Skip to main content

An Overview of Fungal Infections

Abstract

The incidence of fungal infections is increasing at an alarming rate, presenting an enormous challenge to healthcare professionals. This increase is directly related to the growing population of immunocompromised individuals, resulting from changes in medical practice such as the use of intensive chemotherapy and immunosuppressive drugs. HIV and other diseases which cause immunosuppression have also contributed to this problem.

Superficial and subcutaneous fungal infections affect the skin, keratinous tissues and mucous membranes. Included in this class are some of the most frequently occurring skin diseases, affecting millions of people worldwide. Although rarely life threatening, they can have debilitating effects on a person’s quality of life and may in some circumstances spread to other individuals or become invasive. Most superficial and subcutaneous fungal infections are easily diagnosed and readily amenable to treatment.

Systemic fungal infections may be caused by either an opportunistic organism that infects an at-risk host, or may be associated with a more invasive organism that is endemic to a specific geographical area. Systemic infections can be life threatening and are associated with high morbidity and mortality. Because diagnosis is difficult and the causative agent is often confirmed only at autopsy, the exact incidence of systemic infections is difficult to determine. The most frequently encountered pathogens are Candida albicans and Aspergillus spp. but other fungi such as non-albicans Candida spp. are increasingly important.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Groll AH, Shah PM, Mentzel C, et al. Trends in the postmortem epidemiology of invasive fungal infections at a university hospital. J Infect 1996; 33: 23–32

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Denning DW, Evans EGV, Kibbler CC, et al. Guidelines for the investigation of invasive fungal infections in haematological malignancy and solid organ transplantation. Eur J Clin Microbiol Infect Dis 1997; 16: 424–36

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Meyers JD. Fungal infections in bone marrow transplant patients. Semin Oncol 1990; 17 Suppl. 6: 10–3

    PubMed  CAS  Google Scholar 

  4. 4.

    Detandt M, Nolard N. Fungal contamination of the floors of swimming pools, particularly subtropical swimming paradises. Mycoses 1995; 38: 509–13

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Piérard GE, Arrese JE, Piérard-Franchimont C. Treatment and prophylaxis of tinea infections. Drugs 1996; 52: 209–24

    PubMed  Article  Google Scholar 

  6. 6.

    Evans EG. Tinea pedis: clinical experience and efficacy of short treatment. Dermatology 1997; 194 Suppl. 1: 3–6

    PubMed  Article  Google Scholar 

  7. 7.

    Semel JD, Goldin H. Association of athlete’s foot with cellulitis of the lower extremities: diagnostic value of bacterial cultures of ipsilateral interdigital space samples. Clin Infect Dis 1996; 23: 1162–4

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Richardson MD, Warnock DW, Campbell CK. Slide Atlas of Fungal Infection. Oxford, UK: Blackwell Science Limited, 1995

    Google Scholar 

  9. 9.

    Elewski BE. Tinea capitis: a current perspective. J Am Acad Dermatol 2000; 42 (1 Pt 1): 1–20; quiz 21-4

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Bronson DM, Desai DR, Barsky S, et al. An epidemic of infection with Trichophyton tonsurans revealed in a 20-year survey of fungal infections in Chicago. J Am Acad Dermatol 1983; 8: 322–30

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Hay RJ, Clayton YM, De Silva N, et al. Tinea capitis in southeast London — a new pattern of infection with public health implications. Br J Dermatol 1996; 135: 955–8

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Savin R. Diagnosis and treatment of tinea versicolor. J Fam Pract 1996; 43: 127–32

    PubMed  CAS  Google Scholar 

  13. 13.

    Marcon MJ, Powell DA. Epidemiology, diagnosis, and management of Malassezia furfur systemic infection. Diagn Microbiol Infect Dis 1987; 7: 161–75

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Chiritescu MM, Chiritescu ME, Scher RK. Newer systemic antifungal drugs for the treatment of onychomycosis. Clin Podiatr Med Surg 1996; 13: 741–58

    PubMed  CAS  Google Scholar 

  15. 15.

    Levy LA. Epidemiology of onychomycosis in special-risk populations. J Am Podiatr Med Assoc 1997; 87: 546–50

    PubMed  CAS  Google Scholar 

  16. 16.

    Gupta AK, Konnikov N, MacDonald P, et al. Prevalence and epidemiology of toenail onychomycosis in diabetic subjects: a multicentre survey. Br J Dermatol 1998; 139: 665–71

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Tosti A, Piraccini BM, Lorenzi S. Onychomycosis caused by nondermatophytic molds: clinical features and response to treatment of 59 cases. J Am Acad Dermatol 2000; 42 (2 Pt 1): 217–24

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Ellis DH, Watson AB, Marley JE, et al. Non-dermatophytes in onychomycosis of the toenails. Br J Dermatol 1997; 136: 490–3

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Greer DL. Evolving role of nondermatophytes in onychomycosis [review]. Int J Dermatol 1995; 34: 521–4

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Finlay AY. Quality of life measurement in dermatology: a practical guide. Br J Dermatol 1997; 136: 305–14

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Morgan M, McCreedy R, Simpson J, et al. Dermatology quality of life scales — a measure of the impact of skin diseases. Br J Dermatol 1997; 136: 202–6

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Drake LA, Scher RK. Onychomycosis: a significant and important disease. Second International Symposium on Onychomycosis; 1995 Sep 28–29; Florence, Italy

  23. 23.

    Drake LA, Scher RK, Smith EB, et al. Effect of onychomycosis on quality of life. J Am Acad Dermatol 1998; 38: 702–4

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Scher RK. Onychomycosis is more than a cosmetic problem. Br J Dermatol 1994; 130 Suppl. 43.: 15–6

    PubMed  Article  Google Scholar 

  25. 25.

    Lubeck DP, Patrick DL, McNulty P, et al. Quality of life of persons with onychomycosis. Qual Life Res 1993; 2: 341–8

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Mendling W, Gutschmidt J, Gantenberg R, et al. Comparison of strain specificity of yeasts from various organs of women with vaginal candidiasis [in German]. Mycoses 1998; 41 Suppl. 2: 23–5

    PubMed  Article  Google Scholar 

  27. 27.

    Regulez P, Garcia-Fernandez JF, Moragues MD, et al. Detection of anii-Candida albicans IgE antibodies in vaginal washes from patients with acute vulvovaginal candidiasis. Gynecol Obstet Invest 1994; 37: 110–4

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Woolley PD, Higgins SP. Comparison of clotrimazole, fluconazole and itraconazole in vaginal candidiasis. Br J Clin Pract 1995; 49: 65–6

    PubMed  CAS  Google Scholar 

  29. 29.

    Vazquez JA. Options for the management of mucosal candidiasis in patients with AIDS and HIV infection. Pharmacotherapy 1999; 19: 76–87

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Powderly WG, Mayer KH, Perfect JR. Diagnosis and treatment of oropharyngeal candidiasis in patients infected with HIV: a critical reassessment. AIDS Res Hum Retroviruses 1999; 15: 1405–12

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Hoepelman IM, Dupont B. Oral candidiasis: the clinical challenge of resistance and management. Int J Antimicrob Agents 1996; 6: 155–9

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Diz-Dios P, Ocampo A, Miralles C, et al. Frequency of oropharyngeal candidiasis in HIV-infected patients on protease inhibitor therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 87: 437–41

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Rios-Fabra A, Moreno AR, Isturiz RE. Fungal infection in Latin American countries. Infect Dis Clin North Am 1994; 8: 129–54

    PubMed  CAS  Google Scholar 

  34. 34.

    Sharkey-Mathis PK, Kauffman CA, Graybill JR, et al. Treatment of sporotrichosis with itraconazole. NIAID Mycoses Study Group. Am J Med 1993; 95: 279–85

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Chapman SW, Daniel CR 3rd. Cutaneous manifestations of fungal infection. Infect Dis Clin North Am 1994; 8: 879–910

    PubMed  CAS  Google Scholar 

  36. 36.

    Silva JP, de Souza W, Rozental S. Chromoblastomycosis: a retrospective study of 325 cases on Amazonic Region (Brazil). Mycopathologia 1998–99; 143: 171–5

    PubMed  Article  Google Scholar 

  37. 37.

    Bonifaz A, Martinez-Soto E, Carrasco-Gerard E, et al. Treatment of chromoblastomycosis with itraconazole, cryosurgery, and a combination of both. Int J Dermatol 1997; 36: 542–7

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    Lilic D, Cant AJ, Abinun M, et al. Chronic mucocutaneous candidiasis. I. Altered antigen-stimulated IL-2, IL-4, IL-6 and interferon-gamma (IFN-gamma) production. Clin Exp Immunol 1996; 105: 205–12

    CAS  Google Scholar 

  39. 39.

    Lilic D, Calvert JE, Cant AJ, et al. Chronic mucocutaneous candidiasis. II. Class and subclass of specific antibody responses in vivo and in vitro. Clin Exp Immunol 1996; 105: 213–9

    CAS  Google Scholar 

  40. 40.

    Beck-Sague C, Jarvis WR. Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980–1990. National Nosocomial Infections Surveillance System. J Infect Dis 1993; 167: 1247–51

    CAS  Google Scholar 

  41. 41.

    Chen YC, Chang SC, Sun CC, et al. Secular trends in the epidemiology of nosocomial fungal infections at a teaching hospital in Taiwan, 1981 to 1993. Infect Control Hosp Epidemiol 1997; 18: 369–75

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    Meunier-Carpentier F. Symposium on infectious complications of neoplastic disease (Part II). Chemoprophylaxis of fungal infections. Am J Med 1984; 76: 652–6

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    Bodey G, Bueltmann B, Duguid W, et al. Fungal infections in cancer patients: an international autopsy survey. Eur J Clin Microbiol Infect Dis 1992; 11: 99–109

    PubMed  Article  CAS  Google Scholar 

  44. 44.

    Hadley S, Karchmer AW. Fungal infections in solid organ transplant recipients. Infect Dis Clin North Am 1995; 9: 1045–74

    PubMed  CAS  Google Scholar 

  45. 45.

    Kanj SS, Welty-Wolf K, Madden J, et al. Fungal infections in lung and heart-lung transplant recipients. Report of 9 cases and review of the literature. Medicine 1996; 75: 142–56

    CAS  Google Scholar 

  46. 46.

    Still Jr JM, Belcher K, Law EJ. Management of Candida septicaemia in a regional burn unit. Burns 1995; 21: 594–6

    PubMed  Article  Google Scholar 

  47. 47.

    Guiot HFL, Fibbe WE, van’t Wout JW. Risk factors for fungal infection in patients with malignant hematologic disorders: implications for empirical therapy and prophylaxis. Clin Infect Dis 1994; 18: 525–32

    PubMed  Article  CAS  Google Scholar 

  48. 48.

    Martino R, Lopez R, Sureda A, et al. Risk of reactivation of a recent invasive fungal infection in patients with hematological malignancies undergoing further intensive chemo-radiotherapy. A single-center experience and review of the literature. Haematologica 1997; 82: 297–304

    CAS  Google Scholar 

  49. 49.

    Sherertz RJ, Belani A, Kramer BS, et al. Impact of air filtration on nosocomial Aspergillus infections. Unique risk of bone marrow transplant recipients. Am J Med 1987; 83: 709–18

    CAS  Google Scholar 

  50. 50.

    Pittet D, Mourouga P, Perneger TV. Compliance with hand-washing in a teaching hospital. Infection Control Program. Ann Intern Med 1999; 130: 126–30

    CAS  Google Scholar 

  51. 51.

    Benedict S, Colagreco J. Fungal infections associated with malignancies, treatments and AIDS. Cancer Nursing 1994; 17: 411–7

    PubMed  Article  CAS  Google Scholar 

  52. 52.

    Kappe R, Levitz S, Harrison TS, et al. Recent advances in cryptococcosis, candidiasis and coccidioidomycosis complicating HIV infection. Med Mycol 1998; 36 Suppl. 1: 207–15

    PubMed  Google Scholar 

  53. 53.

    Wheat LJ, Connolly-Stringfield PA, Baker RL, et al. Disseminated histoplasmosis in the acquired immune deficiency syndrome: clinical findings, diagnosis and treatment, and review of the literature. Medicine 1990; 69: 361–74

    PubMed  CAS  Google Scholar 

  54. 54.

    Duong TA. Infection due to Penicillium, marneffei, an emerging pathogen: review of 155 reported cases. Clin Infect Dis 1996; 23: 125–30

    PubMed  Article  CAS  Google Scholar 

  55. 55.

    Cohen MS, Isturiz RE, Malech HL, et al. Fungal infection in chronic granulomatous disease. The importance of the phagocyte in defense against fungi. Am J Med 1981; 71: 59–66

    CAS  Google Scholar 

  56. 56.

    Jensen HE, Salonen J, Ekfors TO. The use of immunohisto-chemistry to improve sensitivity and specificity in the diagnosis of systemic mycoses in patients with haematological malignancies. J Pathol 1997; 181: 100–5

    PubMed  Article  CAS  Google Scholar 

  57. 57.

    Caillot D, Casasnovas O, Bernard A, et al. Improved management of invasive pulmonary aspergillosis in neutropenic patients using early thoracic computed tomographic scan and surgery. J Clin Oncol 1997; 15: 139–47

    PubMed  CAS  Google Scholar 

  58. 58.

    Einsele H, Hebart H, Roller G, et al. Detection and identification of fungal pathogens in blood by using molecular probes. J Clin Microbiol 1997; 35: 1353–60

    PubMed  CAS  Google Scholar 

  59. 59.

    Maertens J, Verhaegen J, Demuynck H, et al. Autopsy-controlled prospective evaluation of serial screening for circulating galactomannan by a sandwich enzyme-linked immunosorbent assay for hematological patients at risk for invasive aspergillosis. J Clin Microbiol 1999; 37: 3223–8

    PubMed  CAS  Google Scholar 

  60. 60.

    Rangel-Frausto MS, Wiblin T, Blumberg HM, et al. National epidemiology of mycoses survey (NEMIS): variations in rates of bloodstream infections due to Candida species in seven surgical intensive care units and six neonatal intensive care units. Clin Infect Dis 1999; 29: 253–8

    PubMed  Article  CAS  Google Scholar 

  61. 61.

    Pannuti CS, Gingrich RD, Pfaller MA, et al. Nosocomial pneumonia in adult patients undergoing bone marrow transplantation: a 9-year study. J Clin Oncol 1991; 9: 77–84

    PubMed  CAS  Google Scholar 

  62. 62.

    Wald A, Leisenring W, van Burik JA, et al. Epidemiology of Aspergillus infections in a large cohort of patients undergoing bone marrow transplantation. J Infect Dis 1997; 175: 1459–66

    PubMed  Article  CAS  Google Scholar 

  63. 63.

    Pfaller MA, Jones RN, Messer SA, et al. National surveillance of nosocomial blood stream infection due to Candida albicans: frequency of occurrence and antifungal susceptibility in the SCOPE Program. Diagn Microbiol Infect Dis 1998; 31: 327–32

    PubMed  Article  CAS  Google Scholar 

  64. 64.

    Pfaller MA, Jones RN, Messer SA, et al. National surveillance of nosocomial blood stream infection due to species of Candida other than Candida albicans: frequency of occurrence and antifungal susceptibility in the SCOPE Program. Diagn Microbiol Infect Dis 1998; 30: 121–9

    PubMed  Article  CAS  Google Scholar 

  65. 65.

    Wingard JR. Importance of Candida species other than C. albicans as pathogens in oncology patients [review]. Clin Infect Dis 1995; 20: 115–25

    PubMed  Article  CAS  Google Scholar 

  66. 66.

    Nguyen MH, Peacock Jr JE, Morris AJ, et al. The changing face of candidemia: emergence of non-Candida albicans species and antifungal resistance. Am J Med 1996; 100: 617–23

    PubMed  Article  CAS  Google Scholar 

  67. 67.

    Odds FC. Epidemiological shifts in opportunistic and nosocomial Candida infections: mycological aspects. Int J Antimicrob Agents 1996; 6: 141–4

    PubMed  Article  CAS  Google Scholar 

  68. 68.

    Abi-Said D, Anaissie E, Uzun O, et al. The epidemiology of hematogenous candidiasis caused by different Candida species. Clin Infect Dis 1997; 24: 1122–8 [published erratum appears in Clin Infect Dis 997; 25: 352]

    PubMed  Article  CAS  Google Scholar 

  69. 69.

    Wingard JR, Merz WG, Rinaldi MG, et al. Increase in Candida krusei infection among patients with bone marrow transplantation and neutropenia treated prophylactically with fluconazole. N Engl J Med 1991; 325: 1274–7

    PubMed  Article  CAS  Google Scholar 

  70. 70.

    White MH. The contribution of fluconazole to the changing epidemiology of invasive candidal infections [editorial]. Clin Infect Dis 1997; 24: 1129–30

    PubMed  Article  CAS  Google Scholar 

  71. 71.

    Walsh TJ, Dixon DM. Nosocomial aspergillosis: environmental microbiology, hospital epidemiology, diagnosis and treatment. Eur J Epidemiol 1989; 5: 131–42

    PubMed  Article  CAS  Google Scholar 

  72. 72.

    Eccles NK, Scott GM. Aspergillus in pepper. Lancet 1992; 339: 618

    PubMed  Article  CAS  Google Scholar 

  73. 73.

    Lortholary O, Ascioglu S, Moreau P, et al. Invasive aspergillosis as an opportunistic infection in nonallografted patients with multiple myeloma: a European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the Intergroupe Francais du Myelome. Clin Infect Dis 2000; 30: 41–6

    PubMed  Article  CAS  Google Scholar 

  74. 74.

    van Burik JH, Leisenring W, Myerson D, et al. The effect of prophylactic fluconazole on the clinical spectrum of fungal diseases in bone marrow transplant recipients with special attention to hepatic candidiasis. An autopsy study of 355 patients. Medicine 1998; 77: 246–54

    Google Scholar 

  75. 75.

    Dromer F, Mathoulin S, Dupont B, et al. Epidemiology of cryptococcosis in France: a 9-year survey (1985–1993). French Cryptococcosis Study Group. Clin Infect Dis 1996; 23: 82–90

    CAS  Google Scholar 

  76. 76.

    Ruggieri M, Polizzi A, Vitaliti MC, et al. Fatal biphasic brainstem and spinal leptomeningitis with Cryptococcus neoformuns in a non-immunocompromised child. Acta Paediatr 1999; 88: 671–4

    PubMed  Article  CAS  Google Scholar 

  77. 77.

    Mitchell DH, Sorrell TC, Allworth AM, et al. Cryptococcal disease of the CNS in immunocompetent hosts: influence of cryptococcal variety on clinical manifestations and outcome. Clin Infect Dis 1995; 20: 611–6

    PubMed  Article  CAS  Google Scholar 

  78. 78.

    Fridkin SK, Jarvis WR. Epidemiology of nosocomial fungal infections. Clin Microbiol Rev 1996; 9: 499–511

    PubMed  CAS  Google Scholar 

  79. 79.

    Krcmery V, Krupova I, Denning DW Invasive yeast infections other than Candida spp. in acute leukaemia. J Hosp Infect 1999; 41: 181–94

    PubMed  Article  CAS  Google Scholar 

  80. 80.

    Boutati EI, Anaissie EJ. Fusarium, a significant emerging pathogen in patients with hematologic malignancy: ten years’ experience at a cancer center and implications for management. Blood 1997; 90: 999–1008

    PubMed  CAS  Google Scholar 

  81. 81.

    Sugar AM. Mucormycosis. Clin Infect Dis 1992; 14 Suppl. 1: S126–9

    PubMed  Article  Google Scholar 

  82. 82.

    Parfrey NA. Improved diagnosis and prognosis of mucormycosis. A clinicopathologic study of 33 cases. Medicine 1986; 65: 113–23

    CAS  Google Scholar 

  83. 83.

    Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 38-1982. A 66-year-old diabetic woman with sinusitis and cranial-nerve abnormalities. N Engl J Med 1982; 307: 806–14

    Article  Google Scholar 

  84. 84.

    Reingold AL, Lu XD, Plikaytis BD, et al. Systemic mycoses in the United States, 1980–1982. J Med Vet Mycol 1986; 24: 433–6

    PubMed  Article  CAS  Google Scholar 

  85. 85.

    Klein BS, Vergeront JM, Davis JP. Epidemiologic aspects of blastomycosis, the enigmatic systemic mycosis. Semin Respir Infect 1986; 1: 29–39

    PubMed  CAS  Google Scholar 

  86. 86.

    Kirkland TN, Fierer J. Coccidioidomycosis: a reemerging infectious disease. Emerg Infect Dis 1996; 2: 192–9

    PubMed  Article  CAS  Google Scholar 

  87. 87.

    Lortholary O, Denning DW, Dupont B. Endemic mycoses: a treatment update. J Antimicrob Chemother 1999; 43: 321–31

    PubMed  Article  CAS  Google Scholar 

  88. 88.

    Yozwiak ML, Lundergan LL, Kerrick SS, et al. Symptoms and routine laboratory abnormalities associated with coccidioidomycosis. West J Med 1988; 149: 419–21

    PubMed  CAS  Google Scholar 

  89. 89.

    Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 21-1994. A 20-year-old Mexican immigrant with recurrent hemoptysis and a pulmonary cavitary lesion [clinical conference]. N Engl J Med 1994; 330: 1516–22

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Gary Garber.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Garber, G. An Overview of Fungal Infections. Drugs 61, 1–12 (2001). https://doi.org/10.2165/00003495-200161001-00001

Download citation

Keywords

  • Adis International Limited
  • Candidiasis
  • Invasive Aspergillosis
  • Chronic Granulomatous Disease
  • Coccidioidomycosis