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Current Opinion in Microbiology Aug 2021The incidence of skin fungal infections is increasing at an alarming rate worldwide, presenting a major challenge to health professionals. Cutaneous and subcutaneous... (Review)
Review
The incidence of skin fungal infections is increasing at an alarming rate worldwide, presenting a major challenge to health professionals. Cutaneous and subcutaneous fungal infections are caused by pathogenic or opportunistic organisms varying from mold, yeasts, to dimorphic fungi. Recently, skin fungal have been increasingly reported and studied, giving rise to crucial breakthroughs in etiology and pathogenesis. This review aims to summarize recent insights into the clinical and etiological characteristics of common skin fungal infections according to different fungal species, as well as remarkable advances in the immune mechanisms. We hope it will be helpful to understand these diverse skin fungal infections, and bring about the latest developments that may facilitate novel diagnostic and therapeutic approaches to improve the outcomes in these patients.
Topics: Dermatomycoses; Fungi; Humans; Yeasts
PubMed: 34098513
DOI: 10.1016/j.mib.2021.05.005 -
Current Opinion in Infectious Diseases Apr 2020This review aims to update on recent findings about epidemiology, risk factors and therapeutic options for fungi causing skin and soft tissue infections. The latest data... (Review)
Review
PURPOSE OF REVIEW
This review aims to update on recent findings about epidemiology, risk factors and therapeutic options for fungi causing skin and soft tissue infections. The latest data on emerging antifungal resistance are also discussed.
RECENT FINDINGS
In parallel with increased use of immunosuppression, the incidence of fungal infections is also on rise. This increase involves not only systemic infections but also infections with primary and secondary skin involvement. Antifungal resistance has become a major issue and covers several fungal pathogens including dermatophytes, Candida spp. and, Aspergillus fumigatus. Multidisciplinary usage of newly targeted, immunomodulatory therapies may predispose patients to have fungal infections through mimicking an immunosuppressed status caused by genetic factors or the disease itself. Nonimmunosupressed patients, although less frequently than those with immunosuppression may also be vulnerable.
SUMMARY
Physicians should be aware about skin and soft tissue findings related with systemic or locally occuring mycosis. Emerging antifungal resistance may hamper the success of the treatment. Antifungal susceptibility testing is advisable wherever available and particularly when a disseminated fungal infection is present.
Topics: Antifungal Agents; Dermatomycoses; Drug Resistance, Fungal; Humans; Mycoses; Soft Tissue Infections
PubMed: 31990815
DOI: 10.1097/QCO.0000000000000630 -
Current Opinion in Infectious Diseases Oct 2022to review recent advances in the epidemiology, diagnosis, and treatment of deep fungal infections. (Review)
Review
PURPOSE OF REVIEW
to review recent advances in the epidemiology, diagnosis, and treatment of deep fungal infections.
RECENT FINDINGS
Mycetoma and chromoblastomycosis are the only deep fungal infections incorporated in the list of neglected tropical diseases. These infections start in the skin but progress to deep tissues if not recognized early. A wide array of fungal pathogens are the causative agents. Molecular methods allow for early and accurate identification of the pathogens, but are unfortunately not available in endemic areas. Treatment options are mostly based upon clinical experience rather than on well-designed clinical trials.
SUMMARY
Deep fungal infections of the skin and soft tissues are rare conditions of wide world distribution but mostly reported from tropical countries. Urgent need for affordable and easily accessible molecular methods and well-conducted studies to allow for accurate diagnosis and to provide evidence to guide proper therapy are urgently needed.
Topics: Chromoblastomycosis; Humans; Mycetoma; Skin
PubMed: 35942857
DOI: 10.1097/QCO.0000000000000870 -
Clinics in Geriatric Medicine Feb 2024The population of older adults continues to increase in the United States, leading to a concomitant increase in cutaneous disease. Fungal disease, specifically, commonly... (Review)
Review
The population of older adults continues to increase in the United States, leading to a concomitant increase in cutaneous disease. Fungal disease, specifically, commonly affects this population but often goes undiagnosed for too long. It is therefore important that providers be aware of common fungal pathogens, recognizable symptoms of disease, and treatment options. This article discusses 3 groups of pathogens: dermatophytes, Candida species, and Pityrosporum species, all of which cause a host of conditions that can be debilitating for older adults.
Topics: Humans; Aged; Dermatomycoses; Candida
PubMed: 38000857
DOI: 10.1016/j.cger.2023.09.008 -
Clinics in Dermatology 2021Over the past 10 years, the environmental and veterinary communities have sounded alarms over an insidious keratinophilous fungus, Pseudogymnoascus destructans, that has...
Over the past 10 years, the environmental and veterinary communities have sounded alarms over an insidious keratinophilous fungus, Pseudogymnoascus destructans, that has decimated populations of bats (yes, bats, chiropterans) throughout North America and, most recently, Northern China and Siberia. We as dermatologists may find this invasive keratinophilous fungus of particular interest, as its method of destruction is disruption of the homeostatic mechanism of the bat wing integument. Although it is unlikely that this pathogen will become an infectious threat to humans, its environmental impact will likely affect us all, especially as recent data have shown upregulation of naturally occurring coronaviruses in coinfected bats. Dermatologists are familiar with keratinophilous dermatophyte infections, but these rarely cause serious morbidity in individual patients and never cause crisis on a population basis. This contribution describes the effects of P destructans on both the individual and the population basis. Bringing the white-nose syndrome to the attention of human dermatologists and skin scientists may invite transfer of expertise in understanding the disease, its pathophysiology, epidemiology, treatment, and prevention.
Topics: Animals; Ascomycota; Biological Products; Chiroptera; Dermatomycoses; Humans
PubMed: 34272026
DOI: 10.1016/j.clindermatol.2020.07.005 -
Fungal Genetics and Biology : FG & B Nov 2019Dermatophytoses or tinea refers to superficial fungal infection of keratinized tissues. Although generally considered easy to treat, recalcitrant infections, presenting... (Review)
Review
Dermatophytoses or tinea refers to superficial fungal infection of keratinized tissues. Although generally considered easy to treat, recalcitrant infections, presenting as extensive and difficult to treat tinea corporis and cruris, are on the rise in some parts of the world. The situation demands an understanding of the pharmacokinetic and pharmacodynamic properties of the available antifungals against dermatophytes and the possible contribution of drug resistance and other factors to the present scenario. In this review, we provide the readers a comprehensive account of the available literature on in-vitro and in-vivo resistance to clinically used antifungals among dermatophytes. We have also added, in brief, the relevant skin pharmacokinetics of important systemic drugs. The established and postulated mechanisms of drug resistance are discussed and aspects on lack of in vivo correlation of in vitro resistance are presented. Finally, the lacunae in our existing knowledge on the topic and the arenas for future research are highlighted.
Topics: Antifungal Agents; Dermatomycoses; Drug Resistance, Fungal; Fungi; Humans; Skin; Tinea
PubMed: 31330295
DOI: 10.1016/j.fgb.2019.103255 -
Transplant Infectious Disease : An... Jun 2023
Topics: Humans; Chromoblastomycosis
PubMed: 36852755
DOI: 10.1111/tid.14047 -
Mycoses May 2021Tinea capitis remains a common public health problem worldwide, especially in developing countries. (Review)
Review
UNLABELLED
Tinea capitis remains a common public health problem worldwide, especially in developing countries.
OBJECTIVES
To investigate the changes of the predominant dermatophytes of tinea capitis in children in Hangzhou in recent 9 years.
METHODS
The age, gender and pathogen spectrum of 650 children with tinea capitis at the Department of Dermatology, Affiliated Third People's Hospital of Hangzhou, Anhui Medical University from 2011 to 2019 were analysed, and the distribution of pathogens from 1998 to 2000 was compared.
RESULTS
Among the 650 cases, 340 cases (48.2%) were males and 310 cases (51.8%) were females. The main population infected with tinea capitis was children aged 0-10 years (620 cases, 95.4%). From 2011 to 2019, the predominant dermatophyte was changed from Trichophyton violaceum (2011) to Trichophyton mentagrophytes complex (2012-2015) and later to Microsporum canis (2016-2019). In the past 9 years, M. canis (250 cases, 38.5%) was the most common dermatophyte and followed by T mentagrophytes complex (209 cases, 32.2%). The dermatophyte spectrum was statistically different between the years 2011 and 2019 (Chi square: χ = 69.75, P < .05), and the differences in anthropophilic and zoophilic pathogens between 1989-2000 and 2011-2019 were statistically significant (χ = 24.4, P < .05).
CONCLUSIONS
Research showed that children diagnosed with tinea capitis were mainly 0-10 years old. With age, the percentage of anthropophilic dermatophytes gradually increased, while the percentage of zoophilic dermatophytes decreased. M. canis was the predominant dermatophyte of tinea capitis in children, followed by T. mentagrophytes complex. The dermatophytes have shifted from anthropophilic to zoophilic dermatophytes in the past two decades.
Topics: Adolescent; Animals; Arthrodermataceae; Child; Child, Preschool; China; Dermatomycoses; Female; Humans; Infant; Infant, Newborn; Male; Microsporum; Prevalence; Retrospective Studies; Tinea Capitis; Trichophyton; Zoonoses
PubMed: 33455042
DOI: 10.1111/myc.13243 -
Mycoses Apr 2021Dermatophyte infections usually present as various types of superficial cutaneous mycoses; on very rare occasions, dermatophytes enter deep into the dermis and cause...
Dermatophyte infections usually present as various types of superficial cutaneous mycoses; on very rare occasions, dermatophytes enter deep into the dermis and cause invasive infections. In this study, we aimed to perform a systematic review of all reported invasive dermatophytosis cases over the past 20 years. We performed systematic searches in PubMed/Medline, EMBASE and Web of Science and identified 123 papers reporting 160 individual cases of invasive dermatophytosis between 2000 and 2020. Our study included 103 (64.4%) males, and the mean age at diagnosis was 43.0 years (range: 3-87 years). The most common predisposing factor was superficial dermatophytosis (56.9%), followed by solid organ transplantation (26.9%), the use of topical immunosuppressants (15.6%), gene mutations (14.4%), diabetes (14.4%) and trauma (6.9%). Trichophyton (T.) rubrum was the most prevalent pathogen (53.1%) responsible for invasive dermatophytosis, followed by T. mentagrophytes (7.5%), Microsporum canis (6.9%), T. tonsurans (5.6%), T. interdigitale (5.0%) and T. violaceum (3.8%). Patients with CARD9 or STAT3 mutations were prone to have mixed infection of two or more dermatophytes, present with eosinophilia and high IgE, and develop disseminated infections. Overall mortality was 7.9%, and the mortality in patients with and without gene mutations was 17.4% and 5.5%, respectively. Most of the normal host patients responded well to oral antifungal agents, while gene-deficient patients usually required lifelong treatment to stabilise their infection status. Our review indicated the importance of preventive treatment of superficial tinea in patients with immunosuppression and gene deficiencies to avoid the development of invasive dermatophytosis.
Topics: Antifungal Agents; Dermatomycoses; Humans; Invasive Fungal Infections; Organ Transplantation; Risk Factors; Skin
PubMed: 33217082
DOI: 10.1111/myc.13212 -
Current Opinion in Infectious Diseases Apr 2022As the at-risk population expands and new antifungal resistance patterns develop, it is critical to understand and recognize cutaneous manifestations of old and emerging... (Review)
Review
UNLABELLED
As the at-risk population expands and new antifungal resistance patterns develop, it is critical to understand and recognize cutaneous manifestations of old and emerging fungal diseases.
PURPOSE OF REVIEW
The aim of this review is to provide an overview of the most frequent and emerging deep cutaneous fungal infections following either primary inoculation or secondary spread after haematogenous seeding in disseminated infections in different geographical areas.
RECENT FINDINGS
Fungal skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions based on the site of the infection, route of acquisition of the pathogen, epidemiological setting and the virulence of the fungus in relation to the host. The approach to a patient suspected of having a fungal SSTI is complex and usually poses a major diagnostic challenge. The treatment approach should include attempts at immune reconstitution, targeted antifungal therapy and/or aggressive surgical debridement.
SUMMARY
Fungal SSTIs can be an important cause of morbidity and mortality in both immunocompromised and immunocompetent patients and are being reported with increasing frequency worldwide.
Topics: Antifungal Agents; Dermatomycoses; Drug Resistance, Fungal; Humans; Skin; Soft Tissue Infections
PubMed: 34861654
DOI: 10.1097/QCO.0000000000000806