Overview Candiduria refers to the presence of Candida spp. in the urine. This finding is for the most part a benign process associated with the use of urinary catheters and antimicrobial therapy [1171]. Nevertheless, candiduria may be one of the most challenging of the candidal infections. The challenge comes from the fact that finding Candida spp. in the urine can be either completely insignificant (e.g., due to contamination or asymptomatic colonization) or be a marker of a very serious entity such as invasive renal parenchymal disease related to disseminated candidiasis or postlaparotomy peritonitis [224, 1171, 1602, 2448]. In between these […]

Synonyms Pityriasis nigra, tinea nigra palmaris Definition Tinea nigra is a superficial fungal infection of the stratum corneum. Epidemiology Tinea nigra is a rare condition overall. One hundred ten cases had been reported up to 1989 and only 19 more cases were recovered from a Medline search up to March 2001. Tinea nigra occurs most frequently in tropical climates within Central and South America, Africa, Asia, and North America [970, 1437, 2038, 2085, 2261]. Direct inoculation onto the skin from contact with decaying vegetation, wood, or soil seems to be the form of acquisition. Incubation periods may be as long […]

Tinea corporis, (A):Tinea cruris, and Tinea pedis Tinea corporis Synonyms Ringworm of the body   Definition The key characteristic of Tinea corporis is that the fungus involves the glabrous (relatively hairless) skin. The infection is limited to the stratum corneum of the epidermis. Vellus hair (the fine hair present on glabrous skin) may be invaded, and the hair follicle may serve as a reservoir for the fungus. Tinea pedis,Tinea manuum, and (A):Tinea cruris refer to Tinea corporis that is limited to the foot, hand, and groin, respectively. There is otherwise little special about them. History lesson: The term tinea has […]

Synonyms Ringworm of the beard, tinea sycosis, “barber’s itch” Definition Tinea barbae is a colonization of the bearded areas of the face and neck, hence being restricted to adult males. The most common causes are T. mentagrophytes and T. verrucosum. Epidemiology Zoophilic organisms are acquired from contact with cattle, dogs and other animals, therefore classically seen among dairy farmers and cattle ranchers. However, where not antiseptic techniques are used, person-to-person transmission can occur by being shaved in the barbershop [1996]! Clinical manifestations Lesions are of three types: a) a mild superficial form, b) inflammatory, deep, pustular, kerion-like, and c) the […]

Overview In spite of technical improvements in peritoneal dialysis, peritonitis continues to be the most common complication. Rates as high as one episode of peritonitis per year in every two dialysis patients have been reported [652]. Fungal peritonitis is relatively rare in comparison with bacterial peritonitis. However, it is a serious complication associated with not only important morbidity, but a high index of drop-out from chronic ambulatory peritoneal programs [319, 862, 2489]. Candida spp. are the most common fungal pathogens isolated in cases of fungal peritonitis. The frequency of Candida spp. in different series looking at this entity varies between […]

Synonyms South American blastomycosis Definition Paracoccidioidomycosis refers to the endemic disease produced by N/A(L):Paracoccidioides brasiliensis. The infection is found beginning at about 23 degrees North latitude in Mexico and extends southwards to Argentina. It is not seen in Chile and the Caribbean Islands. The ecologic niche for P. brasiliensis remains obscure and the fungus has only been isolated four times from soil [328, 2107]. Inhalation of conidia is presumably the route of acquisition. Primary infection is asymptomatic in most cases. The fungus can remain dormant for years within lymph nodes to appear later probably in relation to some type of […]

Overview Infection of the pancreas with Candida spp. is another form of intra-abdominal candidiasis that was considered extremely unusual for many years but now it is being recognized as an important, albeit infrequent, problem. All cases of pancreatic candidiasis are related to some form of pancreatic injury. Indeed, its retroperitoneal location seems to protect the pancreas from hematogenous or contiguous infections, but once some type of injury has occurred a predisposition to this type of complication becomes manifest. Bacterial infections are much more frequent in this setting, with enteric microorganisms being the ones usually recovered. Cultures show a polymicrobial flora […]

Overview Oropharyngeal candidiasis (OPC) is the general term given to the oral infection caused by the yeast Candida. This condition is also often referred to informally as “thrush”. As we will discuss in detail in this section, OPC meets all the criteria to be considered an opportunistic infection. Whereas asymptomatic oral colonization may also occur, OPC implies the presence of signs and symptoms of infection. Epidemiology Candida spp. are part of the normal mouth flora in 25-50% of healthy individuals [1672]. Such carriage is referred to as asymptomatic colonization. Candida albicans is the most frequent colonizer (70-80%) but any of […]

Synonyms When the infection is due to a dermatophyte, both “Ringworm of the nail” and “Tinea unguium” are sometimes used as synonyms. For an extended discussion of the nomenclature of the fungal infections of skin and nails, please see our overview of this area. Definition Onychomycosis refers to the invasion of the nail plate by a fungus. The infection may be due to a N/A(L):dermatophyte, yeast, or nondermatophyte mould. The term “tinea unguium” is used specifically to describe invasive dermatophytic onychomycosis [656]. Onychomycosis, particularly fingernail infections have an important impact on the life of affected individuals. Shame may preclude patients […]

Overview Distinct from the CNS candidiasis related to hematogenously disseminated candidiasis, neurosurgery-related CNS candidiasis follows surgical interventions that involve placement of plastic devices into the brain. Most infections are due to ventriculo-peritoneal (VP) shunt placement. Only a few cases have followed simple craniotomies or lumbar punctures [438, 816]. VP shunt infections are common [295, 436, 2017]. Most such infections are bacterial, with fungal cases being rare. However, Candida spp. explains almost all fungal-related VP shunt infections [436, 2017]. Epidemiology Fungal meningitis in patients with VP shunts in place occurs relatively infrequently. Incidence rates of between 1% and 17% have been […]

Overview Invasive candidiasis in neonates is a serious and relatively common cause of late onset sepsis associated with a high mortality. A review of the first 26 cases reported in the English literature up to 1984 reported a mortality rate of 54% [1128]. More recent data from the (A):NICHD Neonatal Research Network centers reported a death rate of 28.1% in the neonates with fungemia [2170]. Premature neonates and particularly low birth weight infants require invasive diagnostic and aggressive therapeutic interventions, many of which increase the risk factors for developing Candida infections (see below). In addition the immaturity of the immune […]

John W. Baddley, MD, MSPH Introduction The number of patients receiving immunosuppressive agents has increased over the past decade and is expected to increase substantially in the near future. Therapeutic antibodies have become an important class of drugs, with annual sales that exceeded $27 billion in 2007[(A):1].  Important new therapeutic biologics include the TNF-a inhibitors (TNFi) infliximab, etanercept, adalimumab, certolizumab pegol and golimumab. These drugs are approved for the treatment of one or more of a number of diseases including rheumatoid arthritis, psoriatic arthritis, plaque psoriasis, Crohn’s disease, juvenile idiopathic arthritis and ankylosing spondylitis.  Although these drugs have revolutionized the […]

Synonyms Keloidal blastomycosis or Lobo’s disease Definition Lobomycosis is a rare chronic cutaneous infection caused by N/A(L):Lacazia loboi previously called Loboa loboi. The disease manifests as keloids, verrucoid to nodular lesions, crusty plaques, and tumors. The fungus grows as globose cells that are connected to each other by a narrow neck. The cells may form branching chains. Developing lesions are well defined, smooth, painless and easily moved around since they lie free over the deeper tissues. Older lesions typically become verrucoid and ulcerative with satellite lesions resulting from autoinoculation [347, 1114, 1944]. Clinical forms Cutaneous and subcutaneous. Prognosis and therapy […]

The Four Overlapping Forms of Invasive Candidiasis The Four Forms of Invasive Candidiasis (from [1914]) Defining the various forms of invasive candidiasis is a challenge. We follow the concepts first proposed by Bodey, Anaissie, & Edwards in their 1993 analysis [271]. As discussed in our overview of invasive candidiasis, essentially all forms of invasive candidiasis begin as an episode of candidemia. However, the degree to which this is clinically obvious varies (figure). From a clinical standpoint, these four forms of invasive candidiasis are sufficiently different that separating them is useful: Catheter-Related Candidemia Candidemia due to infection of a vascular catheter […]

Overview As discussed in the section on candidemia, an intravascular catheter is probably the most important and frequent removable source of Candida spp. in the bloodstream of both adults and children [518, 1308, 1904, 1967, 2411]. Once the organism reaches the catheter (direct contamination and transient fungemia from a gastrointestinal source are two possibilities), it adheres to and propagates on the surface of the catheter or the surrounding fibrin clot. In so doing, a large nidus of infection is produced. However, the label “catheter-related” is sometimes taken to imply that the candidemia is trivial. This is not, however, uniformly the […]

Fungi cause a wide variety of diseases in humans, and the areas we discuss are listed below. You may also want to refer to the Infectious Disease Society of America-Mycoses Study Group (IDSA-MSG) Practice Guidelines for treating invasive mycoses. These cover aspergillosis, blastomycosis, candidiasis, coccidiodomycosis, cryptococcosis, histoplasmosis, and sporotrichosis and are available at the (E):IDSA website. Finally, please be sure to refer to our legal disclaimer. (Site development note: our discussions are currently relatively superficial for all the infections except candidiasis.) Aspergillosis Blastomycosis Candidiasis Coccidioidomycosis Cryptococcosis Histoplasmosis Paracoccidiomycosis Sporotrichosis Zygomycosis Miscellanous Syndromes These diseases are a little harder to classify […]

Synonyms African histoplasmosis. Contrast with North American histoplasmosis due to Histoplasma capsulatum Definition and forms of the disease Histoplasmosis due to N/A(L):Histoplasma duboisii is a mycotic infection primarily involving cutaneous, liver, lung, lymphatic, subcutaneous, and bony tissues. Skin and bone are the most frequently invaded sites [454]. The etiologic agent grows as a large yeast within giant cells. It may also present with small cells that are typical of those seen in histoplasmosis due to Histoplasma capsulatum. Nodular and ulcerative cutaneous and osteolytic lesions of bone that disseminate or remain localized are the primary clinical characteristics of histoplasmosis duboisii [11, […]

Synonyms North American histoplasmosis. Contrast with African histoplasmosis due to Histoplasma duboisii Definition Histoplasmosis refers to the condition caused by the infection with the dimorphic endemic fungi N/A(L):Histoplasma capsulatum var. capsulatum. This anamorphic fungus has a known sexual teleomorph that carries the name Ajellomyces capsulatus. The majority of acute cases of infection with this fungus follow a subclinical and benign course in normal hosts [2412]. However, a disseminated and potentially fatal picture is seen among immunosuppressed individuals, children less than 2 years old, elderly persons, and people exposed to very large inoculum [872]. Since the advent of the HIV epidemic, […]

There are two groups of diseases that bear the title histoplasmosis. The far more common use of this term is to refer to the forms of histoplasmosis caused by Histoplasma capsulatum var. capsulatum. This organism was formerly known simply as Histoplasma capsulatum, and its diseases have also been referred to as North American Histoplasmosis. This organism most often causes pulmonary disease, although disseminated forms are also well known. The other form is that of histoplasmosis caused by Histoplasma capsulatum var. duboisii. This organism was formerly known simply as Histoplasma duboisii, and its diseases have also been referred to as African […]

Overview Within the four overlapping forms of invasive candidiasis, there is a distinct clinical picture that has been given a variety of names: Chronic Disseminated Candidiasis (CDC), Hepatosplenic Candidiasis, Hepatic Candidiasis and Granulomatous Hepatitis. As proposed by Bodey, we will generally use the term hepatosplenic candidiasis [271]. However, the other terms are equally valid. At least in theory, a separation should be made between this entity and liver involvement in cases of acute disseminated candidiasis [273]. Cases of acute disseminated disease can certainly become chronic [2233]. Epidemiology The precise incidence of Hepatosplenic Candidiasis is unknown. Difficulties in diagnosing this entity […]

Overview Under GI-related CP, we include many forms of peritoneal candidal infection, including both diffuse (peritonitis) and localized (abscesses) forms. Others have called this entity “abdominal or intra-abdominal candidiasis” [44, 651]. However, we believe that the more precise term reduces confusion with such closely-related infections as biliary candidiasis or hepatosplenic candidiasis. The role of Candida spp. in the pathogenesis of peritoneal infections has been a controversial issue. To understand this controversy, first we have to remember that Candida spp. are normal commensals of the gastrointestinal tract of human beings. Thus, it is not surprising that Candida spp. would often be […]