Fungal infection

Fungal infection, also known as mycosis, is a disease caused by fungi.^[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 common tinea of the skin, such as tinea of the body, groin, hands, feet and beard, and yeast infections such as pityriasis versicolor.^[7] Subcutaneous types include eumycetoma and chromoblastomycosis, which generally affect tissues in and beneath the skin.^[1][7] Systemic fungal infections are more serious and include cryptococcosis, histoplasmosis, pneumocystis pneumonia, aspergillosis and mucormycosis.^[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 a lump and skin changes.^[3] Pneumonia-like symptoms or meningitis may occur with a deeper or systemic infection.^[2]

Quick Facts Mycosis, Other names ...

Mycosis
Other names	Mycoses,[1] fungal disease,[2] fungal infection[3] ICD-10CM codes: Mycoses B35-B49 [4]
Micrograph showing a mycosis (aspergillosis). The Aspergillus (which is spaghetti-like) is seen in the center and surrounded by inflammatory cells and necrotic 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]

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Fungi are everywhere, but only some cause disease.^[13] Fungal infection occurs after spores are either breathed in, come into contact with skin or enter the body through the skin such as via a cut, wound or injection.^[3] It is more likely to occur in people with a weak immune system.^[14] This includes people with illnesses such as HIV/AIDS, and people taking medicines such as steroids or cancer treatments.^[14] Fungi that cause infections in people include yeasts, molds and fungi that are able to exist as both a mold and yeast.^[3] The yeast Candida albicans can live in people without producing symptoms, and is able to cause both superficial mild candidiasis in healthy people, such as oral thrush or vaginal yeast infection, and severe systemic candidiasis in those who cannot fight infection themselves.^[3]

Diagnosis is generally based on signs and symptoms, microscopy, culture, sometimes requiring a biopsy and the aid of medical imaging.^[6] Some superficial fungal infections of the skin can appear similar to other skin conditions such as eczema and lichen planus.^[7] Treatment is generally performed using antifungal medicines, usually in the form of a cream or by mouth or injection, depending on the specific infection and its extent.^[15] Some require surgically 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, including sporotrichosis, chromoblastomycosis and mycetoma are neglected.^[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 into superficial, subcutaneous, or systemic, where infection is deep, more widespread and involving internal body organs.^[3][11] They can affect the nails, vagina, skin and mouth.^[18] Some types such as blastomycosis, cryptococcus, coccidioidomycosis and histoplasmosis, affect people who live in or visit certain parts of the world.^[18] Others such as aspergillosis, pneumocystis pneumonia, candidiasis, mucormycosis and talaromycosis, 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 both mild candidiasis in healthy people and severe invasive candidiasis in those who cannot fight infection themselves.^[3][7]

Subcutaneous

Subcutaneous fungal infections include sporotrichosis, chromoblastomycosis, and eumycetoma.^[3]

Most common mild mycoses often present with a rash.^[2] Infections within the skin or under the skin may present with a lump and skin changes.^[3] Less common deeper fungal infections may present with pneumonia like symptoms or meningitis.^[2]

Mycoses are caused by certain fungi; yeasts, molds and some fungi that can exist as both a mold and yeast.^[3][6] They are everywhere and infection occurs after spores are either breathed 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 occur after spores are either breathed 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 of medical imaging.^[6]

Keeping the skin clean and dry, as well as maintaining good hygiene, 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 requires topical or systemic antifungal medicines.^[15] Pneumocystosis that does not respond to anti-fungals is treated with co-trimoxazole.^[29] Sometimes, infected tissue needs to be surgically 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 of illness and mortality in children.^[31]

According to the Global 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 to fungal 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 by Hippocrates may have been thrush.^[33] The Hungarian microscopist based in Paris David Gruby first reported that human disease could be caused by fungi in the early 1840s.^[33]

A wide range of fungal infections occur in other animals, and some can be transmitted from animals to people, such as Microsporum canis from cats.^[17]

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