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Fungus Infections - Fungal Overload?

Digestion, Skin Conditions, Immune | February 17, 2015 | Author: The Super Pharmacist

Immune, Skin conditions, AIDS

Fungus Infections - Fungal Overload?

A fungus is neither a plant nor an animal. Fungi like mushrooms may look like plants, but fungi are definitely unique. In fact, in many ways, fungi are more like animals than they are like plants. For one thing, fungi have to get their food from other organisms. They cannot make their own through photosynthesis as plants do. They get their food by absorbing nutrients from their surroundings. The great majority of fungi obtain their food from dead organic matter in the soil and are known as saprophytes; a relatively small percentage derive their food from other living organisms and are known as parasites. Fungi may be unicellular (yeasts) or multicellular (mushrooms). There are over 100,000 species of described fungi and probably over 200,000 undescribed.

Beneficial Uses of Fungi

In the various fields of agriculture, medicine, environmental biology, biotechnology, research and development, fungi provide novel and important products and applications.

Agriculture

One of the primary roles of fungi in an ecosystem is to decompose organic compounds. Petroleum products and some pesticides are organic molecules, and thereby serve as potential carbon sources for fungi. Fungi can eradicate such pollutants from the environment. Fungi are also used in agriculture for pest control and to protect crops from diseases.

Beneficial Uses of FungiFungi as a food or use in food preparation

Fungi have long been used as a direct source of food. Many types of mushrooms and other fungi are eaten, including button mushrooms, shiitake mushrooms, and oyster mushrooms. A type of single-celled fungus called yeast is used in baking bread and fermenting alcoholic beverages. Fungi are used to make Shoyu (soy sauce) and tempeh.

Medicinal uses

Many important pharmaceuticals are made from fungi.

Statins: The most effective cholesterol lowering agents available today are called statins, and these are produced by fungi. The group of statins derived via fermentation include: lovastatin (first isolated from Aspergillus terreus and the first statin approved by the FDA in 1987), pravastatin (from Nocardia autotrophica), and mevastatin (from the fungi, Hypomyces, Paecilomyces, and Trichoderma, and a fermentation product of Penicillium citrinum).

Ergot alkaloids: Ergot alkaloids - produced by the fungus, Claviceps purpurea, a grain (rye, especially) fungus are used in the treatment of migraine.

Antibiotics: Many types of antibiotics come from fungi. These include penicillin (Penicillium chrysogenum) and cephalosporin (Acremonium, formerly, Cephalosporium). Both penicillin and caephalosporins are used to treat bacterial infections. Griseofulvin is an antibiotic produced by the fungus, Penicillium griseofulvum, used to treat fungal skin infections such as jock itch, athlete's foot, ringworm, and fungal infections of the scalp, finger and toe nails.

Anti-tumour agents: Antitumor antibiotics are made from natural products produced by species of the soil fungus Streptomyces. There are several types of antitumor antibiotics:

  • Anthracyclines: Doxorubicin, Daunomycin, Mitoxantrone, and Idarubicin
  • Chromomycins: Dactinomycin and Plicamycin
  • Miscellaneous: Mitomycin and Bleomycin

Chemotherapy: Antibacterial chemotherapy uses fungi. Lentilan, a drug used in cancer treatment, is sourced from the shiitake mushroom.

Immunosuppressants: Cyclosporin is a medication that transplant patients take to suppress their immune system. It is produced by the fungus Beauveria nivea and significantly lowers the risk of transplanted organ rejection.

Fungi used in industry

FFungi used in industryungi are used extensively in the food industry. For example, various cheeses are inoculated  with Penicillium roquefortii to impart a strong and pungent flavor in the resultant cheeses (eg, Roquefort, Gorgonzola, Stilton Blue and Danish Blue). Citric acid is a main ingredient in most sodas and soft drinks. It is also used in making candies, canned goods, and baked goods. It is too expensive to isolate the citric acid from citrus fruits so it is produced in large-scale fermentation vats utilising Aspergillus niger.

Fungi are able to break down plant cell walls by the production of a wide variety of enzymes. The pulp and paper industry benefits from the enzyme production capabilities of certain fungi to soften wood fibers and provide alternatives to chemical bleaching. The textile industry benefits from enzyme production by fungi to treat and modify textile fibers. Stonewashed jeans are produced by placing the denim fabric in a large vat containing the fungus Trichoderma, which produces enzymes (cellulases) that partially digest the cotton fibers of the jeans to add softness and produce the stonewashed look. Enzymes are a sustainable alternative to the use of harsh chemicals in industry. Enzymes are both economically and environmentally beneficial because they are safely inactivated and create little or no waste; rather than being discarded, end-product enzymatic material may be treated and used as fertilizer.

Pathogenic Fungi and Fungus Infections

Of approximately 1.5 million different species of fungi on earth, about 300 of those are known to cause human illness. Mycosis is any disease caused by a fungus, normally fungus infections. Fungi that cause diseases are called pathogenic fungi. Mycoses can be divided into four broad groups; these groups are classified according to how deeply the fungus penetrates into the body:

Superficial mycosis

This type of fungal infection only affects the surface of the skin and does not penetrate. This may include various types of ringworm (tinea), including athlete's foot, scalp ringworm, and body (skin) ringworm.

Athlete’s foot

Athlete's foot (tinea pedis) is the most common type of tinea fungal infection. The fungus thrives in warm, moist areas. Athlete's foot is easily spread. It can be contracted in many locations, including gyms, locker rooms, swimming pools, nail salons, and from contaminated socks and clothing. The fungi can also be spread directly from person to person by contact. Most people acquire fungus on the feet from walking barefoot in areas where someone else with athlete's foot has walked. 

Treatment: Over-the-counter antifungal powders or creams can help control the infection (miconazole, clotrimazole, terbinafine, tolnaftate). In addition, it is important to keep the feet clean and dry, wear clean cotton socks, wear shoes that are well-ventilated, and wear sandals or flip-flops at public showers or pools.

Candidiasis

Candida albicans is a yeast that causes candidiasis. Candida yeasts normally live on the skin and mucous membranes without causing infection; however, overgrowth of these organisms can cause symptoms to develop. Genital/vulvovaginal candidiasis is commonly referred to as a “yeast infection.” It occurs when there is overgrowth of the normal yeast in the vagina. This infection is relatively common -- nearly 75% of all adult women have had at least one "yeast infection" in their lifetime. Symptoms include vulvar pruritis (itching), pain, swelling, redness. A thick, curdy vaginal discharge is common. Candida yeasts may multiply rapidly, especially if the person is ill or has a weakened immune system. Taking antibiotics may sometimes result in rapid reproduction of Candida albicans

Treatment: Short-course topical formulations (i.e. single dose or regimens of 1–6 days) effectively treat uncomplicated vulvovaginal candidiasis. The topically applied azole drugs are more effective than nystatin. Over-the-counter intravaginal agents include: butoconazole, clotrimazole, and tioconazole. Wearing cotton underwear may help to reduce the risk of developing a yeast infection.

Jock itch (Tinea cruris)

Jock itch is commonly seen in boys and men whose anatomy allows for a warm, moist environment which is ideal for fungal growth:

  • Often itchy and occurs in the groin creases (the scrotum is rarely affected), although it may spread to the upper inner thigh, buttocks and sometimes the lower abdomen.
  • Shows as a red-brown scaly rash, sometimes with small blisters or pustules at the edge.
  • At times the skin may show a thickened appearance (lichenification) from rubbing and chronic scratching.

Treatment: Mild fungal jock itch may be treated by washing the groin twice daily with an antifungal shampoo like ketoconazole or selenium sulfide (Selsun Blue shampoo). Moderate fungal jock itch is often treated by a combination of washing the groin twice daily with an antifungal shampoo like ketoconazole or selenium sulfide; using a topical antifungal cream like miconazole, clotrimazole, or terbinafine. Severe fungal jock itch is typically treated by a combination of washing groin twice daily with an antifungal shampoo like ketoconazole or selenium sulfide; using a topical antifungal cream like miconazole, clotrimazole, or terbinafine; and taking an antifungal pill like fluconazole, itraconazole, or terbinafine.

Nail fungus

Nail fungus is also called onychomycosis or tinea unguium. Nail fungus occurs more often in toenails than in fingernails, partly because toenails often are confined in a dark, warm, moist environment — inside shoes — where fungi can thrive. Toes usually have less blood flow than do fingers, making it harder for your body's immune system to detect and stop a fungal nail infection. Infected nails appear thickened, brittle, crumbly or ragged, distorted in shape, and dull with no shine. 

Treatment: Over-the-counter creams and ointments generally do not help in treating this condition. Studies show the most effective treatments are terbinafine and itraconazole. These drugs require a prescription and must be taken orally for 2 to 3 months to clear fungal toenail infections. Alternative topical treatments applied directly to the affected nail require extended treatment of approximately 8-14 months with inconsistent results.

Tinea versicolor

Tinea versicolor is a fungus infection that commonly affects the skin of young people, especially the chest, back, and upper arms and legs. Tinea versicolor is caused by a fungus that lives in the skin of some adults. It does not usually affect the face. This fungus produces spots that are either lighter than the skin or a reddish-brown.

Treatment: Topical antifungal medications are the treatment of choice for tinea versicolor. The following topical antifungal treatment regimens have been shown to produce a greater than 70% clinical response rate: Ketoconazole cream or shampoo, terbinafine solution, clotrimazole solution.

Subcutaneous mycosis

The fungi reach below the skin and infect subcutaneous (area just below the skin), connective and bone tissue. These infections are usually chronic (long-lasting) and often occur when the skin is pierced or wounded, allowing the fungi to enter, usually in the form of vegetable matter. These infections may be hard to treat and often require removal of damaged skin (debridement). Subcutaneous mycoses are much more common in the tropics.

Sporotrichosis

Sporotrichosis caused by Sporothrix schenckii is an example of subcutaneous mycosis. Sporotrichosis used to be common in Europe, but is very rare there today. It is more common in Australia, South Africa, and in the warmer regions of the Americas. Infection may occur as a result of an insect bite, a thorn prick or a scratch from any sharp object. Infection risk is higher among florists, farmers, gardeners and people who work with hay and moss. Outbreaks of sporotrichosis have been documented in the United States, Western Australia, and Brazil.

Treatment: Most cases of sporotrichosis only involve the skin and/or subcutaneous tissues and are non-life-threatening, but the infection requires treatment with prescription antifungal medication for several months. The most common treatment for this type of sporotrichosis is oral itraconazole for 3 to 6 months. Itraconazole may also be used to treat bone and joint infections, but treatment should continue for at least 12 months. For patients with severe disease, and/or an infection that has spread throughout the body, a lipid formulation of amphotericin B should be used.

Systemic mycosis

This is a fungal infection that may reach any part of the body, including the brain and heart, as well as the bloodstream. The fungi usually enter via the lungs, gastrointestinal tract or intravenously.

Aspergillosis

Aspergillosis is the name for a variety of systemic infections caused by Aspergillus fungi. If it is inhaled through the mouth or nose, the fungus can cause a mild allergic reaction or a more serious infection of the sinuses and lungs. The different types of aspergillosis can cause different symptoms. 

The symptoms of allergic bronchopulmonary aspergillosis (ABPA) are similar to asthma symptoms, including:

  • Wheezing
  • Shortness of breath
  • Cough
  • Fever (in rare cases)

Symptoms of allergic Aspergillus sinusitis include:

  • Stuffiness
  • Runny nose
  • Headache
  • Reduced ability to smell

Symptoms of an aspergilloma (“fungus ball”) include:

  • Cough
  • Coughing up blood
  • Shortness of breath

Symptoms of chronic pulmonary aspergillosis include:

  • Weight loss
  • Cough
  • Coughing up blood
  • Shortness of breath

Invasive aspergillosis usually occurs in people who are already sick from other medical conditions, so it can be difficult to know which symptoms are related to an Aspergillus infection. However, the symptoms of invasive aspergillosis in the lungs include:

  • Fever
  • Chest pain
  • Cough
  • Coughing up blood
  • Shortness of breath

Treatment: For allergic forms of aspergillosis such as allergic bronchopulmonary aspergillosis (ABPA or allergic Aspergillus sinusitis, the recommended treatment is itraconazole, a prescription antifungal medication. Corticosteroids may also be helpful. Invasive aspergillosis needs to be treated with prescription antifungal medication, usually voriconazole.

Blastomycosis

BlastomycosisBlastomycosis is a systemic infection caused by the Blastomyces dermatitidis fungus commonly found in soil in the southeastern, midwestern, and south-central United states. The disease's symptoms resemble those of the flu: joint and muscle pain, a cough that brings up sputum, fever, chills, and chest pain. If it progresses, it can lead to chronic pulmonary infection, causing permanent lung damage, or widespread disease that affects the bones, skin, and genital and urinary tracts.

Blastomycosis leads to death in about 5 percent of patients.

Treatment: For people with mild or moderate infections, itraconazole is commonly used. People with more severe infections may require more aggressive treatment with amphotericin B.

Cryptococcosis

Cryptococcosis is a systemic infection caused by the fungus Cryptococcus neofornans, usually found in soil or bird droppings. Typically, the fungus enters the body through the mouth or nostrils when someone inhales fungi spores, and symptoms of a lung infection, such as cough and chest pain, may develop. Although infection with Cryptococcus usually produces no symptoms or only mild symptoms (cough, shortness of breath, fever) in healthy people, the infection may spread in people who have weak immune systems. If it spreads to the central nervous system, it can cause a serious brain infection called cryptococcal meningitis. This is especially common among people with AIDS.

Treatment: People who have C. neoformans infection need to take prescription antifungal medication for at least 6 months, often longer. The type of treatment usually depends on the severity of the infection and the parts of the body that are affected.

  • For people who have asymptomatic infections (e.g., diagnosed via targeted screening) or mild-to-moderate pulmonary infections, the treatment is usually fluconazole.
  • For people who have severe lung infections or infections in the central nervous system (brain and spinal cord), the recommended initial treatment is amphotericin B in combination with flucytosine. After that, patients usually need to take fluconazole for an extended time to clear the infection.

Histoplasmosis

Histoplasmosis is usually a mild systemic infection caused by Histoplasma capsulatum. The fungus lives in the environment, particularly in soil that contains large amounts of bird or bat droppings. In the United States, Histoplasma mainly lives in the central and eastern states, especially areas around the Ohio and Mississippi River valleys. The fungus also lives in parts of Central and South America, Africa, Asia, and Australia. When the soil is disturbed, the fungal spores may be inhaled. Histoplasmosis can cause flu-like symptoms, including body aches, fever, and cough. Most people who become infected do not experience symptoms, but as with other fungal infections, people with weak immune systems are at risk for severe disease. In Latin America, histoplasmosis is one of the most common opportunistic infections among people with HIV/AIDS.

Treatment: For some people, the symptoms of histoplasmosis will go away without treatment. However, prescription antifungal medication is needed to treat severe histoplasmosis in the lungs, chronic histoplasmosis, and infections that have spread from the lungs to other parts of the body (disseminated histoplasmosis). Itraconazole is one type of antifungal medication that’s commonly used to treat histoplasmosis. Depending on the severity of the infection and the person’s immune status, the course of treatment can range from 3 months to 1 year.

Pneumocystis pneumonia (PCP)

PCP is a serious illness caused by the fungus Pneumocystis jirovecii. Symptoms include fever, dry cough, shortness of breath, and fatigue. PCP is one of the most frequent and severe opportunistic infections in people with weakened immune systems, particularly people with HIV/AIDS. Although people with HIV/AIDS are less likely to get PCP today than in recent years, PCP is still a significant public health problem.

Treatment: PCP requires treatment with prescription medicine that must be taken for three weeks. The best form of treatment for PCP is trimethoprim sulfamethoxazole, which is also known by the brand names Bactrim, Septra, and Cotrim. This medicine is given orally or intravenously.

Coccydioidomycosis (Valley Fever)

Valley fever, also called coccidioidomycosis, is an infection caused by the fungus Coccidioides. The fungus is known to live in the soil in the southwestern United States and parts of Mexico and Central and South America. People can get valley fever by breathing in the microscopic fungal spores from the air. Most people (60%) who are exposed to the fungus Coccidioides never have symptoms. Other people may have flu-like symptoms (fatigue, cough, fever, night sweats, muscle aches) that go usually away on their own after weeks to months.

Treatment: For many people, the symptoms of valley fever will go away within a few months without any treatment.  Antifungal medication is typically given to people who are at higher risk for developing severe valley fever. The treatment is usually 3 to 6 months of fluconazole or another type of antifungal medication. Valley fever that develops into meningitis is fatal if not treated, so lifelong antifungal treatment is necessary for those cases.

How Common Are Fungal Diseases in Humans?

Reports of fungal infections are on the rise throughout the world. Some of these reports describe fungi not previously thought to be human pathogens (such as those that caused the outbreak of fungal meningitis), and some describe the emergence of known pathogens with new virulence mechanisms or appearance in new geographic areas. Why the increases and spread of fungal diseases? Many factors are likely to be contributing to the observed emergence and increase in fungal diseases, including:

  • Rising numbers of people at risk
  • Changes in land use and the environment, and the use of azole antifungal agents in agriculture
  • Increased seasonal migration and international travel
  • Changing patterns of weather, including extreme weather events and natural disasters
  • Increases in consumption of processed carbohydrates and alcohol
  • Increased use of antibiotics

Opportunistic infections

The rising numbers of people at risk for fungal disease is related to the increasing number of organ transplants being performed worldwide as well as to the rise in numbers of people afflicted with HIV/AIDS.

Successful organ transplants depend on powerful immunosuppressant drugs to prevent transplant rejection. A compromised immune system, however, presents an "opportunity" for a pathogen (disease-causing organism) to infect.

Infections that take advantage of weakness in host immune defences are called “opportunistic infections.”

Invasive fungal diseases are predominantly opportunistic infections. Although new HIV infections globally have declined by 38% since 2001, there were 35 million people living with HIV in 2013, up from 29.8 million in 2001, the result of continuing new infections, people living longer with HIV, and general population growth.

The human immunodeficiency virus (HIV) infects the cells of the immune system. In particular, HIV attacks and destroys the T helper lymphocytes, or T-cells, which are crucial to the immune system and immune response. (These cells are also called CD4-positive lymphocytes because HIV uses the protein CD4, present on the surface of the cell, to attach itself and pry its way into the cell.) The lower the CD4+ T-cell count, the more susceptible does the HIV/AIDS patient become to viruses and infections that an otherwise healthy body could fight and overcome. HIV/AIDS patients are extremely susceptible to opportunistic infections.

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