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Fungal infections. 400 out of 75,000 Primary infections Opportunistic infections Myco -toxins Allergy. Mycoses. Superficial and cutaneous Subcutaneous Deep (systemic) . Superficial and Cutaneous Mycoses. Skin, hair, nail, mucus membranes Most common World-wide Ringworm infections
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Fungal infections • 400 out of 75,000 • Primary infections • Opportunistic infections • Myco-toxins • Allergy
Mycoses • Superficial and cutaneous • Subcutaneous • Deep (systemic)
Superficial and CutaneousMycoses • Skin, hair, nail, mucus membranes • Most common • World-wide • Ringworm infections • Yeast infections
Subcutaneous Mycoses • Skin, subcutaneous tissues, fascia and bone • Localized • Trauma • More in tropics • Mycetoma, chromomycosis and sporotrichosis
Systemic Mycoses • Deep-seated • Inhalation • Primary (restricted) • Opportunistic (world-wide)
Source of microbes • Food • Drinks • Spices • Dishes • Cutlery
Dishwashers! Found in 40% of homes in UK • They are perfect breeding niche for fungi associated with potentially deadly illnesses • Study on 189 dishwashers in 101 different cities around the world: • 62 % of dishwashers contained fungi on the rubber band in the door • More than half of these included the black yeasts: • Exophialadermatitidis • Exophialaphaeomuriformis • Scedosporiumapiospermum
Source of many fungi • Food, drinks and spices (Aspergillus, Peinicillim • And human own microflora (e.g. Candida)
Could these microbes pass through intestinal barriers and reach our internal organs ?
Microbial translocation Microbial translocation is defined as the passage of viable microbes from the gastrointestinal tract to extra-intestinal sites, such as the mesenteric lymph node, spleen, liver, kidneys, and blood
Systemic mycoses due to opportunistic pathogens • Immune deficiencies: • AIDS • Alteration of normal flora by antibiotics • Immunosuppressive therapy • Cancer • Examples: • Candidiasis, Cryptococcosis, Zygomycosis and Aspergillosis
Candida albicanstranslocation • J Infect Dis. 1993 Nov;168(5):1314-8. • Inhibition of Candida albicanstranslocation from the gastrointestinal tract of mice by oral administration of Saccharomycesspecies
Treatment of invasive intestinal infections • Depending on causative agent: • AmphotericinB Posaconazole or Voriconazole (filamentous fungi) • Fluconazole, Caspofungin, AmphotericinB or Voriconazole (yeast infection) • AmphotericinB (dimorphic and zygomycetes)
Polyene antifungal agents • Amphotericin B • Nystatin
Azoles antifungal agents • Clotrimazole • Econazole • Ketoconazole • Miconazole • Fluconazole • Itraconazole • Posaconazole • Voriconazole
Other antifungal agents • Echinocandins • Anidulafungin • Caspofungin • Micafungin • Terbinafine • 5-fluorocytosine