Introduction:
Aging is a physiological process. It is characterized by functional and morphological changes in the body. Such changes are caused by the production of reactive oxygen species, accumulation of waste products, and changes in hormonal activity. As a result, functional and immune depletion in older individuals is very common. This causes some rare infections in elderly people. These infections are caused by fungi or some opportunistic pathogens.
What Are the Common Fungal Skin Infections in the Elderly?
The common fungal infections in the elderly are:
1. Oral Candidiasis: This is one of the most common fungal infections seen in elderly people. It is seen in the oral cavity and is often called an oral thrush. The causative organism involved in this condition is Candida albicans. Other causative organisms involved are Candida glabrata, Candida tropicalis, Candida kruesi, Candida guillermondii, and Candida lusitaniae. This is most commonly seen in the ventral surface of the tongue, hard palate, soft palate, retromolar area, and corner of the mouth. This is most commonly seen in immunocompromised patients. Patients are suffering from diabetes and malnutrition. Other risk factors associated with this condition are poor oral hygiene, ill-fitting dentures, inhaler use, and radiation therapy. The lesion of the oral thrush appears as a whitish area. However, in some cases, lesions are erythematous or ulcerative in nature. Patients often complain of a burning sensation in the mouth, difficulty in talking, difficulty in chewing, and bleeding from the affected area.
-
Management: Topical antifungal agents such as Miconazole, Clotrimazole, and Ketoconazole are useful to treat this condition. Oral rinse with Betadine or Chlorhexidine can be useful in improving oral hygiene status. Also, multivitamins can be used to improve the nutritional condition of the patient.
2. Seborrheic Dermatitis: This is a common skin disorder seen in older individuals. The most commonly involved areas in this condition are the face and scalp. Other than this, areas like eyebrows, glabella region of the forehead, nasal alar creases, nasolabial folds, and ear folds are commonly affected. The affected area often causes irritation, pain, and itching. In some cases, loss of hair and the presence of whitish flakes are noted. The commonly associated organism with this condition is Malassezia spp. The predominant Malassezia species linked to seborrheic dermatitis are M. globosa and M. restricta. The other species that are associated with this condition are M furfur, M sympodialis, M obtuse, M slooffiae, and M pachydermatis. These fungi cause the degradation of fat in the sebaceous gland and cause skin inflammation. A reduction in the immunity in the body is associated with the pathogenesis of this condition. This condition is very common in persons suffering from AIDS.
M. globosa is also associated with another skin lesion known as tinea versicolor. Another name for this condition is pityriasis versicolor. These lesions are seen in the arms, tranks, and neck region. These lesions appear as hypo or hyperpigmented areas with patches or plaques. In some cases, erythematous areas associated with these lesions are observed.
-
Management: Topical application of 2 percent Ketoconazole, 1 percent Ciclopirox, 1 percent Zinc pyrithione, and 1 percent hydrocortisone can be useful. Systemic application of Itraconazole, Fluconazole, and Terbinafine are indicated in severe cases.
3. Tinea Capitis: This is a fungal infection of the hair shaft. This infection is caused by Trichophyton tonsurans and Microsporum canis. Though this infection is very common among children, it is sometimes seen in elderly people as well. A break in the hair shaft is the most clinical symptom of this condition. Apart from this, round to oval patchy areas of lost hair are seen in this condition. The scalp skin often shows redness with symptoms of itching. In serious conditions, pus-filled abscesses are observed on the scalp.
What Are the Fungal Systemic Infections of the Elderly?
The systemic fungal infection that affects various organs are:
1. Chronic Cavitary Pulmonary Histoplasmosis: This disorder is caused by Histoplasma capsulatum. Persons suffering from emphysema of the lungs or pulmonary histoplasmosis are often affected by this condition. It is commonly seen among the construction workers, factory workers, and smokers. Persons suffering from chronic obstructive pulmonary disorder, tuberculosis, and AIDS often suffer from this condition. Patients often complain of fever, weight loss, and cough with blood. The symptoms of this condition coincide with symptoms of tuberculosis. The presence of cavitation in the lungs and the pleural thickening are the radiographic features of this condition. These radiographic features are mainly seen in the upper lobes of the lungs.
-
Management: Administration of antibiotics like Amphotericin B is the most common method of treatment in this condition. Severe cases can be treated by surgical removal of the affected portion of the lungs. The most recent drug recommended for this condition is Itraconazole.
2. Infection Of the Hospitalized Patients: Several fungal infections may infect hospitalized older individuals. In most cases, these infections are caused by Aspergillus flavus, Aspergillus terreus, and Aspergillus fumigatus. Other pathogens that may infect hospitalized individuals are zygomycetes and Blastomyces dermatitidis. Immunocompromised individuals or persons suffering from AIDS may be infected by these pathogens. Even cancer patients or patients receiving chemotherapy are susceptible to such infections. These fungal infections usually affect the lungs, nose, and eyes. Pain in the periorbital region, loss of vision, and difficulty in breathing are the hallmark features of such infection.
3. Post-COVID-19 Fungal Infection: The COVID-19 pandemic is associated with a major shift in the immune condition of elderly people. Reduced immunity, either caused by COVID-19 infection or a side effect of steroid treatment, is responsible for such infection. The most common fungal infection in this category is mucormycosis. It is caused by pathogens such as Absidiacorymbifera, Rhizopus microsporus var. rhizopodiformis, and Apophysomyces elegans. These pathogens belong to the mucoraceae family. These fungal infections are responsible for some severe complications like rapid bone destruction, loss of vision, and loss of neural sensations in the orofacial regions. Involvement of the gastrointestinal tract causes abdominal pain, bleeding in the abdomen, and vomiting.
-
Management: Management of such infectious conditions is really challenging. In some cases, surgical dissection of the affected part is necessary. Administration of newer drugs like Amphotericin B Liposomal (LAmB) and Isavuconazole can be useful in these cases.
Conclusion:
Fungal infections in elderly people are not common. This is mainly caused by several systemic disorders or due to immunosuppression. Fungal skin infections in the scalp, face, and oral regions are most common. However, systemic fungal infection cases are increasing day by day. Such systemic infections may cause severe complications.
