| Mycosis | |
|---|---|
| Other names | Mycoses,[1] fungal disease,[2] fungal infection[3] ICD-10CM codes: Mycoses B35-B49[4] |
 | |
| Micrograph showing a mycosis (aspergillosis). TheAspergillus (which isspaghetti-like) is seen in the center and surrounded byinflammatory cells andnecrotic debris.H&E stain. | |
| Specialty | Infectious Diseases[5] |
| Types | Systemic, superficial, subcutaneous[3] |
| Causes | Pathogenic fungus:dermatophytes,yeasts,molds[6][7] |
| Risk factors | Immunodeficiency, cancer treatment, large surface area wounds/burns,[8][9]organ transplant,[6]COVID-19,[10]tuberculosis |
| Diagnostic method | Based on symptoms,culture,microscopic examination[6] |
| Treatment | Antifungals[3] |
| Frequency | Common[11] |
| Deaths | 1.7 million (2020)[12] |
Fungal infection, also known asmycosis, isa disease caused byfungi.[5][13] Different types are traditionally divided according to the part of the body affected: superficial,subcutaneous, and systemic.[3][6] Superficial fungal infections include commontinea of the skin, such as tinea of thebody,groin,hands,feet andbeard, and yeast infections such aspityriasis versicolor.[7] Subcutaneous types includeeumycetoma andchromoblastomycosis, which generally affect tissues in and beneath the skin.[1][7] Systemic fungal infections are more serious and includecryptococcosis,histoplasmosis,pneumocystis pneumonia,aspergillosis andmucormycosis.[3] Signs and symptoms range widely.[3] There is usually a rash with superficial infection.[2] Fungal infection within the skin or under the skin may present with alump and skin changes.[3]Pneumonia-like symptoms ormeningitis may occur with a deeper or systemic infection.[2]
Fungi are everywhere, but only some cause disease.[13] Fungal infection occurs afterspores are eitherbreathed in, come into contact with skin or enter the body through the skin such as via acut,wound orinjection.[3] It is more likely to occur in people with aweak immune system.[14] This includes people with illnesses such asHIV/AIDS, and people taking medicines such assteroids orcancer treatments.[14]Fungi that cause infections in people includeyeasts,molds andfungi that are able to exist as both a mold and yeast.[3] The yeastCandida albicans can live in people without producing symptoms, and is able to cause both superficialmild candidiasis in healthy people, such asoral thrush orvaginal yeast infection, and severesystemic candidiasis in those who cannot fight infection themselves.[3]
Diagnosis is generally based on signs and symptoms,microscopy,culture, sometimes requiring abiopsy and the aid ofmedical imaging.[6] Some superficial fungal infections of the skin can appear similar to other skin conditions such aseczema andlichen planus.[7] Treatment is generally performed usingantifungal medicines, usually in the form of acream orby mouth or injection, depending on the specific infection and its extent.[15] Some requiresurgically cutting out infected tissue.[3]
Fungal infections have a world-wide distribution and are common, affecting more than one billion people every year.[11] An estimated 1.7 million deaths from fungal disease were reported in 2020.[12] Several, includingsporotrichosis,chromoblastomycosis andmycetoma areneglected.[16]
A wide range of fungal infections occur in other animals, and some can be transmitted from animals to people.[17]
Mycoses are traditionally divided intosuperficial, subcutaneous, or systemic, where infection is deep, more widespread and involving internal body organs.[3][11] They can affect thenails,vagina,skin andmouth.[18] Some types such asblastomycosis,cryptococcus,coccidioidomycosis andhistoplasmosis, affect people who live in or visit certain parts of the world.[18] Others such asaspergillosis,pneumocystis pneumonia,candidiasis,mucormycosis andtalaromycosis, tend to affect people who are unable to fight infection themselves.[18] Mycoses might not always conform strictly to the three divisions of superficial, subcutaneous and systemic.[3] Some superficial fungal infections can cause systemic infections in people who are immunocompromised.[3] Some subcutaneous fungal infections can invade into deeper structures, resulting in systemic disease.[3]Candida albicans can live in people without producing symptoms, and is able to cause bothmild candidiasis in healthy people and severeinvasive candidiasis in those whocannot fight infection themselves.[3][7]
Superficial mycoses includecandidiasis in healthy people, commontinea of the skin, such as tinea of thebody,groin,hands,feet andbeard, andmalassezia infections such aspityriasis versicolor.[3][7]
Subcutaneous fungal infections includesporotrichosis,chromoblastomycosis, andeumycetoma.[3]
Systemic fungal infections includehistoplasmosis,cryptococcosis,coccidioidomycosis,blastomycosis,mucormycosis,aspergillosis,pneumocystis pneumonia and systemic candidiasis.[3]
Systemic mycoses due to primary pathogens originate normally in thelungs and may spread to other organ systems. Organisms that cause systemic mycoses are inherentlyvirulent.[further explanation needed].[citation needed] Systemic mycoses due to opportunistic pathogens are infections of people with immune deficiencies who would otherwise not be infected. Examples of immunocompromised conditions includeAIDS, alteration of normal flora by antibiotics,immunosuppressive therapy, andmetastatic cancer. Examples of opportunistic mycoses includeCandidiasis,Cryptococcosis andAspergillosis.[citation needed]
Most common mild mycoses often present with a rash.[2] Infections within the skin or under the skin may present with alump and skin changes.[3] Less common deeper fungal infections may present with pneumonia like symptoms ormeningitis.[2]
Mycoses are caused by certainfungi;yeasts,molds and somefungi that can exist as both a mold and yeast.[3][6] They are everywhere and infection occurs after spores are eitherbreathed in, come into contact with skin or enter the body through the skin such as via a cut, wound or injection.[3]Candida albicans is the most common cause of fungal infection in people, particularly as oral or vaginal thrush, often following taking antibiotics.[3]
Fungal infections are more likely in people withweak immune systems.[14] This includes people with illnesses such as HIV/AIDS, and people taking medicines such assteroids orcancer treatments.[14] People withdiabetes also tend to develop fungal infections.[19] Very young and very old people, also, are groups at risk.[20]
Individuals being treated withantibiotics are at higher risk of fungal infections.[21]
Children whoseimmune systems are not functioning properly (such as children with cancer) are at risk of invasive fungal infections.[22]
During theCOVID-19 pandemic some fungal infections have been associated withCOVID-19.[10][23][24] Fungal infections can mimic COVID-19, occur at the same time as COVID-19 and more serious fungal infections cancomplicate COVID-19.[10] A fungal infection may occur afterantibiotics for a bacterial infection which has occurred following COVID-19.[25] The most common serious fungal infections in people with COVID-19 includeaspergillosis and invasivecandidiasis.[26] COVID-19–associatedmucormycosis is generally less common, but in 2021 was noted to be significantly more prevalent in India.[10][27]
Fungal infections occur after spores are eitherbreathed in, come into contact with skin or enter the body through a wound.[3]
Diagnosis is generally by signs and symptoms,microscopy,biopsy, culture and sometimes with the aid ofmedical imaging.[6]
Some tinea and candidiasis infections of the skin can appear similar toeczema andlichen planus.[7] Pityriasis versicolor can look like seborrheic dermatitis,pityriasis rosea,pityriasis alba andvitiligo.[7]
Some fungal infections such ascoccidioidomycosis,histoplasmosis, andblastomycosis can present withfever,cough, andshortness of breath, thereby resemblingCOVID-19.[28]
Keeping the skin clean and dry, as well as maintaining goodhygiene, will help larger topical mycoses. Because some fungal infections are contagious, it is important to wash hands after touching other people or animals. Sports clothing should also be washed after use.[clarification needed][citation needed]
Treatment depends on the type of fungal infection, and usually requirestopical orsystemicantifungal medicines.[15]Pneumocystosis that does not respond to anti-fungals is treated withco-trimoxazole.[29] Sometimes, infected tissue needs to besurgically cut away.[3]
Worldwide, every year fungal infections affect more than one billion people.[11] An estimated 1.6 million deaths from fungal disease were reported in 2017.[30] The figure has been rising, with an estimated 1.7 million deaths from fungal disease reported in 2020.[12] Fungal infections also constitute a significant cause ofillness and mortality in children.[31]
According to theGlobal Action Fund for Fungal Infections, every year there are over 10 million cases of fungal asthma, around 3 million cases of long-term aspergillosis of lungs, 1 million cases of blindness due tofungal keratitis, more than 200,000 cases of meningitis due to cryptococcus, 700,000 cases of invasive candidiasis, 500,000 cases of pneumocystosis of lungs, 250,000 cases of invasive aspergillosis, and 100,000 cases of histoplasmosis.[32]
In 500BC, an apparent account of ulcers in the mouth byHippocrates may have been thrush.[33] The Hungarian microscopist based in ParisDavid Gruby first reported that human disease could be caused by fungi in the early 1840s.[33]
During the2003 SARS outbreak, fungal infections were reported in 14.8–33% of people affected by SARS, and it was the cause of death in 25–73.7% of people with SARS.[34]
A wide range of fungal infections occur in other animals, and some can be transmitted from animals to people, such asMicrosporum canis from cats.[17]
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