Where do fungi live and how can they affect human health. What activities increase the risk of fungal infections. How do pets, medications, and medical conditions impact susceptibility to fungal diseases. Why are hospitalized patients and transplant recipients at higher risk for fungal infections. How can fungal pneumonia be differentiated from bacterial pneumonia.

The Ubiquitous Nature of Fungi and Their Impact on Human Health

Fungi are omnipresent microorganisms that inhabit a vast array of environments, from outdoor soil and plants to indoor surfaces and even the human body. While millions of fungal species exist, only a few hundred have the potential to cause illness in humans. Understanding the nature of these organisms and their potential health impacts is crucial for effective prevention and treatment of fungal infections.

Fungal infections can manifest in various forms, ranging from mild skin conditions to severe systemic diseases. Common skin infections, such as ringworm, are often mistaken for other dermatological issues due to their rash-like appearance. More serious fungal infections, particularly those affecting the lungs, can mimic symptoms of bacterial pneumonia or tuberculosis, leading to potential misdiagnosis and delayed treatment.

• Fungi can live in soil, plants, indoor surfaces, air, and on human skin
• Only a small fraction of fungal species can cause human illness
• Fungal infections range from mild skin conditions to life-threatening systemic diseases
• Misdiagnosis is common due to symptom similarity with other conditions

Geographical Distribution of Fungal Pathogens and Associated Risks

The prevalence of disease-causing fungi varies significantly across different regions. In the United States, certain fungal pathogens are more commonly found in specific geographical areas. For instance, the fungus responsible for Valley fever is predominantly found in the Southwest and parts of the Pacific Northwest. Similarly, histoplasmosis and blastomycosis are more prevalent in the eastern United States.

Understanding the geographical distribution of these pathogens is essential for assessing individual risk and implementing appropriate preventive measures. Travelers and residents of endemic areas should be particularly aware of the potential exposure to these region-specific fungal pathogens.

Key Fungal Pathogens and Their Geographical Distribution in the US

• Valley fever: Southwest and parts of the Pacific Northwest
• Histoplasmosis: Eastern United States
• Blastomycosis: Eastern United States

High-Risk Activities for Fungal Exposure

Certain activities can significantly increase the risk of exposure to harmful fungi. These microorganisms are often found in air, dust, and soil, making outdoor activities particularly risky. Digging, gardening, and cleaning chicken coops are examples of activities that can lead to inhalation of fungal spores. Additionally, cave exploration can expose individuals to unique fungal ecosystems.

Histoplasma, a particularly concerning fungal pathogen, thrives in soil enriched with bird or bat droppings. Individuals engaged in activities that involve contact with such environments should take extra precautions to minimize their risk of exposure.

Activities with Increased Risk of Fungal Exposure

1. Digging and gardening
2. Cleaning chicken coops
3. Cave exploration
4. Working with soil containing bird or bat droppings

The Role of Pets in Fungal Transmission

While pets bring joy and companionship, they can also be vectors for certain fungal infections. Ringworm, a common fungal skin infection, can be transmitted from pets to humans. Dog and cat owners should be aware of this risk and monitor their pets for signs of skin issues.

In South America, a specific fungal pathogen called Sporothrix brasiliensis has been associated with cat-to-human transmission. While this fungus is not currently prevalent in the United States, there is potential for its introduction. Pet owners should remain vigilant and consult with veterinarians if they suspect their animals may be ill.

Fungal Infections Transmissible from Pets to Humans

• Ringworm (common in both cats and dogs)
• Sporothrix brasiliensis (primarily from cats, currently in South America)

Antibiotics and Fungal Infections: Understanding the Connection

While antibiotics are essential for treating bacterial infections, they can inadvertently increase the risk of certain fungal infections. Women, in particular, may be more susceptible to vaginal yeast infections, also known as vulvovaginal candidiasis, following antibiotic treatment. This increased risk is due to the disruption of the normal balance of microorganisms in the body, allowing opportunistic fungi to proliferate.

Pregnant women and individuals with weakened immune systems are also at higher risk for developing genital candidiasis. It’s important to note that men can also experience genital candidiasis, although it is less common than in women.

Factors Increasing Risk of Genital Candidiasis

• Recent antibiotic use
• Pregnancy
• Weakened immune system

Immunosuppressive Medications and Fungal Infection Risk

Certain medications that affect the immune system can significantly increase an individual’s susceptibility to fungal infections. Steroids, biologics, and chemotherapy drugs are examples of treatments that can weaken the immune response, making it easier for opportunistic fungi to establish infections.

Patients undergoing these treatments should be aware of the increased risk and work closely with their healthcare providers to monitor for signs of fungal infections. In some cases, prophylactic antifungal medications may be prescribed to prevent infections in high-risk individuals.

Immunosuppressive Treatments Associated with Increased Fungal Infection Risk

• Steroids
• Biologics
• Chemotherapy

Cancer Treatments and Fungal Infection Susceptibility

Cancer treatments, particularly chemotherapy and radiation therapy, can significantly weaken the immune system, leaving patients more vulnerable to fungal infections. The immune suppression caused by these treatments can allow normally harmless fungi to become opportunistic pathogens.

Patients undergoing cancer treatment should be particularly vigilant about fungal infection symptoms and maintain open communication with their oncology team. Healthcare providers may implement preventive strategies or closely monitor for early signs of fungal infections in these high-risk patients.

Cancer Treatments Increasing Fungal Infection Risk

• Chemotherapy
• Radiation therapy

HIV and Fungal Infections: A Critical Concern

People living with HIV, especially those with CD4 counts below 200, face an increased risk of fungal infections. The compromised immune system in HIV patients can allow opportunistic fungi to cause severe infections that might not occur in individuals with healthy immune responses.

In the United States, two fungal infections commonly associated with HIV are oral candidiasis (thrush) and Pneumocystis pneumonia. On a global scale, cryptococcal meningitis and histoplasmosis are major causes of illness in HIV-positive individuals.

Common Fungal Infections in HIV Patients

• Oral candidiasis (thrush)
• Pneumocystis pneumonia
• Cryptococcal meningitis (globally significant)
• Histoplasmosis (globally significant)

Hospital-Acquired Fungal Infections: A Growing Concern

Hospital environments can pose unique risks for fungal infections. In the United States, one of the most common bloodstream infections acquired in hospitals is caused by Candida species. While Candida is a normal inhabitant of the gastrointestinal tract and skin, it can enter the bloodstream and cause serious infections, particularly in hospitalized patients with weakened immune systems or those undergoing invasive procedures.

Of particular concern is Candida auris, a species often resistant to multiple antifungal medications. This fungus has the ability to spread between patients in healthcare settings, making it a significant challenge for infection control in hospitals.

Key Points About Hospital-Acquired Fungal Infections

• Candida species are a leading cause of hospital-acquired bloodstream infections
• Candida auris is often resistant to multiple antifungal drugs
• Hospital environments can facilitate the spread of resistant fungal pathogens

Transplant Recipients and Fungal Infection Risk

Individuals who have recently undergone organ transplantation or stem cell transplantation are at a heightened risk for fungal infections. The immunosuppressive medications necessary to prevent organ rejection also weaken the body’s natural defenses against fungal pathogens.

To mitigate this risk, doctors often prescribe prophylactic antifungal medications to transplant recipients. This preventive approach aims to protect patients during the critical post-transplant period when they are most vulnerable to opportunistic infections.

Fungal Infection Prevention in Transplant Recipients

• Prophylactic antifungal medications
• Close monitoring for signs of fungal infection
• Patient education on infection prevention strategies

Distinguishing Fungal Pneumonia from Bacterial Infections

Fungal pneumonia can present with symptoms similar to bacterial pneumonia, leading to potential misdiagnosis and inappropriate treatment. Conditions such as Valley fever, histoplasmosis, and blastomycosis can mimic bacterial lung infections, but they do not respond to antibiotic treatment.

Early testing for fungal infections is crucial in cases where pneumonia symptoms do not improve with antibiotic therapy. Proper diagnosis allows for timely initiation of antifungal treatment and helps reduce unnecessary antibiotic use, which is essential in combating antimicrobial resistance.

Key Considerations in Diagnosing Fungal Pneumonia

• Persistent pneumonia symptoms despite antibiotic treatment
• History of exposure to endemic fungal pathogens
• Immunocompromised status of the patient
• Importance of early fungal testing in suspected cases

While anyone can potentially develop a fungal infection, certain factors significantly increase the risk. People with weakened immune systems, whether due to medical conditions or treatments, are particularly susceptible. However, it’s important to note that even healthy individuals can contract fungal infections under certain circumstances.

Fungal spores are ubiquitous in our environment, and people come into contact with them daily without necessarily becoming ill. The key to managing fungal infection risk lies in understanding individual risk factors, recognizing early symptoms, and seeking prompt medical attention when necessary.

For comprehensive information on the signs, symptoms, and treatment of fungal infections, as well as prevention tips, individuals are encouraged to visit the CDC’s fungal diseases website and consult with healthcare providers. Staying informed and vigilant is crucial in protecting oneself against these potentially serious infections.

Fungal Infections: Protect Your Health | Fungal Diseases

Here are 10 questions you can use to understand fungal infections and know what you need to do to stay healthy.

Fungi are everywhere. Sometimes, they are too small to see with the naked eye. Fungi can live outdoors in soil and on plants, indoors on surfaces and in the air, and on people’s skin and inside the body. There are millions of fungal species, but only a few hundred of them can make people sick.

Mild fungal skin infections can look like a rash and are very common. For example, ringworm is a skin infection caused by a fungus—not a worm. Fungal infections in the lungs can be more serious and often cause symptoms that are similar to other illnesses, such as bacterial pneumonia or tuberculosis. Finding the correct diagnosis can be difficult and cause delays in getting the right treatment. Fungal infections like meningitis and bloodstream infections are less common than skin and lung infections but can be life-threatening.

The more you know about fungal infections and your chances of getting one, the better you can protect your health.

Find Out If You’re At Risk Of Getting A Fungal Infection

1. Where do you live and travel? Fungi that can cause infections are more common in some parts of the United States and world. For example, in the United States, the fungus that causes Valley fever is found mainly in the Southwest and parts of the Pacific Northwest. Histoplasmosis and blastomycosis occur most often in the eastern United States.
2. What types of activities are you doing? Harmful fungi can be found in air, dust, and soil. You could inhale fungi during activities like digging, gardening, cleaning chicken coops, and visiting caves. Histoplasma grows especially well in soil that contains bird or bat droppings.
3. Do you have a dog or cat? People can get some fungal infections from their pets, including ringworm, which causes skin rashes. In South America, people can get infections from a fungus called Sporothrix brasiliensis from cats, and this fungus might arrive in the United States. If you think your pet might be sick, talk to your veterinarian.
4. Have you recently taken antibiotics? Antibiotics can make women more likely to get a vaginal yeast infection, also known as vulvovaginal candidiasis. Women who are pregnant or those who have weakened immune systems also are more likely to get this condition. Men also can get genital candidiasis.
5. Are you taking any medicine that affects your immune system? Medicine that weakens your immune system, like steroids, biologics, or chemotherapy, may increase the chance of getting a fungal infection.
6. Are you receiving chemotherapy or radiation treatments? Cancer treatment, such as chemotherapy and radiation, weakens your immune system. These treatments may increase the chance you will get a fungal infection.
7. Are you living with HIV? People living with HIV (particularly those with CD4 counts less than 200) may be more likely to get fungal infections. Two well-known fungal infections associated with HIV in the United States are oral candidiasis (thrush) and Pneumocystis pneumonia. Worldwide, cryptococcal meningitis and histoplasmosis are major causes of illness in people living with HIV.
8. Are you going to be hospitalized? In the United States, one of the most common bloodstream infections acquired in the hospital is caused by a fungus called Candida. Candida normally lives in the gastrointestinal tract and on skin without causing any problems, but it can enter the bloodstream and cause infection. A type of Candida called Candida auris is often resistant to antifungal medicines and can spread between patients in healthcare settings.
9. Have you recently had a transplant? People who recently had an organ transplant or a stem cell transplant have weakened immune systems. That means they have a greater chance of developing a fungal infection. Doctors prescribe antifungal medicine for some transplant patients to prevent fungal infections.
10. Do you have symptoms of pneumonia that are not getting better with antibiotics? Fungal infections, especially lung infections like Valley fever, histoplasmosis, and blastomycosis, can have similar symptoms as bacterial infections. However, antibiotics don’t work for fungal infections. Early testing for fungal infections reduces unnecessary antibiotic use and allows people to start treatment with antifungal medicine, if necessary.

Anyone can get a fungal infection, even people who are otherwise healthy. People breathe in or come in contact with fungal spores every day without getting sick. However, in people with weakened immune systems, these fungi are more likely to cause an infection. To learn more about the signs, symptoms, and treatment of fungal infections and get prevention tips, visit CDC’s fungal diseases website and talk with your healthcare provider.

Bacterial & Fungal Skin Infections in Dogs

Bacterial and fungal infections can have your dog feeling itchy, with skin that appears flaky, crusty or moist. Redness, inflammation and odor may also be a problem, not to mention recurring health concerns when it comes to yeast dermatitis or staph infection.

Skin problems are fairly common for dogs and can indicate underlying health issues. In this post, our Greensboro vets offer some advice about what to do if your dog’s licking, scratching or other symptoms of skin disease are making him – and you – uncomfortable.

Yeast Dermatitis

Also referred to as Malassezia dermatitis, yeast dermatitis is an extremely common cause of skin disease in dogs. Though the fungus Malassezia pachydermatis is normally found on the skin, if it grows excessively, it can lead to dermatitis (skin inflammation).

Staphylococcal Infection (staph infection)

The most common bacterial skin infection that appears in dogs, staph infection is caused by the bacterium Staphylococcus sp. And is a zoonotic risk, which means dogs and humans can transmit the infection between each other, making good hygiene and early treatment a high priority.

This type of infection may impact a dog’s skin or upper respiratory tract, and can be treated using oral antibiotics such as cephalexin, erythromycin or clindamycin. Antibiotic ointments and shampoos can also work.

Symptoms of Fungal & Bacterial Skin Infection in Dogs

Fungal Infection (Yeast Dermatitis)

The most common clinical signs of yeast dermatitis include:

• Thickened skin or “elephant skin”
• Flaky, crusty or scaly skin
• Redness and itchiness
• Musty odor
• Recurrent or chronic ear infections (otitis externa)
• Hyperpigmentation

Staph Infection

The most common clinical signs of staph infection are:

• Excessive itching, licking or chewing
• Eye, ears, skin or respiratory system infections
• Patchy fur with peeling, crusty skin, or moist skin
• Inflamed or red skin
• Pain
• Pus-filled lesions on the skin

Causes of Bacterial & Fungal Skin Infections in Dogs

Many bacteria and fungi live on the skin but are controlled by the immune system and do not cause issues under normal circumstances. But, if skin conditions change or the immune system becomes suppressed, bacterial and fungal infections can result.

Immune deficiencies or an increase in the amount of oils produced on the skin are common causes of yeast infections. While yeast infections are not contagious, they will often recur unless the underlying skin condition or allergy is addressed.

Certain breeds may be genetically predisposed to yeast infections, such as the Lhasa Apso, Poodle, Dachshund, Shetland Sheepdog, West Highland White Terrier, Maltese Terrier, Cocker Spaniel, Basset hound, Australian Terrier, Silky Terrier, and Chihuahua.

When it comes to staph infections, skin can become irritated when a dog excessively scratches, chews or licks. If your dog has an allergy to medications, food or environmental factors, or fleas, you may start to notice these behaviors.

Some chronic debilitating diseases, allergies, fungal infections of the blood and other secondary infections may cause staph infections. Any age or breed of dog can be afflicted, but older dogs are more susceptible due to their weakened immune systems.

Diagnosis of Fungal Dermatitis & Bacterial Skin Infections in Dogs

Our vets at Guilford-Jamestown Animal Hospital are trained in dermatological veterinary medicine. We treat a wide variety of skin, eye, ear, and nail conditions in pets. We use several techniques to collect samples and diagnose yeast dermatitis, including:

• Impression smear
• Skin biopsy
• Skin scraping
• Acetate tape preparations
• Cotton swab sample

For a staph infection, your pet will need a complete physical examination, and your veterinarian may perform a complete blood count, biochemistry profile, and urinalysis, in addition to thoroughly reviewing your pet’s medical history and asking questions such as when you began to notice symptoms.

Skin tests may also be done to find out whether the inflammation is caused by immune-related issues or an allergic reaction. A skin biopsy may be required, during which your veterinarian will swab the skin to determine which antibiotic should be used to treat the condition.

At our in-house lab, we can perform tests and get results quickly with our advanced imaging and testing equipment.

Treatment of Fungal Dermatitis & Staph Infection in Dogs

Yeast dermatitis infections can be treated with oral or topical treatments, or a combination of both based on the severity of your dog’s condition. These medications are highly effective, though they must be given for a prolonged period (often several months).

These drugs can have potential side effects on the liver that will require close monitoring with routine blood tests.

Staph infections are typically treated with oral antibiotics. Antibacterial shampoo or topical ointments can be used for these types of skin conditions. Depending on the severity of the infection, treatment may take several weeks to have an effect.

Because staph infections can be passed between dogs and from dogs to humans, extra care should be taken when handling and treating your dog.

Discuss any supplements or medications your dog is currently taking with your veterinarian so he or she can choose the best treatment for your pet’s individual circumstances while helping to reduce the risk of a potential interaction between drugs.

Note: The advice provided in this post is intended for informational purposes and does not constitute medical advice regarding pets. For an accurate diagnosis of your pet’s condition, please make an appointment with your vet.

Is your dog showing signs of a bacterial or fungal skin infection? Contact our Greensboro vets right away to schedule an appointment for testing. Our vets are experienced in diagnosing a number of conditions and illnesses.

How to identify skin fungus | Directory of medical laboratory Optimum (Sochi, Adler)

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Skin fungus is a pathology that may be accompanied by the appearance of abscesses, severe peeling. It is also characterized by irritation of the epidermis.

Causes of development

A room in which elementary cleanliness is not maintained can become a favorable environment for the reproduction of pathogenic microorganisms. The likelihood of skin fungus increases under the influence of the following factors:

• prolonged fasting;
• severe fatigue;
• chronic pathologies of the nervous system;
• long-term use of antibiotics;
• excessive sweating;
• presence of helminthic infestation;
• unfavorable ecological situation in the region;
• administration of chemotherapy.

Symptoms of fungus

In the presence of skin fungus , the following symptoms may occur:

• burning sensation;
• intense itching;
• feeling of peeling;
• dandruff and excessive dryness of the hair (in case of scalp involvement).

Diagnostic methods

When the first symptoms of diseases appear, it is recommended to visit a dermatologist’s office. In some cases, the patient needs to consult an endocrinologist or an infectious disease specialist. A complete diagnosis of the disease helps to determine the methods of treatment of the disease. According to the signs, the skin fungus is similar to polymorphic photodermatosis, nummular eczema.

The main diagnostic measures include:

• visual examination of the patient;
• performing a biochemical blood test;
• performing an iodine test;
• Wood’s lamp application.

Visual inspection reveals the extent of the lesion. The specialist determines which areas of the skin are affected by the fungus.

To detect mycoses that affect the skin, enzyme immunoassay . Such a diagnostic procedure is performed when it is impossible to take a tissue biopsy for further study. This technique is based on the search for antibody titer to a particular type of fungal disease.

The Wood lamp uses a special ultraviolet light spectrum to perform an examination. Luminescence allows you to detect a fungal infection of the skin.

Treatment

Treatment of skin fungus involves:

• the use of drugs from the group of glucocorticosteroids;
• use of systemic drugs whose active ingredients are fluconazole or ketoconazole;
• use of drugs belonging to the group of immunomodulators;
• conducting physiotherapy sessions;
• use of drugs with antibacterial effect;
• taking multivitamin complexes.

In the presence of skin fungus , various ointments are used. Preparations made on the basis of undecylenic acid are distinguished by pronounced antiseptic and fungistatic properties.

Broad-spectrum drugs made in the form of tablets help fight even advanced forms of the disease. The maximum course duration is 2 months.

symptoms and varieties – Medical laboratory IMD

Fungus (mycosis) of the skin – a group of diseases that affect the skin and its appendages (sweat and sebaceous glands, hair and nails) with a fungal infection. The fungus is common among all age groups and can appear anywhere on the body.

Micro fungi are live microorganisms that are widely distributed in the environment and in the human body (skin, mucous membrane, mouth, intestines and genitals). In most cases, they coexist in harmony with the local bacterial flora, preventing its overgrowth. But when conditions change (increase in temperature and humidity, lack or excessive hygiene), a decrease in the protective functions of the body, the balance is disturbed, and the fungi move from the category of “opportunistic” to “pathogenic”, affecting the skin and its appendages.

Skin fungus: symptoms and types

There are various forms of skin mycosis depending on the affected part of the skin: smooth skin, skin folds, mucous membranes, nails and hair.

Pityriasis multicolor ( Pityriasis versicolor ) is a skin disease from the group of keratomycosis. The causative agents of multi-colored lichen are yeast fungi of the genus Malassezia .

The fungus often affects children and adolescents. Pitiriasis is characterized by the appearance of spots on the trunk, neck and shoulders pink , lighter than healthy skin. These spots are especially noticeable in summer, because they are devoid of melanin. On very white skin, the patches are often slightly darker (pink or light brown) than normal skin. Lichen versicolor is benign and is not considered contagious.

Mycosis of the “large folds” or inguinal dermatophytosis is located in the folds of the groin, between the buttocks, under the armpits, under the breasts in women.

Signs of skin fungus in the crease area include:

• pink spots in the form of a ring with clear boundaries and slight peeling in the area of ​​the folds;
• symmetrical arrangement of spots;
• the presence of an edematous roller along the periphery;
• blistering, weeping, erosion and cracking;
• constant itching, burning, soreness. In women, dermatophytosis of the folds is more common under the breasts, in men – in the groin area.

Foot fungus, also known as Athlete’s foot “, is the most common fungal infection in adolescents and adults, but is much less common in young children. The infection is caused by dermatophyte fungi. The infection appears between the toes and, as a rule, begins with 4-5 toes, and can spread to the sole or even the back of the foot.

The disease is often accompanied by a fungal infection of the nails (onychomycosis), which must be treated at the same time. “Athlete’s foot” is characterized by the appearance of hyperemic areas between the toes, on the back of the foot, as well as cracks in the interdigital spaces. These lesions cause severe itching and pain.
The fungus of the skin of the hands is identical to the fungal infection of the feet, but is less common and mainly affects professions for which it is necessary to frequently use rubber gloves for a long time.

Candidiasis is an infectious disease of the skin, mucous membranes and internal organs caused by fungi of the genus Candida .
Mycosis affects the mucous membranes of the mouth, esophagus and vagina, as well as the tongue and the inside of the cheeks. The disease is common in all age groups, but more often affects children or people who have been treated with antibiotics, in the people these symptoms are called “ thrush “. Candidiasis is manifested by milky white spots on the tongue, inside the cheeks, on the gums and on the palate, as well as painful cracks in the corners of the mouth.

On the skin, the fungus manifests itself as rashes in the form of vesicles with erosive areas of crimson color and excruciating itching.

Ways of skin fungus infection

Today we know that there is a genetic susceptibility to chronic or recurrent forms

People with diabetes or immunodeficiency conditions are more susceptible to infection. 0003

Some medications can also trigger fungal infections, such as antibiotics and corticosteroids.

It should be remembered that during pregnancy and the first months of life, the skin is very vulnerable to fungal infections.

The main environmental factors that contribute to the development of fungal infections of the skin include damp heat and excessive sweating, wearing closed shoes made of non-natural materials, or frequent use of rubber gloves.

Of course, extreme care must be taken when coming into direct contact with potentially infectious surfaces or objects, such as gym floors, showers or swimming pools, hotel carpets, wooden counters, saunas. In this case, the risk of infection with the fungus will be quite high.

Fungus on the skin: laboratory diagnosis

Diagnosis is made by a dermatologist on the basis of

1) examination of the patient:

• – the presence of clinical manifestations,
• – examination of the affected area under a Wood’s fluorescent lamp, with a characteristic yellow or brown glow,
• – samples with iodine.

2) based on the results of laboratory diagnostics:

• – microscopic examination: detection of the pathogen in a skin scraping under a light and fluorescent microscope. Fluorescent microscopy excludes artifacts and therefore false positive results.
• – cultural studies (inoculation): identification of the type of pathogen and selection of an effective antifungal agent.

In our laboratory you can be tested for skin fungus to confirm the diagnosis.

Skin fungus: treatment and prevention

Treatment of skin fungus depends on the type of pathogen and the prevalence of the process. In mild cases, external antimycotic agents are used in the form of a cream, spray or ointment.

If external therapy is ineffective, systemic antimycotics are prescribed: itraconazole 200 mg per day for 7 days, then 100 mg for 1-2 weeks; terbinafine 250 mg once a day daily for 3-4 weeks or fluconazole 150 mg once a week for at least 4 weeks.