fungi of the genus Candida, and molds [2].

• Among the varieties of fungal diseases, infections caused by dermatophyte fungi are the leading ones. These pathogens are the cause of more than 80% of clinical cases. They usually affect the toenails, but they can also be localized on the hands.
• Yeast fungi of the genus Candida – the second most common causative agent of nail fungus.They account for 5 to 10% of cases of fungal diseases of the toenails. On the nails of the hands, this figure reaches 40% [3].
• Molds cause 10-15% of onychomycosis, but they often coexist with another type of fungal infection, namely dermatophytes, forming a mixed focus of the disease.

Damage to the nail by one type of fungus occurs in 75% of cases, two types – in 15.8%, three – in 8.6% [4]. Such a variety of pathogens makes it difficult to select drugs and explains the numerous cases of ineffectiveness of therapy aimed at combating exclusively against dermatophytes.

Note
If a couple of decades ago, onychomycosis was mostly observed in middle-aged and older people, today the picture has changed. Fungal nail disease is increasingly common in children and adolescents: the number of patients reaches 3% of the total number of children undergoing an annual medical examination [5].

Symptoms of the fungus

For better treatment of onychomycosis, it is important to notice the appearance of the first alarming changes in time [6].This is not difficult if the nails are not hidden under a layer of gel polish. In the event that the infection has penetrated into the nail covered with the gel (this could have happened before the procedure or during the treatment with infected manicure instruments), the damage to the nail plate will become evident only after the coating is removed.

What symptoms indicate a fungal nail disease? In short, this is a change in the normal color, texture and shape of the nail. Depending on how far the inflammatory process has gone, the disease is divided into several types, each of which has special symptoms:

• Initially, the color of the nail changes – yellowish and (or) white stripes appear.At this stage, the disease belongs to normotrophic type , the nail does not yet change shape and does not form a thickening.
• At the next stage, the nail becomes noticeably thicker (this phenomenon is called subungual hyperkeratosis – a change in the structure of the nail), its color changes to dark yellow or brown, the edges begin to crumble and become jagged. In this case, they speak of hypertrophic type of the disease.
• Launched onychomycosis is characterized by a significant thickening of the nail plate, sometimes its partial destruction or detachment occurs (in this case, voids can form).This type of fungal nail disease is called atrophic .

When pressed, fluid or pus may leak from under the nail. For onychomycosis caused by mold, a change in the color of the nail to greenish-yellow, gray or black is characteristic. In this case, the nail becomes similar to the claw of a bird of prey (this is most often observed when the big toes are affected). In most cases, fungal infections of the toes are associated with nail fungus on the hands.

Treatment of fungal nail diseases

Often, people who are faced with nail fungus perceive it exclusively as an aesthetic nuisance. This is a fundamentally misunderstanding: onychomycosis is a serious disease that can develop into a chronic one and lead to significant problems.

In some cases, for example, when an immunodeficiency condition occurs, in the presence of diabetes mellitus and blood diseases, fungal nail disease causes the spread of mycosis to a significant surface of the body: on the palms, feet, skin folds.The use of antibiotics, corticosteroid and cytostatic drugs can also provoke the growth of the fungus. The development of such severe complications as diabetic foot syndrome (which is one of the main causes of limb amputation in diabetes) and chronic erysipelas is also possible [7].

Fungal diseases are transmitted by contact with infected areas of the nail plate or skin, to which the fungus has spread. You can also get infected when using common household items: shoes, clothes, gloves, towels, washcloths, bath rugs and manicure supplies.Therefore, a sick person automatically becomes a source of infection for loved ones and must take this unpleasant fact into account in everyday life.

For these reasons, it is highly undesirable to delay the treatment of fungal nail diseases.

So how to treat fungal nail disease?

Drug therapy

The choice of tactics and treatment regimen is the prerogative of a dermatologist, who assesses the stage and localization of the disease, and most importantly, the type of pathogen.

As already mentioned, the causative agents of the disease can belong to three different groups (yeast, mold or dermatophytes), so the first step towards cure will be to undergo an examination. For this, a laboratory specialist removes fragments of the nail plate and the biomaterial scraped out from under it.

Based on the results of the study (which can take up to 23 days), the type of pathogen is determined, after which the doctor prescribes treatment, choosing the drug to which this type of fungus is sensitive.If, for any reason, testing is not possible, a universal drug is usually prescribed.

Treatment can be both local – with the help of surface agents, and systemic (when the medicine is taken orally and it enters the body through the blood). In advanced cases, combination therapy is prescribed.

At various depths of the inflammatory process, the doctor can choose the following types of treatment [8]:

• In case of a superficial form (damage to 1/3 of the depth of the nail with absent or moderate hyperkeratosis), topical therapy is used – most often these are solutions, lacquer forms preparations for fungal nail diseases.

This is important
Monotherapy with medicinal varnishes is possible if the disease is at an initial stage, there is no hypertrophic type of lesion, and no more than half of the nail area is affected [9].

• In case of damage to 2/3 of the depth of the nail plate in the absence or moderate picture of hyperkeratosis, local therapy can be used, but its effectiveness depends on the rate of nail growth; with a slowly growing nail, systemic therapy is indicated.
• In case of lesions of more than 2/3 of the depth of the nail with moderate hyperkeratosis, systemic therapy is used. In some cases, removal of keratinized masses is required.
• In case of damage to more than 2/3 of the depth of the nail, which is combined with splitting and severe hyperkeratosis, combined treatment e of fungal nail diseases is necessary with the appointment of a systemic drug and the mandatory removal of the nail plate (surgical or chemical method, or laser) and cleaning the bed.

Notes
In case of hypertrophic type of lesion, cosmetic cleaning of the nails is mandatory, they must be carried out by a health worker. Cleaning is performed after applying a special ointment with urea (40%) to the affected nail in order to soften the surface. In pharmacies there are also ointments for self-use by patients at home [10].

The use of any systemic drug should always be justified.It is selected taking into account the correspondence between the therapeutic effect and the safety of the treatment. Therefore, the reception of such funds is possible strictly according to indications, taking into account the patient’s age and the presence of other diseases.

Home remedies

Vinegar, hydrogen peroxide and iodine are the most commonly mentioned home treatments for fungal nail diseases. 3% peroxide and vinegar (apple or wine) are used in the form of lotions or baths. Iodine is applied with a cotton swab to sore nails and the bed, or mixed with sea salt for bathing.

In all cases, we are not talking about the fight against the causative agent of the disease, but about disinfection and regeneration of the nail. Disinfection helps prevent bacterial infections on sensitive areas of the skin and speeds up recovery.

It is important not only to notice the signs of a fungal disease of the nails of the feet or hands in time, but, of course, to start treatment in a timely manner. The process of healing from the fungus usually takes a long time, deeply affected by mycosis nails require long-term combined treatment, which takes up to 6-12 months.Therefore, you need to be patient and strictly follow the prescribed therapy regimen. It is possible to speak of a complete cure for onychomycosis only after the persistent disappearance of symptoms and appropriate laboratory confirmation.

How does it manifest and how is it treated?

Onychomycosis (or, as it is popularly called, nail fungus) is a lesion of the nail plates with pathogenic fungi. There are many causative agents of the fungus, and in a quarter of cases they can act together – for example, fingernails can simultaneously attack dermatomycetes and yeast-like fungi.Skin fungus is found on its own much less often than nail fungus, but it can develop in parallel with it, because disease-causing fungi are very viable. They not only easily “travel” through the body, but are also transmitted through household items, so during the period of self-isolation it is important to pay special attention to your body so as not to infect your family. Of course, fungal infections of the skin and nails are not a fatal disease, but nevertheless, it can ruin your life in a big way. What causes it, how it manifests itself and how to treat a fungal infection, we will tell in the article.

What can cause a fungal infection

Some people think that a skin or nail fungal infection is a companion of unclean people, but this is not at all the case. It can appear in everyone, because quite a few factors lead to it. The most common causes of fungal infection are:

• Wearing tight shoes . A warm, humid environment creates excellent conditions for the development of pathogenic fungi. In this case, the risk group is people whose occupation does not allow changing clothes at work in light breathable shoes – security officials, athletes, miners and others.
• Injuries to nails and skin . We know from childhood that any wound needs to be disinfected so that an infection does not get into it. The same is with the fungus: even the smallest damage to the nail plate or skin “attracts” pathogens.
• Violation of blood supply in fingers . It usually affects overweight people, fast food lovers, smokers and anyone who leads a sedentary lifestyle. The lack of blood supply robs cells of nutrients and makes them easy prey for the fungus.
• Various diseases . Diabetes mellitus and all kinds of hormone problems also often contribute to the development of fungal infections on the legs and other parts of the body.
• Immunocompromised . When the body has all its strength to fight the disease or recover from it, the resources to resist the fungus may not be enough.
• Older age . Fungal infection in the elderly is a consequence of age-related changes in the body. These are stagnation of salts, weakening of ligaments and joints, and much more.

It is worth remembering that representatives of the older generation are hardened by difficulties and often do not pay attention to such a “trifle” as a fungus. Therefore, when you see alarming signs in your elderly relative, it is better to immediately take control of his treatment, and not wait until he decides to go to the doctor himself.

Signs of a fungus

Symptoms of a fungal infection are quite obvious, so it is difficult to miss them. Fungal infections of the toenails and hands are easily recognized by the following signs:

• Delamination .Fungus-affected nails become brittle, brittle and lose their integrity.
• Color change . The nail affected by the fungus turns from pale pink to yellowish, brownish or even grayish.
• Detachment of the nail plate . Perhaps the most unpleasant manifestation of the fungus, because even with a weak effect, the exfoliated nail can come off. It is difficult to restore the plate, not to mention the fact that being left without a nail is very painful.
• Burning and itching . It is also a clear symptom of a fungal infection of the nail plates, which usually manifests itself upon contact with water and direct sunlight, as well as exposure to the nail. With the advanced stage of the fungus, burning and itching can be constant.
• Inflammation of the skin around the nail . Often the fungus does not want to remain only on the plate and begins to “capture” the adjacent areas. Therefore, fungal infections of the skin around the nails are very common.The inflamed areas may ache, throb and swell slightly.

For signs of fungal skin infection, these include:

• Itching and burning . Here the picture is the same as with nails, because both types of fungus are caused by the same pathogenic microorganisms.
• Peeling, redness of the skin in the lesions . No matter how much you want, it is better not to comb the skin affected by the fungus, otherwise it can lead to rather deep wounds.
• Bubbles or ulcers .It is also better not to touch them again, and even more so not to open them yourself.
• Inflammation and redness . This is a standard skin reaction to various types of irritants.

It is easy to argue that there are many skin infections and the symptoms listed above may signal not a fungus, but another disease. Moreover, as we have already said, a fungal infection of nails occurs several times more often than its “skin” version. However, we also mentioned that these diseases can run in parallel – especially often, skin fungus manifests itself in inflammation around the nails and between the fingers.Therefore, at the first signs of a fungal infection of the nail plates, you should carefully examine your body for other foci. It is impossible not to treat the fungus – in addition to the above physical inconveniences and aesthetic unattractiveness, it is a good “gateway” for other, more dangerous infections.

Treatment for a fungal infection

How to cure a fungal infection? To begin with, it is worth understanding that this is a disease that you need to see a doctor with. Fungal infection is dealt with by a dermatologist or a physician of narrow specialization – a mycologist.After examination and all analyzes, doctors will be able to confirm the presence of the fungus and prescribe therapy based on the “location” of the infection, its phase of development and the general condition of the patient.

Adherents of traditional medicine will say that this is superfluous – they say, the Internet is full of recipes for various baths based on propolis, soda, celandine, ammonia and so on. However, you should not rely on them. Firstly, the effectiveness of such solutions has not been proven, and secondly, if a fungal infection on the hands or feet proceeds in parallel with another skin disease, the baths can only aggravate the situation.Therefore, it is better to give preference to pharmacology.

There are several types of agents for the treatment of fungal infections. In the pharmacy, you can find special varnishes for covering nails affected by fungus. Their composition, as a rule, includes the substance amorolfine, which destroys fungal colonies and their spores. However, it has the proper effect if pathogenic microorganisms live only in the upper layers of the nail plate – varnishes do not penetrate deep into the tissue. Therefore, it is highly likely that in a few days the fungus will be visible again, and the nails will have to be “tinted” constantly.Against a fungal infection of the skin, varnishes, of course, cannot be used. In this case, it is worth giving preference to special creams that are aimed at fighting the fungus. By the way, most antifungal creams act not only on the cause, but also relieve the symptoms of infection – inflammation, itching, burning, and so on.

According to experts, solutions are best for treating fungal infections on the nails of the hands and feet. Unlike varnishes, their components get into all layers of the plate and destroy the fungus.In addition, some solutions help to avoid relapses of the disease, of course, if you do not stop using them after the first improvements. You can also use solutions in combination with ointments. Even if the fungus is localized only on the nails, this will be a good prevention to prevent pathogenic microorganisms from spreading to the skin. In the case of a fungal infection of the skin and nails, complex treatment is absolutely necessary.

Of course, the manifestation of a fungal infection is not the most pleasant event in a person’s life.As we already said, there are still enough prejudices around the fungus, and many people are embarrassed to admit such a problem even to the closest people. Of course, this is a personal matter for everyone, but the relatives of the sick person who live with him in the same apartment must know about this. Why – no need to explain. But if we ignore emotions, the fungal infection is not so terrible and passes rather quickly – the main thing is to choose the right drug.

Skin infections – ProMedicine Ufa

Skin infections are divided into bacterial, viral, fungal and parasitic.These include diseases such as: scabies, warts, herpes, fungal diseases, lichens, etc.

The pathogen alone is not enough for the development of the disease. For its vigorous activity and reproduction, certain conditions are necessary, for example, a weakening of the immune system. If a person has a strong immune system, the disease may not exist.

Reasons

Infection is one of the leading causes of skin diseases. The infection multiplies, causing an inflammatory response.In addition, any infection releases toxins into the body, which disrupt the work of the filter organs. The toxins released by infections are the primary and aggressive allergens. The presence of infections in the body significantly increases the allergic component. The organs responsible for detoxification (liver, kidneys, lymphatic system), with a huge amount of toxins, will cease to cope with their work, to fully perform their functions. In fact, skin diseases are a pathological pathway for the percutaneous elimination of toxins from the body.

Types of skin infections and their symptoms

Scabies – a characteristic symptom is itching at night, which prevents sleep and is very annoying. Scabies can also be recognized by small itchy pimples and a gray line extending from them – this is the course of a tick.

Warts. In fact, they are a benign tumor caused by the human papillomavirus (HPV). Warts are of several types: common, genital warts, plantar warts, flat and senile warts.This disease is very common. It is a skin growth, usually small. Although sometimes they can merge and grow to an impressive size.

Herpes. In this case, we are talking about herpes type 1. There are also other types of herpes viruses, but they no longer belong to skin diseases, but rather affect the internal organs.

So, the herpes simplex virus type 1 (or herpes simplex virus) is an infection that lives in almost all of us.According to statistics, 9 out of 10 people on earth are infected with herpes. First symptoms: small sores can be seen on the lips or near the nose. In the first hours, the skin begins to swell and aches a little, causing discomfort. Symptoms of an exacerbated herpes virus, in addition to skin manifestations, may resemble a common cold – weakness, fever, etc.

Fungal diseases. Fungi, which, getting on the skin, hair and nails of a person, cause their change, a huge number. You can become infected with a fungal infection, like other skin diseases, upon contact with a carrier (including animals), when using general hygiene items, shoes, as well as in saunas and swimming pools, that is, where it is warm and damp, especially if there are mechanical damage to the skin.

Symptoms of fungal diseases can be: itching, burning, redness, peeling, oozing, cracking, flaking of scales, the formation of round plaques with a flaky raised rim, a change in the color and texture of the nail, the appearance of clearly defined foci on the hairy surface of the skin, in which hair becomes dull, brittle and eventually fall out, the appearance of black spots, severe seborrhea or dandruff.

Lishai. These are diseases that can also be caused by viral microorganisms and fungi.Infectious varieties include ringworm, pink, multicolored (or pityriasis). A common symptom of these diseases is a rash in the form of scaly, discolored plaques of very different sizes that cause itching.

Erythema multiforme exudative. Infectious disease with an acute course. The seasonal form develops more often in spring or autumn. It is caused by an infection against the background of colds.

Toxicoallergic form occurs due to intoxication of the body with medications or after vaccination (more often in children).

Both forms are characterized by skin rashes in the form of pinkish spots or slightly raised papules. In their middle, vesicles filled with serous and sometimes bloody contents may appear. The disease is also accompanied by general malaise, fever. Pain in the throat and joints is often felt.

Ostiofolliculitis or staphylococcal impetigo. The causative agent is more often Staphylococcus aureus. The main cause of the disease is violation of hygiene rules, excessive sweating.It is characterized by the appearance on the skin of small semicircular rashes filled with purulent contents. Their size is about the size of a pinhead. There is a hair in the center of the abscess.

Accompanied by painful sensations in the area of ​​dislocation of the rash. In the absence of adequate treatment, the infection can spread deep into the epidermis, provoking the development of folliculitis, the appearance of boils.

Pyoderma. A wide group of pustular diseases caused by bacteria: streptococci, staphylococci and pathogenic fungi.
The main symptom is follicles appearing mainly on the face, back, chest, armpits and scalp. If you do not seek help from a doctor in a timely manner, there is a high risk of developing sepsis, a life-threatening condition.
Actinomycosis. Bacterial skin disease with a chronic course.
The main symptom is the appearance of a dense, lumpy neoplasm (infiltrate) under the skin, which consists of several nodules fused together. The skin in this area acquires a bluish-reddish tint.With the development of the disease, the infiltrate breaks through, forming fistulas from which purulent contents are released.

Thrush or yeast stomatitis – often diagnosed in newborns or debilitated children. It is characterized by the appearance of a white film (plaque) on the oral mucosa.

Diagnostics

In the diagnosis of skin diseases, it is especially important to detect hidden infections that prevent the immune system from functioning normally. The condition of internal organs is also assessed, the malfunction of which can cause skin diseases.

Therefore, an examination for skin diseases consists of a carefully verified list of tests and examinations by doctors of other specializations (for example, a cosmetologist-dermatologist), which are designed not only to detect skin diseases (often this can be done with the naked eye), but to identify the true causes of all available in the body of disorders. With such a systematic approach, the treatment carried out is enough to save the patient from skin disease for a long time, and often for a lifetime.

Treatment

Therapy of infectious diseases is carried out in a complex manner.Conventionally, all treatment is divided into several stages, which depend on the established diagnosis and the individual characteristics of the organism of each patient.

Various methods of treatment are used: medications, including antibiotics of different groups. They also use homeopathic remedies, phyto and physiotherapy methods. In certain cases, cryotherapy procedures are effective. Depending on the disease, ultraviolet blood irradiation may be necessary. In addition, drugs are prescribed that improve the functioning of internal organs, strengthen the immune system.

For external use use certain ointments, gels, talkers and creams. As an additional treatment, effective folk remedies are used.

Treatment is usually carried out on an outpatient basis, although in especially severe cases, the patient is shown referral to a hospital.

90,000 Infectious diseases: types, features, treatment, prevention

Viral infections occur due to infection with a virus. There may be millions of different viruses in the world, but to date, researchers have identified only about 5,000 types.Viruses contain a small piece of genetic code enclosed in a coat of proteins and lipid (fat) molecules that protects them.

Viruses invade the host’s body and attach to the cell. When they enter a cell, viruses release their genetic material. This material causes the cell to multiply, and new viruses multiply with it. When a cell dies, it releases new viruses that infect all new neighboring cells. However, not all viruses destroy host cells.Some of them change the function of the cell. Certain viruses, such as human papillomavirus (HPV) and Epstein-Barr virus (EBV), can lead to cancer by causing cells to replicate in an uncontrolled manner.

The virus can also target certain age groups such as infants or young children. Viruses can remain inactive for a period before multiplying again. A person with the virus may appear to have fully recovered, but they may get sick again when the virus activates.

Viral infections include:

• colds (ARVI), which mainly arise from rhinovirus, coronavirus and adenovirus;

• encephalitis and meningitis due to infection with enteroviruses and herpes simplex virus (HSV) and West Nile virus;

• warts and skin infections caused by HPV and HSV;

• gastroenteritis caused by norovirus and rotavirus;

• COVID-19, a respiratory disease that develops after a new coronavirus infection and is currently causing a global pandemic.

Other viral diseases include:

• Zika virus;
• HIV;
• hepatitis C and partly B, delta;
• poliomyelitis;
• influenza, including h2N1 swine flu;
• dengue fever
• Ebola;
• Middle East Respiratory Syndrome (MERS-CoV).

Diseases caused by fungi – a directory of diseases – HealthInfo

Mushrooms are one of the kingdoms of living nature, numbering more than 100 thousand species.Among them are edible mushrooms, yeast, molds. There are many disease-causing fungi (in everyday life they are usually called fungi, which is incorrect), which are caused from the Greek. the word mykes is a human disease. Such diseases are called mycoses (from the Greek word mykes – mushroom).

Mushrooms include molds and the actual mushrooms. The spores of many fungi are found everywhere. They are often in the air. Spores that enter the skin or lungs can cause minor infections that only rarely spread to other organs.Several varieties of fungi, such as Candida strains, can normally live on various surfaces of the body and in the intestines. They sometimes cause local infections of the skin, vagina, or mouth, rarely causing much harm. But some strains of fungi can cause severe diseases of the lungs, liver and other organs.

The development of severe fungal infections more often occurs in AIDS patients or those receiving treatment for cancer. Sometimes people with compromised immune systems develop infections with fungal species, which are extremely rare in people with normal immune systems.Such infections include mucromycosis and aspergillosis.

Certain fungal infections are more common in certain geographic areas. Blastomycosis is found only in North America and Africa.

Most fungal infections develop slowly and it may take months or years before a person realizes the need to see a doctor. Unfortunately, these infections are difficult to treat and take a long time.

There are many antifungal drugs available.

A therapy that suppresses the immune system, contributing to the development of fungal infections:

• Antineoplastic agents (chemotherapy).
• Corticosteroids and other immunosuppressants.

Diseases and conditions:

• AIDS
• Renal failure
• Diabetes mellitus
• Lung diseases, e.g. emphysema
• Hodgkin’s disease or other lymphomas
• Leukemia
• Extensive burns

Infectious diseases of the eye: prevention symptoms, treatment.What to choose: drops or ointment?

The cause of eye infections is harmful microorganisms – bacteria, fungi and viruses that enter the eyeball and surrounding tissues, including the outer transparent part of the eyeball (cornea) and the thin mucous membrane that lines the eyelid from the inside and passes on the eyeball (conjunctiva).

Symptoms of Eye Infections

The following common symptoms of eye infections are distinguished:

For the slightest suspicion of an eye infection, contact the optometrist for an eye exam .Self-diagnosis efforts can delay the initiation of effective treatment and potentially irreversible vision loss.

If you wear contact lenses , you must take them off and wear glasses until you go to see an ophthalmologist or physician for diagnosis and treatment.

There are many types of eye infections, so an optometrist or physician must first determine the type of eye infection in order to prescribe the necessary treatment.

A doctor may take a tissue sample from the affected area of ​​the eye to determine the presence and type of infection. This will help prescribe the most effective treatment, such as an antibiotic that kills the specific type of bacteria that caused the infection.

Types of Eye Infections

Examples of Viral, Fungal and Bacterial Eye Infections:

Conjunctivitis

Conjunctivitis is the most common acutely infectious eye infection often experienced by children in kindergartens, schools and similar.Teaching staff working directly with young children are also at high risk of contracting conjunctivitis.

The most common types of conjunctivitis are often viral or bacterial in origin. Babies can acquire infectious conjunctivitis (gonorrheal and chlamydial conjunctivitis) during birth if the mother has a sexually transmitted disease.

Other viral eye diseases (viral keratitis)

In addition to conjunctivitis, there are other viral eye diseases such as herpes simplex ophthalmic herpes.

Fungal keratitis

This type of eye infection became widely known to the world in 2006 when a contact lens solution (which is no longer in production) was associated with an outbreak of disease among contact lens wearers.

Fungal eye infection was caused by fungi of the genus Fusarium, found in organic matter. These and other fungi can enter the eyes in other ways, for example, due to injury from a tree branch.

Acanthamebic keratitis

Contact lens wearers are at increased risk of exposure to parasites that can enter the eye and cause serious eye infections. This infection is called acanthamoebic keratitis. Therefore, contact lens wearers must take precautions such as not swimming with contact lenses.

If you wear contact lenses while swimming or taking a hot bath, be sure to remove and disinfect the lenses immediately afterwards.

Contact lens wearers are at increased risk of fungal and bacterial eye infections, so proper contact lens care must be taken.

Trachoma

Trachoma is a serious eye infection caused by Chlamydia trachomatis , which is the leading cause of blindness in some geographic regions. The carriers of the pathogens are flies, and the cause is the low sanitary culture of the population.At the same time, the risk of re-infection is high.

Trachoma usually affects the inner eyelid, which begins to scar. Scarring leads to the formation of a “curl” of the eyelid, as a result of which the eyelashes begin to rub against the cornea and damage it, which leads to irreversible blindness. To treat and prevent trachoma, good personal hygiene must be followed, and medicines such as oral antibiotics must be made available.

Endophthalmitis

Endophthalmitis is a serious disease of the inner lining of the eye caused by bacteria.The most common cause of endophthalmitis is eye injury . It also occurs in rare cases as a complication after eye surgery such as cataract surgery .

To prevent severe vision loss or even blindness, endophthalmitis requires urgent treatment with strong antibiotics.

Complications from eye infections

Barley or chalazion may develop on the inner side of the upper and lower eyelids.You should not rub or “crush” the barley, otherwise it can lead to a more serious infection – orbital cellulitis.

Orbital cellulitis is an infection of the soft tissue surrounding the eyeball. This disease requires urgent treatment, otherwise it can cause blindness, meningitis, or even death.

Infection can lead to inflammation and obstruction of the lacrimal canals and, as a result, to dacryocystitis.

Infection can be the root cause of a corneal ulcer, which is an abscess on the surface of the eye.If left untreated, a corneal ulcer can lead to significant loss of vision.

Treating eye infections

Fortunately, most bacterial eye infections can be effectively treated with prescription antibiotic eye drops or ointments and compresses.

Many viral eye infections go away on their own. For severe viral eye infections, antiviral eye drops may be prescribed. Some viral eye infections require caution with steroid eye drops to reduce the accompanying inflammation.

Depending on the underlying cause of the eye infection, your doctor may prescribe oral antibiotics or antiviral drugs. If you see a worsening or change in symptoms, contact your optometrist or physician immediately.

How to prevent eye infections

Prevent eye infections by washing your hands before touching your eyes or eyelids and before using contact lenses.

If someone with red eyes is around you, do not touch your eyes until you have washed your hands thoroughly.

To minimize the chance of bacterial or viral eye infections, avoid rubbing your eyes, wash your hands frequently throughout the day (especially before putting on or removing contact lenses), wash towels and bedding frequently, and use antibacterial products to clean your work surfaces and other areas.

Page published in November 2020

Page updated June 2021

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