Fungi are living organisms, but they are not plants or animals. All living things are divided into categories called kingdoms, and fungi have their own kingdom.
Some fungi cause infections in people:
Some fungi cause skin infections (see also Fungal Skin Infections.)
Fungi can grow in two forms:
Yeasts: Single round cells
Molds: Many cells forming long, thin threads called hyphae
Some fungi exist as both forms during their life cycle. These fungi are called dimorphic fungi.
Fungi often grow in soil and decaying plant material. Many fungi, including bread molds and mushrooms, can be seen with the naked eye.
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Fungi reproduce by spreading microscopic spores. These spores are often present in the air and soil, where they can be inhaled or come into contact with the surfaces of the body, primarily the skin. Consequently, fungal infections usually begin in the lungs or on the skin.
Of the wide variety of spores that land on the skin or are inhaled into the lungs, most do not cause infection. A few types cause infection only in people who have one of the following:
A weakened immune system
Foreign material, including medical devices (such as an artificial joint or heart valve), in their body
The immune system may be weakened when people take medications that suppress the immune system (immunosuppressants), such as chemotherapy or medications used to prevent rejection of an organ transplant, or when they have a disorder that causes immunodeficiency, such as AIDS. People who spend many days in an intensive care unit can develop a weakened immune system because of medical procedures, underlying disorders, undernutrition, or a combination.
Except for some superficial skin infections, fungal infections are rarely passed from one person to another.
Fungal infections can affect only one area of the body (localized) or many areas of the body (systemic).
Localized fungal infections affect only one area of the body. They typically affect the skin and nails, vagina, or mouth and may occur in people who have a normal or weakened immune system.
Localized fungal infections sometimes occur when the mix of other microorganisms (eg, bacteria) that normally live in certain parts of the body (also called the microbiome) is out of balance. For example, certain types of fungi (such as Candida) are normally present on body surfaces or in the intestine. The bacteria normally present in the digestive tract and vagina limit the growth of these fungi in those areas. When people take antibiotics, the helpful bacteria can be killed, allowing the fungi to grow unchecked. The resulting overgrowth of fungi can cause symptoms, which are usually mild. As the bacteria grow back, the balance is restored, and the problem usually resolves.
Systemic fungal infections affect organs such as the lungs, eyes, liver, and brain and also can affect the skin. They typically occur in people who have a weakened immune system.
Fungal infections are either
Opportunistic fungal infections
Opportunistic fungal infections take advantage of a weakened immune system. Thus, they usually occur in people whose immune system is weakened by disorders such as AIDS or by medications that suppress the immune system. Opportunistic fungal infections occur worldwide.
Examples of opportunistic fungal infections include
Opportunistic fungal infections can be very aggressive, spreading quickly to other organs and are often fatal.
Primary fungal infections
Primary fungal infections can occur in people with a normal immune system, sometimes with serious consequences. These infections usually occur after people inhale fungal spores, which can cause pneumonia to develop in the lungs as the first sign of infection.
Certain primary fungal infections are more common in certain geographic areas, as in the following examples:
Histoplasmosis is especially common in the Ohio and Mississippi River valleys, central New York, and Texas in the United States. It also occurs in parts of Central and South America, Africa, Asia, and Australia.
Blastomycosis is particularly common in the eastern and central United States. It also occurs in Africa and in the Saint Lawrence River valley of Canada.
Coccidioidomycosis occurs almost exclusively in the Southwest and in Washington state in the United States and in northern Mexico and Central and South America.
Paracoccidioidomycosis occurs mainly in South America.
The time from transmission to development of an infection varies, so travelers may develop symptoms after returning from these areas.
Because many primary fungal infections develop slowly, months or years may pass before people seek medical attention. Typically, if the immune system is normal, fungal infections do not spread to organs deep in the body.
Diagnosis of Fungal Infections
Culture and examination of a sample
Blood tests
If doctors suspect a primary fungal infection, they ask people questions that can help with the diagnosis, such as the following:
Where they have traveled and lived to determine whether they may have been exposed to certain fungi, even if they were exposed years ago
Whether they are taking any medications that can suppress the immune system
Whether they have a disorder than weakens the immune system
Doctors then take a sample to be grown in a laboratory (cultured) and examined under a microscope. The sample may be sputum or blood, but, occasionally, doctors must take a sample from the lungs. To take a sample from the lungs, doctors insert a flexible viewing tube (a bronchoscope) through the mouth and into the airways. Fluid is squirted through the tube, then suctioned back into the tube, bringing cells and any fungi (or other microorganisms) with it. Sometimes biopsy or surgery is necessary to obtain a sample.
If the diagnosis is unclear, blood tests may be done. These tests check for antibodies (which are produced by the person's immune system in response to foreign substances, including fungi), antigens (molecules from foreign substances that can trigger an immune response in the body), or other evidence of the fungi.
Tests that detect genetic material in microorganisms are also done for some fungal infections.
Treatment of Fungal Infections
Antifungal medications
Several medications effective against fungal infections are available, but the structure and chemical makeup of fungi make them difficult to kill.
Antifungal medications may be applied directly to a fungal infection of the skin or other surface, such as the vagina or inside of the mouth. Antifungal medications may also be taken by mouth or injected when needed to treat more serious infections.
For serious infections, several months of treatment are often needed.
Medications for Serious Fungal Infections
Medication | Common Uses | Some Side Effects |
|---|---|---|
Most fungal infections | Chills, fever, headache, vomiting, a low potassium level* in the blood, kidney failure, and anemia | |
Nausea, diarrhea, headache, liver inflammation, inflammation of the veins, and rash | ||
Candidal and other fungal infections, including coccidioidomycosis and cryptococcal infections | Nausea, rash, and liver inflammation | |
Candidal and cryptococcal infections | Nausea, vomiting, and bone marrow damage | |
Nausea, vomiting, and liver inflammation | ||
Fungal skin infections, histoplasmosis, blastomycosis, coccidioidomycosis, sporotrichosis, and aspergillosis | Nausea, diarrhea, liver inflammation, rash, headache, dizziness, a low potassium level* in the blood, high blood pressure, accumulation of fluid (edema), and heart failure | |
Nausea, vomiting, rash, and liver inflammation | ||
Candidal infections | Sensitivity to sunlight, abnormal liver test results, infusion-related reactions (flushing, sensation of warmth, hives, nausea, chest tightness) | |
Aspergillosis and candidal infections, fusariosis, and scedosporiosis | Temporary disturbances in vision (such as blurred vision, changes in color vision, and sensitivity to light), nausea, vomiting, rash, and liver inflammation | |
* A low potassium level (hypokalemia) can cause muscle weakness, cramping, and twitches and abnormal heart rhythms. | ||
Candida and cryptococcal infections. | ||
