Cutaneous Manifestations of Systemic Mycoses in Immunocompromised Patients

Introduction:

Systemic mycoses are a type of candidal or fungal infection affecting the internal organs of the human body. Through blood, the fungus can disseminate to various other body sites. Sometimes, it may affect the deeper tissues called deep mycoses. The fungus involves the central nervous system, which is difficult to eradicate if the medical treatment is not given on time, and the affected person may die. The fungi can be superficial or cutaneous mycoses. The respiratory system is the main system involved in the systemic mycoses. The infection can occur through the inhalation of air-borne conidia. Proper treatment is required to prevent the patient from life-threatening infection and death. The article discusses systemic mycoses, their causes, risk factors, signs and symptoms, diagnosis, treatment, and prevention.

What Are Systemic Mycoses?

Systemic mycoses are fungal infections that affect the internal organs when the fungi enter the human body through the lungs, to the intestine, the sinuses, or the skin. It can affect multiple organs through the bloodstream, such as the skin, and cause organ failure, causing patient death. Immunocompromised individuals or individuals with a weakened immune system are at high risk of getting infected. If the condition affects immunocompromised individuals, it is called opportunistic mycotic infection.

What Are the Causes of Systemic Mycoses?

The predisposing individuals for systemic mycoses are immunocompromised individuals. However, the condition may affect a healthy person. The causes of systemic mycoses are described under two varieties: endemic respiratory infections and opportunistic infections. These are described as follows:

1. Endemic Respiratory Infections: This type of infection affects people with normal or healthy immune systems and immunocompromised people or people with weakened immune systems. The fungi responsible for causing systemic mycoses in immunocompromised individuals and normal healthy people include:

• Histoplasma capsulatum (this fungus causes histoplasmosis). Samuel Darling first described this, also called Darling disease. The fungus is present in the soil, rotting areas, and the feces of bats and birds. Healthy people or immunocompromised people inhale conidia or mycelial fragments and convert them into yeasts, causing localized granulomatous inflammation. The fungi are predominant in the southern United States, South America, Africa, Asia, and Central America.

• Coccidioides immitis (which causes coccidioidomycosis) is a fungus that affects the lungs and respiratory tract. It is present in soil and rodents. The infection mainly occurs through the inhalation of arthroconidia, which may recur in immunocompromised individuals. The fungus is common in the southern United States and Central America.

• Blastomyces dermatitidis (causes blastomycosis). It is caused by the inhalation of spores and is transformed into yeasts when these spores reach the lungs. It is also called Gilchrist disease or Chicago disease. It is common in North America.

• Paracoccidioides brasiliensis (causes paracoccidioidomycosis) is a granulomatous infection affecting the lungs and disseminating into the skin, mucosa, and internal organs. It grows as a budding yeast in tissue and may grow as yeast or mold on a culture medium. The condition mainly affects the nasal and oral mucosa, gingiva, and conjunctiva.

• Penicillium marneffei (causes penicilliosis) is also called Talaromyces marneffei. It is endemic in tropical Southeast Asia.

2. Opportunistic Infections: The fungi affect immunocompromised individuals or sick individuals. The fungi responsible for causing opportunistic infection are as follows:

• Candida species causes candidiasis. It is a common fungal disease affecting humans. It affects the mucosa, skin, internal organs, and nails, causing deep and superficial infections. Candida albicans is the most common pathogenic species. Candida flora is present on the skin, gastrointestinal tract, and female genital tract. It is the most common fungal infection affecting immunocompromised individuals, such as HIV (human immunocompromised virus) individuals.

• The Aspergillus species causes aspergillosis.

• Cryptococcus causes cryptococcosis.

• Zygomycetes cause zygomycosis.

What Are the Risk Factors of Systemic Mycoses?

The risk factors of systemic mycoses are as follows:

• Old and young individuals.

• Immunocompromised individuals.

• Human immunodeficiency virus (HIV).

• Systemic malignancy (cancer).

• Organ transplant individuals.

• Poorly controlled diabetes mellitus.

• Neutropenia (low white blood cell count).

• After a major surgical operation.

What Are the Signs and Symptoms of Systemic Mycoses?

People with normal immune systems or healthy people may experience minor symptoms, and some people may not experience any symptoms. The general symptoms of systemic mycoses are as follows:

• Fever.

• Cough.

• Loss of appetite.

The signs and symptoms affecting internal organs are as follows:

• Lungs: The lungs are affected when the fungal spores are inhaled by the person and reach the lungs, causing dry cough, fever, breathing pain, and shortness of breath. If the condition is left untreated, it can become a life-threatening condition, such as acute respiratory distress syndrome. Sometimes, the person may experience coughing up blood (hemoptysis) if the inflammation affects the airways.

• Bone: The fungal infection may involve the bone when the infection spreads through the bloodstream. The affected person may experience pain in the affected bone.

• Brain: If the fungal infection involves the brain, it causes a life-threatening condition. The affected person may experience headaches, seizures, and brain deficits.

• Meningitis: It is the inflammation of the brain lining caused by candidiasis and cryptococcosis. The affected person may experience headaches, irritability, and stiff neck.

• Eyes: Candida species and Cryptococcus species affect the ocular structures. The affected person may experience blurred images, red eyes, dark and black images.

Skin or Cutaneous Manifestation:

• Histoplasmosis: There will be mouth ulcers, scaly patches, nodules, sinuses, or abscesses.

• Coccidioidomycosis: There will be hypersensitivity reactions. The affected person may experience a generalized red rash, papular lesions, plaques, abscesses, and ulceration.

• Blastomycosis: Nodules, papules, abscesses, ulcers, and scars will appear.

• Aspergillosis: A red patch with black dead tissue will be present at the center.

• Cryptococcosis: There will be skin eruptions, such as papules, abscesses, sinuses, ulcers, and bleeding on the skin.

• Penicilliosis: There will be a presence of ulcers and papules.

• Zygomycosis: There will be firm and hard nodules that involve the nose and sinuses.

• Candidiasis: Red papules and nodules will form.

How Are Systemic Mycoses Diagnosed?

The healthcare provider may perform a skin biopsy by taking a small sample from the affected area and observing it under a microscope to see the associated fungal spores causing the infection. In addition, blood and fungal cultures are done to confirm the diagnosis. Furthermore, the doctor may ask the patient about the patient's travel history to the endemic areas.

How Are Systemic Mycoses Treated?

The healthcare provider may prescribe antifungal medications and immunosuppressant medications. The suitable antifungal medications are as follows:

• Amphotericin B.

• Fluconazole.

• Itraconazole.

• Voriconazole.

• Caspofungin.

Conclusion:

Systemic mycosis is a fungal infection that affects the lungs, bones, skin, and brain. Immunocompromised individuals and healthy individuals experience symptoms, such as the formation of patches, nodules, or ulcers. If the condition is not treated on time, it may cause life-threatening complications and even death. If the person is experiencing any systemic symptoms, they should contact a healthcare provider immediately to prevent complications.