Overview This condition, sometimes called fungal “bezoar”, is classically caused by Candida spp. However, N/A(L): Penicillium, N/A(L):Phycomycetes and N/A(L):Aspergillus have also been reported as the cause of fungus balls. Epidemiology Fungus balls are commonly associated with the following underlying conditions: Diabetes mellitus Nephrolithiasis Any other cause of urinary obstruction Clinical Manifestations Patients with a fungus ball may have almost any presentation. Asymptomatic fungus balls are seen when the obstruction is incomplete. Complete obstruction is often associated with a urosepsis-like picture that includes fever, chills, and flank pain. Some patients will report having spontaneously passed whitish debris (“fungus balls”) in their […]

Introduction The clinical nomenclature for the fungal infections of the hair, nail, skin, and subcutaneous tissues is often confusing upon first encounter. The terms overlap, some of the terms sound like names of fungi (but aren’t), and different definitions may be encountered in different texts. A general overview to this area is found below, and it provides one consistent scheme for thinking about this area. As you read it, it is helpful to understand these terms: Phaeohyphomycosis: Used for infections due to melanin-producing, or dematiaceous, species of moulds. Melanin is a black pigment, and fungi that produce melanin are visible […]

[ (A):Mycotic keratitis | (A):Endogenous oculomycosis | (A):Extension oculomycosis ] Mycotic keratitis   Definition Mycotic keratitis refers to the corneal infection caused by either filamentous fungi (moulds) or yeast. There are important epidemiological and clinical differences (see table below) between these two forms. The most important risk factors related to fungal keratitis include trauma (generally with plant material), chronic ocular surface diseases, contact lens usage, surgery, corneal anesthetic abuse, and immunodeficiencies [432, 1139, 1963, 2223]. Interestingly, fungal keratitis is a condition related to warm climates [1341]. In the southernmost states of the United States, fungal keratitis explains up to 35% […]

Overview Cutaneous candidiasis is arguably the most common form of candidiasis. The infection involves the very outer-most layers of the skin. Healthy skin is quite resistant to candidal infection and in essentially all cases a (A):predisposing factor is present. Although neither invasive nor life-threatening, these forms of localized candiasis can be very irritating to the patient. The most common and important forms of candidal skin infections are: Erosio interdigitalis blastomyceticaFinger or toe webspaceEroded erythematous area surrounded with macerated skin Diaper rashThe lesions begin in the infant’s perianal area and then spread toward the genitalia and the inner thighsEroded areas surrounded with […]

Overview Cryptococcosis in cats is well described and known to occur throughout the world. The disease is due to infection with Cryptococcus neoformans and is treatable with itraconazole, fluconazole or ketoconazole. Following the concepts of therapy that have evolved for N/A(L):human cryptococcosis, the obvious choices would be fluconazole and itraconazole. The progress of the disease and response to antifungals can be serologically monitored. Feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) might be sought as underlying diseases that could affect the prognosis or required duration of therapy. Some Relevant References and Their Abstracts   Title: Feline systemic fungal infections […]

Overview With few exceptions, veterinary and human mycology deal with the same fungal pathogens. Veterinary medical mycology deals with fungal disease in both invertebrate and vertebrate animals. Invertebrate fungal infections are typically dealt with on an individual basis by mycologists working with other specialists. Because fungal infections involving invertebrate animals are unusual, classical mycologists are typically needed to assist with the identification of the pathogenic fungus. In fact, the first reported animal disease was the fungus Beauvera bassiana that nearly destroyed the silk industry in China by attacking silkworms (Bassi A. 1835. Del male del segno calcinacio o muscordino malattia […]

Overview Candida spp., although rare Central Nervous System (CNS) pathogens, can infect both the meninges and the parenchymal brain tissue. In practice, the majority of cases of CNS candidiasis are associated with disseminated or invasive candidiasis (IC). On this page we will focus on the discussion of this form of infection and will refer to it as IC-related CNS Candidiasis. Another form of candidal CNS infection is the one occurring as a postoperative complication of neurosurgical procedures, especially ventriculo-peritoneal (VP) shunt placement. Because of the unique characteristics of this patient population, we have a separate discussion neurosurgery-related CNS candidiasis. Epidemiology About […]

Overview Chronic mucocutaneous candidiasis (CMC) is the label given to a group of overlapping syndromes that have in common a clinical pattern of persistent, severe, and diffuse cutaneous candidal infections. These infections affect the skin, nails and mucous membranes. As suggested by Kirkpatrick’s papers on this topic [1196, 1197, 1198], the syndromes of CMC can be grouped as follows: Classification of Chronic Mucocutaneous Candidiasis (CMC) (A):Chronic oral candidiasis Related to denture stomatitis HIV-associated candidiasis Related to inhaled corticosteroid use (A):CMC and polyendocrinopathy Localized CMC Diffuse CMC CMC with thymoma CMC with interstitial keratitis CMC associated with “KID” (keratitis, ichthyosis, deafness) […]

Overview It has been proposed that the asymptomatic colonization with Candida might be associated with a variety of symptoms and cause a “Candida Hypersensitivity Syndrome” [599] This concept was popularized by William Crook, MD in his book The Yeast Connection [491]. Previously, C.O. Truss, a physician from Birmingham, Alabama had proposed the existence of such a malady [2257, 2259]. Other names that have been given to this presumed condition include: Candida-Related Complex Polysystemic Candidiasis Chronic Candidiasis (This term should not be confused with Chronic Mucocutaneous Candidiasis) The syndrome is theoretically due to an overgrowth of Candida albicans in the gastrointestinal […]

Overview Candida spp. are the most frequent fungal agent causing cardiac infection both in adults and children [137, 1981, 2361]. From a histopathologic perspective three types of cardiac candidiasis may occur and are discussed on this page: (A):endocarditis, myocarditis, and pericarditis. Candidal Endocarditis   Overview Candidal endocarditis is a severe condition that has been traditionally associated with an exceptional high mortality and recurrence rates [2040]. Both native and prosthetic valves may be affected [1981]. Combining medical with surgical interventions, the hospital survival rates have been commonly below 50%. The highest long term survival rate is 67% [137, 1135, 1513, 1592, […]

Overview Candidemia is the isolation of Candida from one or more blood specimens. While it is more convincing to have two or more positive cultures, even a single culture should not be ignored. An important debate took place for many years regarding the possibility that candidemia could be an insignificant finding. It is possible for any organism in a blood culture to represent contamination of the specimen during the collection process, and early reports also suggested that candidemia was often a trivial process that could simply be ignored [664]. This idea was gradually reversed by reports showing that candidemia was […]

Overview Unlike oropharyngeal candidiasis, Candida vulvovaginitis is generally not considered an opportunistic infection. The majority of cases of Candida vulvovaginitis occur in perfectly healthy women and respond well to (A):conventional antifungal treatments for Candida vulvovaginitis. Epidemiology Vaginal colonization Candida spp. are part of the lower genital tract flora in 20 to 50% of healthy asymptomatic women [855]. Carriage rates are higher in: Women treated with broad spectrum antibiotics [346, 1693]. Pregnant women [256, 346]. Diabetic women [2300]. Women with the diagnosis of AIDS (CD4+ counts < 200 cells/mL) [629]. Lower CD4+ T-cell counts are associated with higher rates of colonization […]

Overview Most cases of onychomycosis are due to dermatophytes, and we discuss this entity separately under our N/A(L):general discussion of onychomycosis. However, Candida spp. also cause this condition, and there are enough differences to warrant a separate discussion. Onychomycosis due to dermatophytes occurs more frequently in toenails than in fingernails. Conversely, candidal onychomycosis more commonly affects the fingernails. Indeed, about 50% of cases of fingernail-related onychomycosis is caused by Candida spp. In addition, most episodes of Candida onychomycosis begin as paronychial infections (“whitlow”). In other words, infection begins in the structures around the nail rather than in the nail itself. […]

Overview Candida pneumonia is one of the most challenging of all the Candida infections. Rules for a practical and accurate diagnostic approach are elusive. As Candida spp. are frequent asymptomatic colonizers of the upper respiratory tract, especially among hospitalized patients, the predictive value of sputum and even bronchoalveolar cultures for actual candidal lung invasion is very low. In addition, physicians would ideally like to distinguish hematogenous Candida pneumonia related to invasive candidiasis from isolated lung infection. However, in the clinical practice such discrimination is very difficult. Nevertheless, in order to make this discussion meaningful, some standards must be applied. The […]

Candida peritonitis refers not simply to the isolation of Candida spp. from the peritoneal fluid, but concomitant documentation of inflammation of the peritoneal cavity. Two groups of patients are generally affected and are discussed separately. Note that the group of surgical patients can be further subdivided into two quite different populations: Patients on peritoneal dialysis Surgical patients with gut injury Patients with hollow organ (intestine, biliary tree) injury Solid (abdominal) organ transplant recipients Occasionally, the isolation of Candida from the peritoneal fluid seems to be an incidental phenomenon [205]. For a case to be considered under this category, the following […]

Overview Candida osteomyelitis is one of the less frequent manifestations of invasive candidiasis. However, this condition carries significant morbidity, particularly when its diagnosis is delayed by lack of recognition of Candida spp. as potential bone pathogens. Osteomyelitis due to Candida species can occur following either hematogenous dissemination or direct traumatic inoculation. Epidemiology Limited data are available regarding the incidence of candidal osteomyelitis. Gathe et al. reviewed all reports through to 1986, and found 53 cases, 21 of which were pediatric cases [814]. A decade later, Hennequin et al. reviewed the world literature up to 1995 for cases of Candidal spondylodiskitis, […]

Overview Candida can be implicated as causes of both exogenous endophthalmitis (following surgery or trauma) and endogenous endophthalmitis due to hematogenous seeding of the eye. Candidal exogenous endophthalmitis is comparatively rare. Reported cases have been linked to eye surgery (keratoplasty, cataract extraction), traumatic ulcers, and contaminated ophthalmic irrigation solutions [210, 1166, 1293, 1477, 2434]. Most cases of exogenous endophthalmitis have a bacterial etiology. Conversely, Candida is recognized as the most common cause of endogenous endophthalmitis and that will be the focus of our discussion here. Embolic seeding of Candida spp. into the retina may cause both retinal and vitreal lesions […]

Overview Septic arthritis due to Candida species can be due either to hematogenous dissemination or direct inoculation due to trauma, surgery, or intra-articular injections. Candida arthritis is for the most part a manifestation of disseminated or invasive candidiasis. The literature includes cases of patients with disregarded episodes of candidemia that later presented with Candida arthritis [207, 1600]. However, there are also cases of Candida arthritis that have presented after episodes of candidemia that were treated with appropriate dosages of amphotericin B [937]. Epidemiology Available data regarding the incidence of this rare presentation of Candida infection are limited to case reports […]

b>Authored by:  Carol A. Kauffman, MD Mycology Blastomycosis is caused by Blastomyces dermatitidis or B. gilchristii, thermally dimorphic fungi. In the environment, the organism grows as a mould that produces conidia, which are responsible for transmission of infection to humans. In the laboratory on Sabouraud’s agar at 25-28oC, the organism grows as a fluffy white mould, whose conidia are not distinctive. In tissues and in the laboratory at 35-37oC, B.dermatitidis assumes the yeast form. The yeast form is distinctive, appearing as an 8-15 micron, thick-walled yeast that produces a single, broad-based daughter bud. Epidemiology B. dermatitidis is endemic in the […]

Overview Biliary Candidiasis refers to the infection of the gallbladder and/or the biliary tree caused by Candida spp. Even when Candida is isolated from the bile drained during gallbladder surgeries, such recovery is not enough proof that Candida plays a pathogenic role [274]. However, Candida spp. have been clearly implicated in some cases of biliary diseases: Cholecystitis [10, 843, 1043, 1423, 2054, 2084, 2216, 2380]. The majority of these cases were acalculous cholecystitis. Biliary tract obstruction (fungus ball) [955, 1412, 1435]. Cholangitis [592]. These forms of biliary candidiasis are related to invasive candidiasis in the sense that candidemia or other […]

Overview Asymptomatic means absence of symptoms and colonization is the innocuous presence of a microorganism. Thus, asymptomatic colonization is the condition in which Candida spp. can be grown from a body surface without appearing to be causing a disease. Asymptomatic colonization with Candida spp. is common. However, colonization is also the prelude to development of most candidal infections. This has been particularly well demonstrated for patients at high risk to develop invasive candidiasis [1454, 1808, 2131, 2343]. It has been shown by DNA typing that the colonizing is often identical with the infecting strain [1879, 2343]. Thus, asymptomatic colonization is […]

Overview and Discussion Without a doubt, assessing the significance of a urine culture that has yielded Candida is quite a challenge. Although commonly refered to as “Urinary tract ASYMPTOMATIC colonization” we prefer the term “Insignificant Candiduria”, as many cases of pathologic presence of Candida also occur without any symptomatology. Candida are only rarely found in the urine of healthy individuals. If present at all, colony counts less than 1000 col/ml are found. The incidence of asymptomatic candiduria is higher in girls than boys, which is probably due to vaginal colonization [859]. A single course of antibiotics (erythromycin, amoxacillin, cephalexin, or […]

Definition Aspergillosis refers to the spectrum of disease caused by members of the genus Aspergillus (see Table below). The three principal entities are: allergic bronchopulmonary aspergillosis (ABPA), pulmonary aspergilloma (fungus ball), and invasive aspergillosis [2163]. Colonization of the respiratory tract is also common. The clinical manifestation and severity of the disease depends upon the immunologic state of the patient [218]. Lowered host resistance due to such factors as underlying debilitating disease, neutropenia chemotherapy, disruption of normal flora, and an inflammatory response due to the use of antimicrobial agents and steroids can predispose the patient to colonization, invasive disease, or both […]