Fungal infection, also known as mycosis, is

disease A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...

caused by

fungi A fungus ( : fungi or funguses) is any member of the group of eukaryotic organisms that includes microorganisms such as yeasts and molds, as well as the more familiar mushrooms. These organisms are classified as a kingdom, separately fr ...

. Different types are traditionally divided according to the part of the body affected; superficial, subcutaneous, and systemic. Superficial fungal infections include common tinea of the skin, such as tinea of the body,

groin In human anatomy, the groin (the adjective is ''inguinal'', as in inguinal canal) is the junctional area (also known as the inguinal region) between the abdomen and the thigh on either side of the pubic bone. This is also known as the medial comp ...

hands A hand is a prehensile, multi- fingered appendage located at the end of the forearm or forelimb of primates such as humans, chimpanzees, monkeys, and lemurs. A few other vertebrates such as the koala (which has two opposable thumbs on eac ...

, feet and

beard A beard is the hair that grows on the jaw, chin, upper lip, lower lip, cheeks, and neck of humans and some non-human animals. In humans, usually pubescent or adult males are able to grow beards. Throughout the course of history, societal at ...

, and yeast infections such as pityriasis versicolor. Subcutaneous types include

eumycetoma Eumycetoma, also known as Madura foot, is a persistent fungal infection of the skin and the tissues just under the skin, affecting most commonly the feet, although it can occur in hands and other body parts. It starts as a painless wet nodule ...

and

chromoblastomycosis Chromoblastomycosis is a long-term fungal infection of the skin and subcutaneous tissue (a chronic subcutaneous mycosis). It can be caused by many different types of fungi which become implanted under the skin, often by thorns or splinters. Ch ...

, which generally affect tissues in and beneath the skin. Systemic fungal infections are more serious and include

cryptococcosis Cryptococcosis is a potentially fatal fungal infection of mainly the lungs, presenting as a pneumonia, and brain, where it appears as a meningitis. Cough, difficulty breathing, chest pain and fever are seen when the lungs are infected. When the ...

, histoplasmosis,

pneumocystis pneumonia ''Pneumocystis'' pneumonia (PCP), also known as ''Pneumocystis jirovecii'' pneumonia (PJP), is a form of pneumonia that is caused by the yeast-like fungus ''Pneumocystis jirovecii''. ''Pneumocystis'' specimens are commonly found in the lungs of ...

aspergillosis Aspergillosis is a fungal infection of usually the lungs, caused by the genus ''Aspergillus'', a common mould that is breathed in frequently from the air around, but does not usually affect most people. It generally occurs in people with lung dis ...

and

mucormycosis Mucormycosis, also known as black fungus, is a serious fungal infection that comes under fulminant fungal sinusitis, usually in people who are immunocompromised. It is curable only when diagnosed early. Symptoms depend on where in the body the ...

. Signs and symptoms range widely. There is usually a rash with superficial infection. Fungal infection within the skin or under the skin may present with a lump and skin changes.

Pneumonia Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severit ...

-like symptoms or

meningitis Meningitis is acute or chronic inflammation of the protective membranes covering the brain and spinal cord, collectively called the meninges. The most common symptoms are fever, headache, and neck stiffness. Other symptoms include confusion or ...

may occur with a deeper or systemic infection. Fungi are everywhere, but only some cause disease. Fungal infection occurs after

spore In biology, a spore is a unit of sexual or asexual reproduction that may be adapted for dispersal and for survival, often for extended periods of time, in unfavourable conditions. Spores form part of the life cycles of many plants, algae, ...

s are either breathed in, come into contact with skin or enter the body through the skin such as via a cut,

wound A wound is a rapid onset of injury that involves lacerated or punctured skin (an ''open'' wound), or a contusion (a ''closed'' wound) from blunt force trauma or compression. In pathology, a ''wound'' is an acute injury that damages the epider ...

or injection. It is more likely to occur in people with a weak immune system. This includes people with illnesses such as HIV/AIDS, and people taking medicines such as

steroids A steroid is a biologically active organic compound with four rings arranged in a specific molecular configuration. Steroids have two principal biological functions: as important components of cell membranes that alter membrane fluidity; and ...

or cancer treatments.

Fungi A fungus ( : fungi or funguses) is any member of the group of eukaryotic organisms that includes microorganisms such as yeasts and molds, as well as the more familiar mushrooms. These organisms are classified as a kingdom, separately fr ...

that cause infections in people include

yeast Yeasts are eukaryotic, single-celled microorganisms classified as members of the fungus kingdom. The first yeast originated hundreds of millions of years ago, and at least 1,500 species are currently recognized. They are estimated to constit ...

mold A mold () or mould () is one of the structures certain fungi can form. The dust-like, colored appearance of molds is due to the formation of spores containing fungal secondary metabolites. The spores are the dispersal units of the fungi. Not ...

s and fungi that are able to exist as both a mold and yeast. The yeast ''

Candida albicans ''Candida albicans'' is an opportunistic pathogenic yeast that is a common member of the human gut flora. It can also survive outside the human body. It is detected in the gastrointestinal tract and mouth in 40–60% of healthy adults. It is usu ...

'' can live in people without producing symptoms, and is able to cause both superficial mild candidiasis in healthy people, such as

oral thrush Oral candidiasis, also known as oral thrush among other names, is candidiasis that occurs in the mouth. That is, oral candidiasis is a mycosis (yeast/fungal infection) of ''Candida'' species on the mucous membranes of the mouth. ''Candida albica ...

vaginal yeast infection Vaginal yeast infection, also known as candidal vulvovaginitis and vaginal thrush, is excessive growth of yeast in the vagina that results in irritation. The most common symptom is vaginal itching, which may be severe. Other symptoms include bu ...

, and severe systemic candidiasis in those who cannot fight infection themselves. Diagnosis is generally based on signs and symptoms,

microscopy Microscopy is the technical field of using microscopes to view objects and areas of objects that cannot be seen with the naked eye (objects that are not within the resolution range of the normal eye). There are three well-known branches of micr ...

culture Culture () is an umbrella term which encompasses the social behavior, institutions, and norms found in human societies, as well as the knowledge, beliefs, arts, laws, customs, capabilities, and habits of the individuals in these groups ...

, sometimes requiring a

biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a dise ...

and the aid of

medical imaging Medical imaging is the technique and process of imaging the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs or tissues (physiology). Medical imaging seeks to re ...

. Some superficial fungal infections of the skin can appear similar to other skin conditions such as

eczema Dermatitis is inflammation of the skin, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened. The area of skin involved c ...

and

lichen planus Lichen planus (LP) is a chronic inflammatory and immune-mediated disease that affects the skin, nails, hair, and mucous membranes. It is not an actual lichen, and is only named that because it looks like one. It is characterized by polygonal, fla ...

. Treatment is generally performed using antifungal medicines, usually in the form of a

cream Cream is a dairy product composed of the higher-fat layer skimmed from the top of milk before homogenization. In un-homogenized milk, the fat, which is less dense, eventually rises to the top. In the industrial production of cream, this process ...

or by mouth or injection, depending on the specific infection and its extent. Some require surgically cutting out infected tissue. Fungal infections have a world-wide distribution and are common, affecting more than one billion people every year. An estimated 1.7 million deaths from fungal disease were reported in 2020. Several, including

sporotrichosis Sporotrichosis, also known as rose handler's disease, is a fungal infection that affects skin, lungs, bone and joint, and can be widespread. It presents with firm painless nodules that later ulcerate. It can be localized or widespread. The disea ...

and

mycetoma Mycetoma is a chronic infection in the skin caused by either bacteria (actinomycetoma) or fungi (eumycetoma), typically resulting in a triad of painless firm skin lumps, the formation of weeping sinuses, and a discharge that contains grains. 80% ...

are neglected. A wide range of fungal infections occur in other animals, and some can be transmitted from animals to people.

Classification

Mycoses are traditionally divided into superficial, subcutaneous, or systemic, where infection is deep, more widespread and involving internal body organs. They can affect the nails,

vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...

skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different ...

and

mouth In animal anatomy, the mouth, also known as the oral cavity, or in Latin cavum oris, is the opening through which many animals take in food and issue vocal sounds. It is also the cavity lying at the upper end of the alimentary canal, bounded on ...

. Some types such as

blastomycosis Blastomycosis or blasto is a fungal infection caused by inhaling spores of a ''Blastomyces'' fungus. Only about half of people with the disease have symptoms, which can include fever, cough, night sweats, muscle pains, weight loss, chest pain, ...

, cryptococcus,

coccidioidomycosis Coccidioidomycosis (, ), commonly known as cocci, Valley fever, as well as California fever, desert rheumatism, or San Joaquin Valley fever, is a mammalian fungal disease caused by '' Coccidioides immitis'' or ''Coccidioides posadasii''. Coccid ...

and histoplasmosis, affect people who live or visit certain parts of the world. Others such as

, candidiasis,

and

talaromycosis Talaromycosis is a fungal infection that presents with painless skin lesions of face and neck, fever, anaemia, large lymph glands and liver. It is caused by the fungus''Talaromyces marneffei'', which is found in soil and decomposing organic ma ...

, tend to affect people who are unable to fight infection themselves. Mycoses might not always conform strictly to the three divisions of superficial, subcutaneous and systemic. Some superficial fungal infections can cause systemic infections in people who are immunocompromised. Some subcutaneous fungal infections can invade into deeper structures, resulting in systemic disease. ''

'' can live in people without producing symptoms, and is able to cause both mild candidiasis in healthy people and severe

invasive candidiasis Invasive candidiasis is an infection (candidiasis) that can be caused by various species of ''Candida'' yeast. Unlike ''Candida'' infections of the mouth and throat ( oral candidiasis) or vagina ( ''Candidal'' vulvovaginitis), invasive candidia ...

in those who cannot fight infection themselves.

ICD-11 codes

ICD-11 The ICD-11 is the eleventh revision of the International Classification of Diseases (ICD). It replaces the ICD-10 as the global standard for recording health information and causes of death. The ICD is developed and annually updated by the World H ...

codes include: * 1F20

Aspergillosis Aspergillosis is a fungal infection of usually the lungs, caused by the genus ''Aspergillus'', a common mould that is breathed in frequently from the air around, but does not usually affect most people. It generally occurs in people with lung dis ...

* 1F21 Basidiobolomycosis * 1F22

Blastomycosis Blastomycosis or blasto is a fungal infection caused by inhaling spores of a ''Blastomyces'' fungus. Only about half of people with the disease have symptoms, which can include fever, cough, night sweats, muscle pains, weight loss, chest pain, ...

* 1F23 Candidosis * 1F24

Chromoblastomycosis Chromoblastomycosis is a long-term fungal infection of the skin and subcutaneous tissue (a chronic subcutaneous mycosis). It can be caused by many different types of fungi which become implanted under the skin, often by thorns or splinters. Ch ...

* 1F25

Coccidioidomycosis Coccidioidomycosis (, ), commonly known as cocci, Valley fever, as well as California fever, desert rheumatism, or San Joaquin Valley fever, is a mammalian fungal disease caused by '' Coccidioides immitis'' or ''Coccidioides posadasii''. Coccid ...

* 1F26 Conidiobolomycosis * 1F27

Cryptococcosis Cryptococcosis is a potentially fatal fungal infection of mainly the lungs, presenting as a pneumonia, and brain, where it appears as a meningitis. Cough, difficulty breathing, chest pain and fever are seen when the lungs are infected. When the ...

* 1F28

Dermatophytosis Dermatophytosis, also known as ringworm, is a fungal infection of the skin. Typically it results in a red, itchy, scaly, circular rash. Hair loss may occur in the area affected. Symptoms begin four to fourteen days after exposure. Multiple ar ...

* 1F29

Eumycetoma Eumycetoma, also known as Madura foot, is a persistent fungal infection of the skin and the tissues just under the skin, affecting most commonly the feet, although it can occur in hands and other body parts. It starts as a painless wet nodule ...

* 1F2A Histoplasmosis * 1F2B Lobomycosis * 1F2C

Mucormycosis Mucormycosis, also known as black fungus, is a serious fungal infection that comes under fulminant fungal sinusitis, usually in people who are immunocompromised. It is curable only when diagnosed early. Symptoms depend on where in the body the ...

* 1F2D Non-dermatophyte superficial dermatomycoses * 1F2E

Paracoccidioidomycosis Paracoccidioidomycosis (PCM), also known as South American blastomycosis, is a fungal infection that can occur as a mouth and skin type, lymphangitic type, multi-organ involvement type (particularly lungs), or mixed type. If there are mouth ulce ...

* 1F2F

Phaeohyphomycosis Phaeohyphomycosis is a diverse group of fungal infections, caused by dematiaceous fungi whose morphologic characteristics in tissue include hyphae, yeast-like cells, or a combination of these. It can be associated an array of melanistic filamentou ...

* 1F2G Pneumocystosis * 1F2H

Scedosporiosis Scedosporiosis is the general name for any mycosis - i.e., fungal infection - caused by a fungus from the genus Scedosporium. Current population-based studies suggest ''Scedosporium prolificans'' (also known and recently more commonly referred to ...

* 1F2J

Sporotrichosis Sporotrichosis, also known as rose handler's disease, is a fungal infection that affects skin, lungs, bone and joint, and can be widespread. It presents with firm painless nodules that later ulcerate. It can be localized or widespread. The disea ...

* 1F2K

Talaromycosis Talaromycosis is a fungal infection that presents with painless skin lesions of face and neck, fever, anaemia, large lymph glands and liver. It is caused by the fungus''Talaromyces marneffei'', which is found in soil and decomposing organic ma ...

* 1F2L Emmonsiosis

Superficial mycoses

Superficial mycoses include candidiasis in healthy people, common tinea of the skin, such as tinea of the body,

, feet and

, and '' malassezia'' infections such as pityriasis versicolor. File:Human tongue infected with oral candidiasis.jpg, Oral candidiasis File:Dermatophytosis 20190815-02ASD.jpg, Tinea corporis File:Pityriasis versicolor frontal retouche.jpg, Pityriasis versicolor File:Toefungus.jpg, Onychomycosis

Subcutaneous

Subcutaneous fungal infections include

, and

Systemic

Systemic fungal infections include histoplasmosis,

and systemic candidiasis. Systemic mycoses due to primary pathogens originate normally in the

lung The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of ...

s and may spread to other organ systems. Organisms that cause systemic mycoses are inherently virulent.. Systemic mycoses due to opportunistic pathogens are infections of people with immune deficiencies who would otherwise not be infected. Examples of immunocompromised conditions include

AIDS Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual ma ...

, alteration of normal flora by antibiotics, immunosuppressive therapy, and metastatic cancer. Examples of opportunistic mycoses include Candidiasis,

and

Signs and symptoms

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

Causes

Mycoses are caused by certain

;

s and some fungi that can exist as both a mold and yeast. 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. ''Candida albicans'' is the most common cause of fungal infection in people, particularly as oral or vaginal thrush, often following taking antibiotics.

Risk factors

Fungal infections are more likely in people with weak immune systems. This includes people with illnesses such as HIV/AIDS, and people taking medicines such as

or cancer treatments. People with

diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...

also tend to develop fungal infections. Very young and very old people, also, are groups at risk. Individuals being treated with

antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention ...

s are at higher risk of fungal infections. Children whose immune systems are not functioning properly (such as children with cancer) are at risk of invasive fungal infections.

COVID-19

During the

COVID-19 pandemic The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel virus was first identi ...

some fungal infections have been associated with

COVID-19 Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was identified in Wuhan, China, in December 2019. The disease quick ...

. Fungal infections can mimic COVID-19, occur at the same time as COVID-19 and more serious fungal infections can complicate COVID-19. A fungal infection may occur after

antibiotics An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and preventio ...

for a bacterial infection which has occurred following COVID-19. The most common serious fungal infections in people with COVID-19 include

and invasive candidiasis. COVID-19–associated

is generally less common, but in 2021 was noted to be significantly more prevalent in India.

Mechanism

Fungal infections occur after spores are either breathed in, come into contact with skin or enter the body through a wound.

Diagnosis

Diagnosis is generally by signs and symptoms,

, culture and sometimes with the aid of

Differential diagnosis

Some tinea and candidiasis infections of the skin can appear similar to

and

. Pityriasis versicolor can look like seborrheic dermatitis, pityriasis rosea,

pityriasis alba Pityriasis alba is a skin condition, a type of dermatitis, commonly seen in children and young adults as dry, fine-scaled, pale patches on the face. It is self-limiting and usually only requires use of moisturizer creams. The condition is so name ...

and

vitiligo Vitiligo is a disorder that causes the skin to lose its color. Specific causes are unknown but studies suggest a link to immune system changes. Signs and symptoms The only sign of vitiligo is the presence of pale patchy areas of depigmen ...

. Some fungal infections such as

, histoplasmosis, and

can present with

fever Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...

cough A cough is a sudden expulsion of air through the large breathing passages that can help clear them of fluids, irritants, foreign particles and microbes. As a protective reflex, coughing can be repetitive with the cough reflex following three ph ...

, and

shortness of breath Shortness of breath (SOB), also medically known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing di ...

, thereby resembling

Prevention

Keeping the skin clean and dry, as well as maintaining good

hygiene Hygiene is a series of practices performed to preserve health. According to the World Health Organization (WHO), "Hygiene refers to conditions and practices that help to maintain health and prevent the spread of diseases." Personal hygiene refer ...

, 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.

Treatment

Treatment depends on the type of fungal infection, and usually requires

topical A topical medication is a medication that is applied to a particular place on or in the body. Most often topical medication means application to body surfaces such as the skin or mucous membranes to treat ailments via a large range of classes ...

systemic Systemic fundamental to a predominant social, economic, or political practice. This refers to: In medicine In medicine, ''systemic'' means affecting the whole body, or at least multiple organ systems. It is in contrast with ''topical'' or ''loc ...

antifungal medicines. Pneumocystosis does not respond to anti-fungals is treated with

co-trimoxazole Trimethoprim/sulfamethoxazole, sold under the brand name Bactrim among others, is a fixed-dose combination antibiotic medication used to treat a variety of bacterial infections. It consists of one part trimethoprim to five parts sulfamethox ...

. Sometimes, infected tissue needs to be surgically cut away.

Epidemiology

Worldwide, every year fungal infections affect more than one billion people. An estimated 1.6 million deaths from fungal disease were reported in 2017. The figure has been rising, with an estimated 1.7 million deaths from fungal disease reported in 2020. Fungal infections also constitute a significant cause of

illness A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...

and mortality in children. 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.

History

In 500BC, an apparent account of ulcers in the mouth by

Hippocrates Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek physician of the classical period who is considered one of the most outstanding figures in the history o ...

may have been thrush. The Hungarian microscopist based in Paris David Gruby first reported that human disease could be caused by fungi in the early 1840s.

SARS 2003

During the 2003 SARS outbreak, fungal infections were reported in 14.8–33% of people affected by SARS, and it was the cause of death in 25–73.7% of people with SARS.

Other animals

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.

References

External links

{{Authority control Tropical diseases Animal fungal diseases Fungal diseases