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Fungal infections 400 out of 75,000 Primary infections Opportunistic infections Myco-toxins Allergy

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Mycoses Superficial and cutaneous Subcutaneous Deep (systemic)

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Superficial and Cutaneous Mycoses Skin, hair, nail, mucus membranes Most common World-wide Ringworm infections Yeast infections

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Subcutaneous Mycoses Skin, subcutaneous tissues, fascia and bone Localized Trauma More in tropics Mycetoma, chromomycosis and sporotrichosis

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Systemic Mycoses Deep-seated Inhalation Primary (restricted) Opportunistic (world-wide)

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GIT Mycoses

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DANGEROUS ORGANISMS AROUND US

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Source of microbes Food Drinks Spices Dishes Cutlery

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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: Exophiala dermatitidis Exophiala phaeomuriformis Scedosporium apiospermum

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Source of many fungi Food, drinks and spices (Aspergillus, Peinicillim And human own microflora (e.g. Candida)

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Could these microbes pass through intestinal barriers and reach our internal organs ?

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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

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Systemic mycoses due to opportunistic pathogens Immune deficiencies: AIDS Alteration of normal flora by antibiotics Immunosuppressive therapy Cancer Examples: Candidiasis, Cryptococcosis, Zygomycosis and Aspergillosis

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Candida albicans translocation J Infect Dis. 1993 Nov;168(5):1314-8. Inhibition of Candida albicans translocation from the gastrointestinal tract of mice by oral administration of Saccharomyces species

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Systemic mycoses due to primary pathogens AgentinfectionDissemination Blastomyces dermatitidis BlastomycosisSkin and bone Later nervous system and visceral organs Coccidioides immitisCoccidioidomycosisSkin, bones, joints, subcutaneous tissues, and visceral organs Paracoccidioidoes brasiliensis ParacoccidioidomycosisOro-nasal mucosa latter spleen, liver, intestine and skin Histoplasma capsulatum Histoplasmosis Acute pneumonia (cave disease) Chronic pneumonia (smoker) Disseminated (immunocompromised) Primary cutaneous (lab accidents)

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Treatment of invasive intestinal infections Depending on causative agent: Amphotericin B Posaconazole or Voriconazole (filamentous fungi) Fluconazole, Caspofungin, Amphotericin B or Voriconazole (yeast infection) Amphotericin B (dimorphic and zygomycetes)

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Polyene antifungal agents Amphotericin B Nystatin

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Azoles antifungal agents Clotrimazole Econazole Ketoconazole Miconazole Fluconazole Itraconazole Posaconazole Voriconazole

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Other antifungal agents Echinocandins Anidulafungin Caspofungin Micafungin Terbinafine 5-fluorocytosine