i. Athlete Foot: Trichophyton
Athlete's foot is a very common skin condition that affects the sole of the foot and the skin between the toes. It is usually a scaly, red, itchy eruption and occasionally may be weepy and oozing. It affects the feet of athletes and nonathletes alike. Although it is frequently caused by a fungal infection, other causes may be indistinguishable without proper testing.
The medical name for athlete's foot caused by a fungus is Trichophyton. There are a variety of fungi that cause athlete's foot, and these can be contracted in many locations, including gyms, locker rooms, swimming pools, nail salons, and from contaminated socks and clothing. The fungi can also be spread directly from person to person by contact. Most people acquire fungus on the feet from walking barefoot in areas where someone else with athlete's foot has walked.
There are three common types of fungal athlete's foot:
Athlete's foot is a fungal infection of the skin. Moccasin-type athlete's foot may begin with minor irritation, dryness, itching, burning, or scaly skin on the sole and heel of the foot. It then progresses to thickened, cracked, peeling skin. In severe cases, the toenails become infected and can thicken, crumble, and even fall out.
Interdigital tinea pedis is the most common form and usually manifests in the interspace of the fourth and fifth digits and may spread to the underside of the toes. Patients often complain of itching and burning sensations on the feet accompanied by malodor.
There are generally two types of interdigital tinea pedis. The first is a scaly, dry type called dermatophytosis simplex. The skin of the interdigital space is dry with low-grade peeling. This form is usually asymptomatic except for occasional pruritus.
The second type is symptomatic and presents with wet, macerated interdigital spaces. Dermatophytosis complex, as it is called, may have fissuring of the interspace along with hyperkeratosis, leukokeratosis, or erosions. Wet conditions along with fungal invasion increases the incidence of bacterial infection in these patients by breaching cutaneous integrity.
A collection of fluid underneath the top layer of skin (epidermis). There are many causes of blisters, including burns, friction forces, and diseases of the skin. Also known as bleb and bulla.
According to the Centers for Disease Control and Prevention, "Nails should be clipped short and kept clean. Nails can house and spread the infection." Recurrence of athlete's foot can be prevented with the use of antifungal powder on the feet.
Keeping socks and shoes clean is one way to prevent fungi from taking hold and spreading. Avoiding the sharing of boots and shoes is another way to prevent transmission. Athlete's foot can be transmitted by sharing footwear with an infected person. Hand-me-downs and purchasing used shoes are other forms of shoe-sharing. Not sharing also applies to towels, because, though less common, fungi can be passed along on towels, especially damp ones.
Athlete's foot resolves without medication in 30 – 40% of cases. Conventional treatment typically involves thoroughly washing the feet daily or twice daily, followed by the application of a topical medication. practicing good hygiene is crucial for killing the fungus and preventing reinfection.
Because the outer skin layers are damaged and susceptible to reinfection, topical treatment generally continues until all layers of the skin are replaced, about 2 – 6 weeks after symptoms disappear. Keeping feet dry and
ii. Madura Foot: Madurella
Madura foot is also known as mycetoma. Chronic granulomatous disease characterized by localized infection of subcutaneous tissues and sometimes bone characterized by discharging sinuses filled with organisms like actinomycetes or fungi.
This disease first discovered by “Gill” at Madura district of India in 1842. That’s why this term is Madura foot is used for this disease.
* The infection can be caused by true fungi (eumycetoma) in 40%, or filamentous bacteria (actinomycetoma) in 60%.
* Actinomycetoma may be due to Actinomadura madurae, Actinomadura pelletieri, Streptomyces somaliensis, Nocardia spp.
* Eumycetoma is often due to Pseudallescheria boydii (Scedosporium apiospermum), Madurella mycetomatis.
* Infection enters through sites of local trauma - eg, a cut or splinter, causing a granulomatous reaction. Spread occurs through skin facial planes and can involve the bone. It most commonly involves the foot but can involve the hands, back or shoulders.
No vaccine is available. Simple hygienic precautions like wearing shoes or sandals while working in fields, and washing hands and feet at regular intervals may help prevent the disease. Drugs like ketoconazole, voriconazole, and itraconazole are generally employed in treating the infection. Actinomycetes usually respond well to medical treatment, but the eumycetes are generally resistant and may require surgical interventions including amputation.
iii. Ringworm: Microscorium
Ringworm is a common fungal skin infection otherwise known as tinea. Ringworm most commonly affects the skin on the body (tinea corporis), the scalp (tinea capitis), the feet (tinea pedis, or athlete's foot), or the groin (tinea cruris, or jock itch).
Certain fungi can help the body, but the dermatophyte type that cause ringworm irritate the skin instead. These fungi live off the dead tissues of your skin, hair, and nails. Dermatophytes thrive in warm, moist areas, such as the skin folds of the groin area or between the toes. You’re at greater risk of getting ringworm if you sweat excessively or have minor injuries to your skin, scalp, or nails.
* Itchy, red, raised, scaly patches that may blister and ooze.
* The patches tend to have sharply-defined edges.
* Red patches are often redder around the outside with normal skin tone in the center. This may look like a ring.
* Avoid sharing clothing, sports equipment, towels, or sheets.
* Wash clothes in hot water with fungicidal soap after suspected exposure to ringworm.
* Avoid walking barefoot; instead wear appropriate protective shoes in locker rooms and sandals at the beach.
* After being exposed to places where the potential of being infected is great, wash with an antibacterial and antifungal soap or one that contains tea tree oil, which contains terpinen.
* Avoid touching pets with bald spots, as they are often carriers of the fungus.
Candidiasis, commonly called a yeast infection, is an infection caused by a fungal microorganism, most often the fungus Candida albicans. Candidiasis is also known as candida and thrush.
It can cause yeast infections in many areas of the body including:
* Mouth (oral thrush)
* Vagina (vaginal yeast infection, vaginal thrush)
* Digestive tract (gastroenteritis)
The fungus that causes most cases of candidiasis, Candida albicans, normally lives in the mouth, vagina, and other places in the body. It exists in a certain balance with other microorganisms, including bacteria. However, some factors or conditions may cause an overgrowth of Candida albicans resulting in candidiasis. Candidiasis can also be passed from a pregnant woman to her child during pregnancy or breastfeeding.
In women, signs and symptoms of a vaginal yeast infection are a white cheesy discharge that typically itches and irritates the vagina and surrounding outer tissues. On occasion there may be pain during sexual intercourse or burning with urination.
Oral candidiasis is called oral thrush. Thick, white lacy patches on top of a red base can form on the tongue, palate or elsewhere inside the mouth. These patches sometimes look like milk curds but cannot be wiped away as easily as milk can. If the white plaques are wiped away, the underlying tissue may bleed. This infection also may make the tongue look red without the white coating. Thrush can be painful and make it difficult to eat. Care should be given to make sure a person with thrush does not become dehydrated.
If Candida gets into your bloodstream, you may become sick with or without fever. If the infection spreads to your brain, you may have acute changes in mental function or behaviour.
A diet that supports the immune system and is not high in simple carbohydrates contributes to a healthy balance of the oral and intestinal flora. While yeast infections are associated with diabetes, the level of blood sugar control may not affect the risk.
Wearing cotton underwear may help to reduce the risk of developing skin and vaginal yeast infections, along with not wearing wet clothes for long periods of time.
v. Blastomycosis: Blastomyces Dermatidis
Blastomycosis is a fungal infection of humans and other animals, notably dogs and occasionally cats, caused by the organism Blastomyces dermatitidis. Endemic to portions of North America, blastomycosis causes clinical symptoms similar to histoplasmosis. The disease occurs in several endemic areas the most important of which is in eastern North America, particularly in the western and northern periphery of the Great Lakes Basin, extending eastward along the south shore of the St. Lawrence River Valley and southward in the territory spanned by the central Appalachian Mountains in the east, to the Mississippi River Valley in the west. Sporadic cases have been reported in continental Africa, the Arabian Peninsula and the Indian subcontinent.
* A flu-like illness with fever, chills, arthralgia (joint pain), myalgia (muscle pain), headache, and a nonproductive cough which resolves within days.
* An acute illness resembling bacterial pneumonia, with symptoms of high fever, chills, a productive cough, and pleuritic chest pain.
* A chronic illness that mimics tuberculosis or lung cancer, with symptoms of low-grade fever, a productive cough, night sweats, and weight loss.
* A fast, progressive, and severe disease that manifests as ARDS, with fever, shortness of breath, tachypnea, hypoxemia, and diffuse pulmonary infiltrates.
* Skin lesions, usually asymptomatic, can be verrucous (wart-like) or ulcerated with small pustules at the margins.
* Bone lytic lesions can cause bone or joint pain.
* Prostatitis may be asymptomatic or may cause pain on urinating.
* Laryngeal involvement causes hoarseness.
* 40% immunocompromised individuals have CNS involvement and present as brain abscess, epidural abscess or meningitis.
vi. Otomycosis: Aspergillus fumigans
Otomycosis is an acute, subacute or chronic fungal infection of the pinna, external auditory meatus and the ear canal. Factors that predispose to otomycosis include absence of cerumen, humid climate, increased temperature, instrumentation of the ear and increased use of topical antibiotic/ steroid preparations. Aspergillus niger and Candida albicans are the most common causative agents of otomycosis. Here we present an unusual case of chronic otomycosis caused by Malassezia species.
Careful drying and cleaning of external auditory canal is the first step in treatment, which is done preferably by suction evacuation (Patow, 1995). Syringing of external auditory canal should be avoided as it may sometimes lead to flare up ofthe infection to deeper anatomical sites, particularly when the tympanic membrane is perforated and is not visible due to impacted debris material overlying it. If the facilities of suction evacuation are not available, syringing should be done under all aseptic conditions with normal saline mixed with antifungal powder. The ear should be mopped up absolutely dry following syringing as moisture support continued growth of fungi. Although slightly painful, methylated spirit may be used to dry mop the ear.