Mycoses

Definition

Mycosis is a group of infectious diseases caused by pathogenic (pathogenic) fungi.

Etiology

Pathogenic fungi are numerous and diverse. They affect humans and animals, some of them are monopathogenic. Currently, several hundred mushrooms are known to be dangerous to humans. Pathogenic fungi, their genera and species are distributed in different families, subclasses and classes of mushrooms. Among fungi, unicellular and multicellular are found. The size and shape of the cells varies depending on the environment and age. A feature is the ability to form mycelium - a round tube with a diameter of 1 to 10 microns and various lengths. The plexuses of the mycelium form a mycelium. Mushrooms of the genus Candida have the ability to form pseudomycelia. The propagation of fungi is carried out by division, germination, budding of the cell and diverse sporulation. Spores in fungi are a means of reproduction and distribution in the external environment. Vital activity is associated with sporulation (spore formation), and in some cases pathogenic properties. Mushroom spores, poor in water, are resistant to drying and solar radiation, easily and quickly enter the external environment, infect people and animals when breathing. Disputes are of great importance in the formation of aerogenic sensitization of the population in densely populated regions, inadequate dwellings, industrial premises, etc.

Some pathogenic fungi saprophytize in soil or water, on living plants and dead plant materials, on the skin and mucous membranes of animals and humans, without causing disease. Mushrooms are aerobic microorganisms. Pathogenic fungi are immobile, their distribution in the environment is carried out by colonization of the substrate or by mechanical transfer of cellular elements by air, water and other factors. Pathogenic fungi are characterized by variability in the structure of cells and the nature of cultures, their biological characteristics, viability and pathogenicity. Passages through the body of susceptible macroorganisms strengthen, and immunity (immunized) weaken the pathogenicity of fungi. According to parasitic activity, fungi are divided into anthropophilic (affect only humans), bestial (only animals), as well as pathogenic for humans and animals.

Pathogenesis

Mushrooms enter the body in various ways. The primary focus is localized in the area of ​​the entrance gate. For some mycoses, the respiratory organs are the entrance gate, but most fungi enter the human body through damaged skin and mucous membranes (injuries, bruises, cuts, etc.). The development of fungal infections contributes to frequent skin hydration. Factors predisposing to the development of mycoses are chronic diseases, prolonged use of antibacterial agents, steroid therapy, leaving catheters in the body for a long time, immune system deficiency, leukemia, malignant tumors, treatment with cytostatics, radiation, hormonal and metabolic disorders. In some cases, frequent and prolonged contact with microscopic fungi leads to the development of deep and systemic lesions even in practically healthy people: professional mycoses and allergies in milling mills, cotton sorters, people involved in the processing of hemp, flax and other moldy raw materials.

Several periods are conditionally distinguished in the development of fungal diseases. Immediately after the introduction of the fungus, an incubation period begins, the duration of which can be from one week to several months. This is followed by a period of predecessors, not clearly delimited with certain mycoses. Without appropriate therapy, some mycoses may occur throughout the patient's life. A fatal outcome is observed with deep septicopyemic forms and with damage to vital organs. After introduction into the human body, most fungi develop in the place of the entrance gate: in the skin, mucous membranes, soft tissues, respiratory organs, gastrointestinal tract, and urogenital system. Some fungi from the primary focus migrate to the lymph nodes, blood-forming organs, liver and spleen, where they can multiply. The ability of fungi to spread hematogenously leads to a mycotic lesion of the central nervous system, joints, and bones.

Most fungi have a pronounced tropism, i.e., selectively affect certain tissues.

With organ mycoses, the lungs and intestines are often affected, less often the spleen, liver and heart, lesions of the nervous system and musculoskeletal system are rare.

Pathological changes in internal organs are characterized by granulomatous changes of varying intensity. Suppurative forms of damage are characteristic of especially dangerous mycoses (chronic coccidiosis, blastomycosis). Vegetative and ulcerative lesions of the skin and subcutaneous tissue, lymph nodes and blood vessels occur with chromomycosis, sporotrichosis, and sometimes with dermatomycosis. Recently, a frequent clinical manifestation is mycotoxicosis, mycogenic sensitization (allergization) of living and dead cells of fungi and their metabolic products. There are polymycoses caused by 2-3 species of fungi, and mixed mycoses due to the association of pathogenic and conditionally pathogenic fungi with various bacteria and viruses. At the same time, atypical, erased forms of fungal diseases and mycobacteria are often found.

The cellular response to pathogenic fungi is diverse:

• acute and chronic suppuration with a predominance of:
  • lymphocytes and plasma cells,
  • histiocytic reaction with or without the formation of giant cells;
• the formation of tuberculoid granulomas with caseous necrosis or without it, with microabscesses;
• necrotic changes of an ischemic or toxic nature.

Reparative processes are aimed at differentiating the fungus from healthy tissues with various cellular elements, varying degrees of phagocytic activity of special cellular forms, the reticuloendothelial system, calcification of lesions in the parenchymal organs, rejection of the pathogenic fungus and expelling it from damaged tissues, impregnating it with substances of complex nature, confinement to and grain or dissolution (as a more pronounced immune response).

The body's resistance to pathogenic fungi is ensured by the action of specific and non-specific defense mechanisms. As with other infectious diseases, antibodies are detected in the process of mycosis development in the blood. Antibodies appear during the first 4-5 days, increase rapidly over several weeks, reach maximum titers, which gradually decrease in the future, but are accompanied by increased production of antibodies and allergic reactions to re-infection.

Clinical picture

The clinical manifestations of mycoses are diverse. With the flow, they are divided into acute and chronic, superficial and deep, focal and common. Currently, fungal sepsis and pyemia are recorded with dissemination (spread and penetration) of the pathogen into various organs and tissues (secondary lesions). The following groups of mycoses are distinguished: keratomycoses, dermatomycoses, candidiasis, blastomycosis, coccidioid mycosis, histoplasmosis, mold mycoses, sporotrichosis, rare mycoses (rhinosporidiosis, chromomycosis).

Keratomycosis

With keratomycosis, the most superficial sections of the stratum corneum and hair cuticle are affected. Inflammatory changes in the underlying sections are mild or absent.

Multi-colored lichen (pityriasis versicolor) (see also: Lichen) is a fungal disease characterized by brown and white spots on the surface of the skin of the predominantly upper part of the body. The foci are usually not accompanied by inflammation and are well limited from the adjacent areas. The disease most often spreads in tropical areas and countries with high humidity. Mostly young people and children get sick. The disease is contagious, but develops with a predisposition. Predisposing factors may include increased sweating, a change in the chemical composition of sweat, seborrhea, and reduced nutrition.

Yellowish-pink non-inflammatory spots appear on the skin, which quickly take on a brown color. The foci are small at first, increase due to peripheral growth and are located around the hair follicles on the skin of the neck, chest, abdomen, back, in children - often on the scalp (hair is not involved in the process). The surface of the foci is peeling. Small scales resemble bran. In a humid climate, foci quickly spread, merge and capture the skin of the face, limbs, inguinal folds. After exfoliation, pseudochromatia occurs - normally pigmented areas on the background of tanned skin. The course is chronic, prone to relapse. Any sensations (itching, burning) are absent. The disease is prone to recurrence.

Piedra is a disease of the hair cuticle, characterized by the formation of nodules of white or black color on the hair (white pedera, black pedera). The causative agent of the white pedestrian is Trichosporon, and the black one is Piedraria. White pedestrian is found in Europe and Asia, black - in countries with a tropical climate. Infection occurs when using the patient’s clothing, linen and personal hygiene items (combs, headbands, hats). The development of the disease contributes to increased humidity, violation of the integrity of the hair cuticle, the use of water to wash your hair from unverified water bodies, lubricating hair with milk and linseed oil. The disease is chronic. Small, very dense nodules of white or black color appear on the surface of the hair, which have an oval or irregular shape. Only the hair shaft is affected, but breaking it off does not occur.

Dermatomycosis

Dermatomycoses are divided into epidermophytosis, trichophytosis, microsporia and foot mycoses. A common clinical sign is the formation of ring-shaped pinkish lesions on the skin with a whitish center and marginal impetigo. Affected hair is whitish gray, brittle. Nail plates are deformed, thickened, crumble. The periungual ridges are swollen, inflamed. Visceral, septicopyemic and allergic forms may develop. Without treatment, dermatomycosis lasts for years. People of all ages, animals, birds get sick.

Epidermophytosis - mycosis of large folds of the skin, with a rare involvement in the pathological process of the nail plates and skin of the feet. It is found everywhere. The causative agent is Epidermophyton. Infection occurs when using objects whose surface is contaminated with scales from a patient with this mycosis, poorly disinfected vessels, oilcloths, thermometers, etc. When localizing mycosis on the feet - in bathhouses and other public places where they walk barefoot. A feature of the disease is a certain androtropism, since men are more likely to get sick. A moist environment and increased sweating contribute to the development of the disease. The skin is affected in large folds of the body (inguinal, gluteal, axillary, under the mammary glands, less often interdigital). This inflammatory nature of the spots is red or red-brown in color, well delimited from the surrounding skin, rounded, merge with each other. On the periphery, the spots have a well-defined continuous roller, consisting of vesicles, small pustules and scales. The course is acute at first, and if untreated, it becomes chronic.

Mycoses of the feet - usually chronically occurring mycoses with a predominant localization of rashes in the interdigital folds and on the skin of the feet, frequent damage to the nail plates. The causative agent is dermatophytes Trichophyton and others, as well as mold. Prevalence is ubiquitous. Infection occurs more often in public places: baths, showers, bathtubs, pools, beaches, gyms, and through shoes infected with dermatophytes. Predisposing factors are conditions of high and low humidity, functional disorders of the vessels of the lower extremities, microtrauma, flat feet, prolonged use of rubber shoes, and a decrease in immunity. Clinical disease is characterized by superficial ulceration, eczematization, or large plate desquamation. The skin on the arches of the feet is affected, first in the form of dyshidrotic vesicles, then - large-plate peeling. The nails are affected. They are grayish-dirty, thickened, crumble, the surface is uneven. With allergic forms, skin manifestations are diverse, occur intermittently and are secondary in nature. Fungal elements are not found in them. The course is chronic with a tendency to exacerbation.

Trichophytosis is a fungal disease of the skin and its appendages, caused by anthropophilic, bestial and geophilic Trichophytons. Prevalence is ubiquitous. The source is sick people and animals with superficial and chronic trichophytosis. Infection is carried out by direct contact or through household items. On the smooth and scalp of the scalp appear ring-shaped, scaly, rarely pustular lesions.

With a suppurative form of lesion of the scalp, the foci of inflammation are ordinary, bright red in color, soft consistency, with purulent contents.

In chronic trichophytosis of adults, on the flaky foci of the scalp you can see the "black dots" of short-broken, sometimes twisted hair with fungal spores, which can be detected with a magnifier. Deep granulomatous lesions of the skin, lymph nodes and internal organs (lungs, gastrointestinal tract, central nervous system), as well as septicemia forms with lethal outcome can be noted. A special form of trichophytosis is a favus with characteristic saucer-like crusts of a yellowish yellowish consistency (scutula), which subsequently leads to scarring and persistent baldness at the lesion sites. Nail damage during trichophytosis is intermittent, more often with a prolonged course and layering of the bacterial flora.

Microsporia - mycosis of the skin, hair, sometimes nails, due to various types of fungi of the genus Microsporum. Anthropophilic, bestial and geophilic microsporums are distinguished. Infection occurs through a contact-domestic way. The source of infection is a sick person, cats, dogs. Mostly children get sick. Microtraumas of the skin are important, where fungi begin to develop rapidly.

Microsporia

The lesions are localized on the hair and smooth skin, have different sizes, can merge into garlands. The affected hair is grayish-white with a cover at the base, easily removed. On the trunk, fluffy hair is affected. Sometimes abscess forms are found.

Favus is a chronically occurring disease of the skin and its appendages, characterized by the formation of cheekbones, cicatricial-atrophic changes at the site of the former rashes and a rare damage to internal organs. The causative agent belongs to the genus Trichophyton. The disease is widespread in Asia and Africa. Mostly children get sick. The source of infection is the patient. Way of transfer contact household. The causative agent can spread hematogenously (with blood flow), which leads to damage to internal organs and bones. The main symptom is the formation of a favus shield - the scutula. At the injection site, a red spot (around the hair) forms, which peels off easily, and a yellow dot, which increases in diameter to 2-3 or more centimeters. Rising along the periphery, the skutula looks like a miniature saucer.

Scooters merge, forming crusts of "canary" color. Characteristic is the smell that comes from the scutula ("barn", "mouse"), due to the presence of microorganisms in the scutulas. The hair is dull, lose shine and elasticity, resemble bundles of tow. There is no broken hair, but cicatricial atrophy is formed - the skin is thinning, the follicular apparatus atrophies. On the scalp, in addition to the scutular, there is an impetiginous, squamous and suppurative form of the favus. On smooth skin, erythematous-squamous lesions are formed that resemble seborrheic eczema, psoriasis, and other dermatoses. There is an increase in regional lymph nodes.

Favus of nails is more often observed in adults: yellow plates are visible in the thickness of the nail. Nail configuration saved for a long time. Toenails are usually not affected. In rare cases, internal organs are affected.

Candidomycosis

The true causative agents of candidomycosis are yeast-like fungi of the genus Candida. Mushrooms affect the skin, mucous membranes, various organs and tissues of the human body, often causing complications during irrational antibiotic therapy. The age factor plays an important role, as young children and elderly people are affected more often. Candidomycosis is ubiquitous. Pathogenetic factors can be hypothyroidism, hypoparathyroidism, disorders of carbohydrate metabolism associated with decreased pancreatic function, circulatory disorders of the extremities, allergic changes in the walls of blood vessels of various tissues and organs, hypo- and vitamin deficiencies, dysbiosis, functional disorders of the autonomic nervous system, hormonal disorders and associated metabolic diseases, traumatic injuries of the skin and mucous membranes.

Skin candidiasis - most often found in childhood and proceed as an intertrigo axillary, intergluteal and inguinal folds or generalized dermatitis of the skin. In some patients, the lesion acquires a granulomatous character with the localization of fungi in the lesion.

Superficial candidiasis in children and adults is manifested in the form of erythematous-squamous, vesicular-bullous, psoriasiform or scarlet-like rashes. Less often, tubercular and ulcerative forms, vascular lesions (capillaritis, vasculitis, thrombophlebitis) are recorded. Candidiasis of the nipples in nursing women is often the cause of the development of thrush in a child. Clinically, candidiasis of the nipples is manifested by redness, swelling, cracks in the area of ​​the nipples.

Erosions of the corners of the mouth are intertriginous lesions at the border of the mucous membrane of the oral cavity and the red border of the lips. The damaged mucosa has a grayish-white color. Erosions and cracks are located at the bottom of the fold, a slight infiltration of the lesion is noted.

Cheilitis - redness, swelling and peeling of the red border of the lips. The skin at this localization of the infection is thinned, streaked with radial grooves of a grayish-cyanotic shade. In some patients, the red border of the lips is covered with painful bleeding cracks, white films or bloody crusts with erosion or granulation under them.

Candidiasis of the scalp resembles seborrheic eczema without a pronounced exudative component. On the head and face, in the nose and ears in children, there may be vesicles, abscesses, erythematous-squamous foci, tubercles and warty growths, covered with brownish-gray crusts. After removing the crusts, papillomatous growths, bleeding granulations are detected.

Intertriginous lesion of the skin of the feet and hands begins with the appearance of vesicles, after the opening of which erosion is formed with an inflammatory red rim on the periphery. Patients often complain of itching, burning, moderate pain in the affected area. Without appropriate treatment, the disease can last for years. Typical symptoms are the localization of the pathological process in the interdigital folds, the whitish hue of the foci, the large-plate rejection of the damaged epidermis, the shiny "greasy" surface of the eroded areas, cracks and erosion in the depth of the interdigital folds.

Paronychia and onychia - damage to the soft tissues of the periungual platen and the nail plate accompany each other, being stages of one process. The disease begins with redness at the site of introduction of the fungus (at the very edge of the cushion), which gradually increases over several days in parallel with edema. Pus is released from under the nail roller when pressed. In the future, edema and hyperemia increase, the skin protrudes above the nail plate, turns red, glossy, sometimes cracks form. The process spreads rapidly with the formation of onychia. Furrows and elevations appear on the nail plate, and brownish patches are noted in the thickness of the nail. The nail gradually loses its gloss, grows dull, thickens and begins to separate partially or completely from the bed.

Mucous candidiasis - yeast stomatitis (thrush) is the most common form of candidiasis of the oral mucosa in children. With this localization of the lesion, the "lacquer" tongue, macroglossia, cracks in the corners of the mouth, and inflammation of the red border of the lips are noted in the clinical picture. On the unchanged or hyperemic mucous membrane of the tongue, lips, cheeks, palate, groups of pearlescent white spots of rounded shape of various sizes are found. If untreated, the spots gradually increase in size, merge and form a white film that rises above the surface of the mucosa, and resembles "curdled milk". Mushrooms are first located on the surface of the mucosa and are easily removed with a swab. In the future, the plaque is removed with difficulty and leaves a bleeding surface, which indicates the spread of the process deep into the tissues.

Mycotic tonsillitis is characterized by the presence of white shiny follicular plugs without a visible inflammatory reaction of the mucosa, an increase in tonsils against the background of a dim general reaction of the patient's body. Glossitis is accompanied by the formation of whitish-gray patches, pronounced striation of the tongue with longitudinal and transverse grooves, foci of various sizes (smooth, devoid of papilla surface), an increase in the size of the tongue. Patients complain of dryness and burning in the oral cavity.

In chronic stomatitis and glossitis, in some cases, pseudo-leukoplastic, hyperplastic and granulomatous processes on the oral mucosa are noted.

Gastrointestinal candidiasis - accompanied by symptoms of esophagitis, gastritis, enterocolitis, acute and chronic diarrhea, indigestion and anorectal lesions. The most important symptoms of damage to the digestive tract are a decrease in appetite up to the development of a feeling of aversion to food, difficulty in swallowing (obstruction when the esophagus is blocked by fungal films), frequent indomitable vomiting with the release of curd films. Liquid stool with an admixture of mucus and blood, exsicosis, toxicosis, immobility, bloating, fever are characteristic.

Candidiasis of the respiratory system - takes second place after damage to the digestive tract. Lesions of the pharynx and larynx are accompanied by coughing attacks, voice changes, laryngostenosis with the release of mucopurulent sputum. Candida rhinitis and pharyngitis do not have specific clinical manifestations. Candidiasis pneumonia is observed in adults and children treated with antibiotics and immunosuppressants. The course of candidal pneumonia is similar in nature to the course of pulmonary tuberculosis, tumor process and bacterial pneumonia. A feature is the tendency for the process to become chronic with frequent relapses. In a chronic course, the disease is often accompanied by a melting of the lung tissue with the formation of cavities in the lower lobes of the lungs.

Urogenital candidiasis - characterized by multiple granulomatous lesions in the form of small whitish tubercles with necrotic decay in the center. In urine, protein, red blood cells and cylinders with an abundance of the pathogen are found. The lesions resemble tuberculosis. Renal filtration function is impaired, which is accompanied by increased excretion of whey proteins. Urethritis, cystitis, balanoposthitis, vulvitis, vaginitis, candidiasis of the external genitalia are often recorded.

Candidiasis of the central nervous system - is most often detected by chance when revealing fungi in the brain tissue at the autopsy of elderly people and children suffering from thrush who died with brain abscesses. The disease proceeds in the beginning in an erased form or in the form of bacterial carriage, and with a significant damage to brain tissue in the clinical picture, the symptomatology characteristic of an abscess or tumor of the brain appears.

Septic forms of candidiasis have a protracted course, characterized by damage to many organs and tissues: miliary changes in the lungs, kidneys, liver, damage to heart valves, microabscesses in the myocardium. Candidiasis sepsis can cause damage to the central nervous system in the form of meningitis, encephalitis, meningoencephalitis, brain abscesses.

The outcome of candidal lesions depends, first of all, on the immunological reactivity of the patient’s body, but the septic option in childhood often leads to death. After a disease, fungi usually remain in the body for life.

Blastomycosis

Cryptococcosis (torulosis, European blastomycosis, Busse-Bushke disease) is a serious disease caused by budding, asporogenous yeast-like fungi, with a primary lesion of the central nervous and respiratory systems. Infection occurs through the skin, respiratory tract, and the gastrointestinal tract. The course of this mycosis is chronic. The prognosis for the localization of the pathological process in the brain and lung tissue is unfavorable.

Pulmonary cryptococcosis usually proceeds in a subacute form with a slight increase in body temperature. Coughing is intermittent. Sputum mucous discharge with streaks of blood is noted. Most often, the lesion is focal in nature with the involvement of one or more lobes. A massive blackout is determined by X-ray. Cryptococcosis of the nervous system develops gradually: a headache appears, the intensity of which increases, dizziness, meningeal symptoms, visual disturbances, and neurological symptoms are progressively increasing. In the peripheral blood, hypochromic anemia, slight leukocytosis, and an increase in ESR are noted.

Primary skin lesions can be widespread and localized. In open areas of the skin, nodules appear that are necrotic, ulcerated, spread along the surface and in depth. The bottom of the ulcers is covered with granulations, mucopurulent discharge with a peculiar shine and reddish tint, with the presence of a large number of fungal elements. The course of the disease is slow, periods of remission are replaced by exacerbations. In the absence of adequate therapy, the patient develops cachexia, metastases in the internal organs, bone marrow, which ultimately ends in the death of the patient.

North American blastomycosis is a chronic disease that occurs in cutaneous and visceral forms. The causative agent is Blastomyces. Men are sick 9-10 times more often than women. The disease is slightly contagious, but does not exclude the possibility of inhalation infection. Predisposing factors are injuries, bites of infected animals. Skin forms can be transmitted by contact.

The skin form of the disease is more benign. The course is long, up to several years. Skin lesions are primary and secondary. Primary lesions are detected on open and closed parts of the body. The onset of the disease is accompanied by the appearance of nodule-pustular elements with blood-purulent contents, which ulcerate in the center and become covered with a crust. The foci can grow, merge.

When pressed from the depths of granulation growths, drops of creamy pus appear. The healing of skin lesions begins from the center, while the peripheral roller continues to spread along the periphery. The appearance of subcutaneous nodes is a prognostically unfavorable sign, since it is the first symptom of the generalization of the process. Secondary skin lesions are nodular, gummous in nature, have a dark red color and sizes from 0.5 cm to several centimeters in diameter. The foci further soften, secrete pus and tend to merge with the formation of a ulcerative process of a verrucous nature. Healing can occur with deep scarring. The defeat of the mucous membranes is not typical for North American blastomycosis.

The visceral form of blastomycosis begins as an acute respiratory viral infection, which acquires a chronic course. First of all, the lungs are affected, the pleura is often involved. The clinical picture resembles the course of pulmonary tuberculosis. Patients complain of dry cough, chest pain, night sweats, fever. Multiple darkening cords, less defined than with miliary tuberculosis, are found on an x-ray. At the beginning of the disease, lung damage is one-sided, and later the second lung is involved in the process. There is an increase in peripheral lymph nodes, which, merging, form conglomerates, and then necrotic. Bone damage is characterized by destructive and proliferative changes in the ribs and vertebrae. In women, the disease can be accompanied by damage to the genitals (dysfunction of the uterus, pathological foci in the tubes and ovaries). With North American blastomycosis, a specific allergy develops, determined by the intradermal administration of a vaccine from the cells of the yeast phase of the fungus or blastomycocin. An allergic condition, the degree of sensitization have a significant impact on the possibilities of therapeutic effects.

South American blastomycosis is a serious disease that is accompanied by damage to the skin, mucous membranes of the oral cavity, gastrointestinal tract, lungs, and bones. Men are sick 10 times more often than women. Endemic foci are California, Brazil, Rio de Janeiro, Argentina, Paraguay, Peru. Sources of infection are unknown, a reservoir in nature was not found. Clinical manifestations of the disease can be focal or generalized. The disease often ends with the death of the patient within 2-3 years. There are mucocutaneous (local) lesions, damage to the lymph nodes, visceral and mixed forms. Mucocutaneous forms are characterized by the appearance of small papules, which grow in depth and on the periphery, quickly ulcerate. The peripheral lymph nodes are involved in the process: they increase in size, necrotic, their contents come out after the formation of the fistula. Lesions on the skin are papillomatous-verrucous in nature. The central part of the foci undergoes ulceration, and when localized on the face (typical localization), tissue disintegration leads to disfigurement of the patient ("amphibian mouth").

Localization of the pathological process on the mucous membranes of the oral cavity, pharynx, epiglottis, vocal cords, tongue is clinically accompanied by difficulty swallowing and a pain symptom, which leads to the development of cachexia. The lymphatic form is manifested by damage to the cervical nodes (soften, necrotic and empty outward through the fistula). With the development of visceral forms, patients complain of abdominal pain, upset stool. Ulcerative lesions are noted in the liver, spleen, intestines, lungs. The mixed form is characterized by damage to the skin, mucous membranes and internal organs, bones.

Keloid blastomycosis is an anthroponotic disease. The disease is recorded in Brazil, not contagious to others. Infection is possible with skin injuries, with bites of snakes and insects. The course of the disease is chronic, difficult to treat. The lesions are localized mainly in open areas of the body: the skin of the face, forearms, lower extremities. Elements of papular-tuberous, dense consistency, delimited from surrounding tissues. The surface of the focus has a shiny pink surface that resembles keloid scars. In the presence of the causative agent in the lymphoid tissue, regional adenopathy is noted. The disease lasts for years, but is not life threatening to the patient.

Koscididioid mycosis - this disease is described in the literature under the name coccidioidosis, coccidioid granuloma, valley fever, desert rheumatism, fever St. Joachim, Pasadas-Wernicke disease. The causative agent is coccidia. In the process of the disease, a specific sensitization of the body is formed, which, with early manifestation, protects the body from the development of generalized forms, facilitates the course of mycosis.

Coccidioid mycosis proceeds in two forms: primary (acute) and secondary (chronic). The primary form is characterized by mass distribution in endemic foci, has a short incubation period (7-14 days). The onset of the disease is accompanied by malaise, headache, mild cough, fever, symptoms of pharyngitis, laryngitis. Patients may complain of pain in the heart and small joints. Symptoms of damage to the respiratory system are not pronounced and quickly collapse. An x-ray in the acute period of the disease reveals infiltration of the gate of the lung, middle and lower lobes, single or multiple focal lesions and adenopathy in the area of ​​mediastinal lymph nodes and pleural damage. The course of the disease in some patients resembles the clinical picture of tuberculosis, accompanied by hemoptysis. In most cases, the primary form of coccidioid mycosis undergoes reverse development within 2-3 weeks. When the fungus enters the blood, lesions of bones, skeletal muscles, and the nervous system with the development of meningitis are noted.

The secondary form is characterized by a long and chronic course with the destruction of the structure of affected tissues and organs, with the decay of foci, the formation of fistulas, asthenia, cachexia of varying degrees. The disease in most cases ends with the death of the patient, since drug therapy does not give a positive result. The clinical picture of damage to the lungs and lymph nodes is pronounced. A characteristic symptom of coccidioidosis is changes in bone tissue: ribs, clavicles, scapula, vertebrae, small bones of the arms and legs. Skin changes are characterized by the formation of a nodule, infiltrate, which are necrotic and ulcerate with the formation of papillomatous growths. The skin can acquire a peculiar density. Skin seals can persist for a long time, which resembles scleroderma. Changes in the skin of the abdomen are accompanied by damage to the deep lymph nodes in the form of a tuberous conglomerate of various sizes from a few centimeters to tens of centimeters in diameter. Clinically, the defeat of this localization is manifested by fever, pain in the lower abdomen. In some cases, the conglomerate, increasing in size, occupies most of the abdominal cavity.

In a chronic course, periods of remission lasting 2-3 months are replaced by periods of exacerbation, when new abscessed lesions appear, a rise in body temperature is noted, weakness develops, loss of appetite, sleep is disturbed. Data from laboratory research methods can detect changes in the composition of protein fractions of blood plasma, impaired functional activity of the liver.

The course of acute primary coccidioidosis is often benign. Generalization of infection with secondary coccidioidosis leads to death.

Rare mycoses

Rare mycoses include rhinosporidiosis, chromomycosis

Rhinosporidiosis is accompanied by papillomatous lesions mainly of the mucous membranes and, less commonly, the skin. The most common localization is damage to the nasal mucosa. At the beginning of the disease, lesions are represented by papillomatous and polypous growths, which are located on the stalk, gradually increase in size, merge and resemble cauliflower. In this case, nasal breathing and swallowing are disturbed. A bright pink color is characteristic. On the surface of the growths, a large number of tiny spots (sporangia) are noted, under which the mucous membrane is covered with mucus. Eye damage at the beginning of the disease is represented by fine-grained mobile formations on the conjunctiva and mucous membranes of the eyelids, are nodular in nature. The patient complains of photophobia, lacrimation when the lacrimal canal is blocked. In some patients, in the presence of significant growths, eversion of the eyelids is noted.

Localization of the lesion on the vaginal mucosa resembles cauliflower, and on the head of the penis - syphilitic condylomas or hemorrhoidal growths.

Polypous growths in the ear canal lead to hearing loss. On the skin, papillomatous growths gradually turn into warty, reach large sizes and become painful when palpated. The lesions on the skin and mucous membranes are covered with viscous mucus, and when the secondary bacterial flora is stratified, the discharge is purulent.

Chromomycosis is ubiquitous and is a chronic skin disease of a granulomatous-verrucous nature. The clinical manifestations of mycosis are diverse and depend on the duration of the disease, the characteristics of the fungus and the degree of its parasitic activity, the individual characteristics of the patient’s body, and the localization of the pathological process. The disease develops slowly, but has a progressive course. Foci of lesion are primary (formed at the site of fungus introduction) or secondary (occur in the presence of traumatic injuries) in nature. The first symptom of the disease is the formation of a small nodule or wart. From the primary focus, the pathogen with the flow of lymph or blood can spread to various organs (liver, brain, bones, etc.). Favorite localization is the lower, less often - the upper limbs, hands and wrists. A rare localization is considered to be damage to the skin of the face, neck, trunk. The defeat is accompanied by proliferation of connective tissue, which leads to compression of the lymphatic vessels and the development of elephantiasis. The regional lymph nodes are often involved in the process.

The following types of lesions are distinguished: nodular, tumor-like, verrucous, scaly, cicatricial. The nodular type is characterized by the presence of soft pink-purple nodules with an even scaly or warty surface. With the tumor type, nodules are larger papillomatous or lobed in nature, covered with crusts and flaky. Verrucous type is accompanied by hyperkeratosis, warty foci are localized on the edges of the foot. The scaly type is represented by flat foci of infiltration of various sizes and shapes of a reddish-violet color. The cicatricial type of lesion leads to atrophic and sclerotic changes in the center of the focus in the presence of warty growths on the periphery. The prognosis of the disease is always favorable, the best result is obtained with early detection of the disease and timely treatment.

Histoplasmosis

Histoplasmosis is a particularly dangerous mycosis. The disease is a deep mycosis mainly of the reticuloendothelial system of humans and some animals. Places of natural foci are the middle and western states of the USA, South America, Argentina, Uruguay, Canada, England, France, Bulgaria, Turkey, etc. Mostly children are ill. The spread of infection is carried out by inhalation with the localization of histoplasmas in the soil, animal droppings, in abandoned rooms. Initial lesions with histoplasmosis are noted in the nasopharynx, larynx, lungs or in the gastrointestinal tract. In the place of the entrance gate, a superficial ulcerative process is formed. Pulmonary localization is characterized by fever, cough with sputum, exhaustion, and in severe cases - cachexia. In many patients, the pathological process in the lungs leads to the development of foci of calcification, the formation of caverns. In this case, a negative reaction to tuberculin and a positive response to histoplasmin helps to distinguish histoplasmosis from tuberculosis.

The defeat of the reticuloendothelial system can be limited or disseminated. In the latter case, the course of the disease becomes fulminant. The clinical picture is characterized by fever, enlarged liver and spleen, pronounced hypotrophy, leukopenia and anemia. The disease in the clinic resembles Hodgkin's disease, lymphosarcoma, aplastic anemia.

Damage to the gastrointestinal tract is clinically manifested by a decrease in appetite, vomiting, loose stools, and an increase in mesenteric lymph nodes.

Mold fungal infections

Aspergillosis, penicilliosis and mucorosis are distinguished in the group of mold mycoses. The causative agents of these diseases are widespread in the external environment: in soil, on vegetables, fruits, plant materials, on old things and objects, in dust. Infection occurs by inhalation of dust, ingestion of spores of mushrooms with food, when mushrooms get on damaged skin and mucous membranes, with traumatic damage to the eyes, ear, nail plate and periungual ridges.

Aspergillosis is a fungal disease in humans, animals, and birds caused by aspergillus. More often adults are sick than children. The disease occurs mainly in people engaged in cleaning and disassembling wool, for the degreasing of which rice flour containing fungal spores is used. High morbidity is registered in flour mills, in the silicate industry, in breweries and in workers of other specialties whose professional activity is related to plant raw materials. Aspergillosis of the skin and its appendages, mucous membranes and internal organs is isolated. Microtrauma, maceration, and inflammatory skin changes contribute to the development of skin aspergillosis. Skin lesions are manifested by hyperemia, profuse peeling and crusting. When the process is localized on the nail plate, a primary lesion of the nails of the big toes is noted. The nail plate is dirty gray with a yellowish tint, thickened, crumbles easily. Primary lesions of the skin and mucous membranes in some cases end in self-healing. The contact of the pathogen on the eye tissue leads to clouding of the cornea, purulent panophthalmitis, ulcerative conjunctivitis, blepharitis. Total damage to the eyeball can cause the pathological process to transition to the brain tissue and the development of aspergillus meningitis, which ends in the death of the patient. Visceral aspergillosis is usually represented by a pathology of the bronchopulmonary system (damage to the bronchi and lungs). In most cases, pulmonary aspergillosis develops against the background of tuberculosis. In the chronic course of bronchomycosis, fibrosis, emphysema, bronchiectasis, and peribronchial abscesses develop. The prognosis for visceral forms is always serious.

Penicilliosis is caused by fungi, which are permanent residents of soil microbial associations, are found in the air and on plants, and they are detected in large quantities in rooms with unsanitary conditions. The clinical manifestations of the disease are diverse: epidermodermatitis, nodular and eczematous skin lesions, onychia and paronychia, single or multiple foci of the type of leukoplakia in the oral mucosa, pseudotuberculous lesions of the lungs, acute and chronic lesions of the ear, gummy lesions of the tongue and eyes. The fungus is isolated from malignant tumors of various localization.

Mucorosis is a disease caused by lower fungi from the Mukorotsee family, of the Psycomycetes class. Tissue damage in mucoroses can be superficial and deep, focal and widespread. The course of the disease is acute or chronic. The clinical manifestations of mucoroses are diverse. There are superficial and deep, focal and common mucoroses, which are often accompanied by symptoms of intoxication. The course of these mycoses can be acute or chronic. A distinctive feature of mucorrheal lesions is a peculiar change in the tongue, which is called the "black hairy tongue". In the clinical picture, otomycosis, keratitis, nasopharyngitis, onychia and paronychia can occur. Generalization of a fungal infection is manifested by damage to the lungs, spleen, kidneys, abdominal organs, central nervous system, and bones. Often, mucoroses complicate the course of another disease.

Sporotrichosis

The disease is recorded mainly in France and North America, which is associated with a certain type of vegetation suitable for sporotrichums. There are various types of sporotrichous lesions involving lymph nodes, skin, mucous membranes, bone system, internal organs. The lesions are deep and are accompanied by a number of common symptoms. An important place in the development of the disease is the allergic reaction of the patient. Sporotrichosis is divided into primary (focal) and secondary (disseminated). Most often, lymph nodes are affected, which increase in size, condense and form conglomerates. The skin above them is pink in the beginning, then acquires a bluish tint and, finally, becomes dark brown. Subsequently, the lymph nodes undergo necrosis with the formation of fistulas and peculiar ulcers, called spirochrichous chancres. Multiple nodules appear along the lymphatic vessels. The wall of the lymphatic vessels is compacted, large lymph nodes are involved in the process, after the destruction of which the fungi penetrate the bloodstream and disseminate throughout the body. The result of the septicopyemic process are multiple dense nodes in various parts of the skin and granulomatous infiltrates in the internal organs. Sporotrichous nodes are cold abscesses, at the opening of which ulcers resembling syphilitic form. Ulcers heal with a scar under which, after some time, a cold abscess re-forms. Cases of fulminant course of the disease ending in the death of the patient are described. Changes in the mucous membranes are represented by erythematous, ulcerative, vegetative and papillomatous rashes. Visceral forms are clinically manifested by symptoms of pyelonephritis, orchitis, epididymitis, lesions of the lungs, bones, joints, tendons, muscles are less commonly recorded. An isolated skin lesion is accompanied by the presence of rashes in the form of nodules, ulcers, perifollicular infiltrates, intertriginous, eczematoid and ulcerative lesions, fungal warty growths.

Diagnosis

Keratomycosis

The diagnosis of multicolored lichen is made on the basis of the clinical picture, detection of foci of mycosis using a fluorescent lamp (golden yellow or brownish glow) and microscopy (detection of fungus scales and its mycelium, round spores). The differential diagnosis is carried out with pigmented syphilis, psoriasis and other dermatoses, seborrhea, Zhiber pink lichen, chloasma, vitiligo, pint and erythrasma.

The diagnosis of the pedestal is made when detecting the formation of stone density and fungal elements during microscopy, as well as the culture of the fungus when sowing. The differential diagnosis is carried out with a false pedestrian, which is caused by bacteria.

Dermatomycosis

The diagnosis of epidermophytosis is based on the data of an objective examination of the patient and excretion of the fungus. Differentiate epidermophytosis with mycosis due to red trichophyton, epidermophytosis of the feet, erythrasma.

The diagnosis of foot mycoses is made when the pathogen is detected: plating on Sabur medium (skin flakes, scrapings from the surface of the nails).

Candidomycosis

The diagnosis is based on the results of general clinical, immunological and bacteriological diagnostic methods. The test material is sown on a differential diagnostic medium Saburo with subsequent identification of pathogens of fungal infection to the species.

Blastomycosis and histoplasmosis

Diagnosis of blastomycosis is based on clinical, clinical, instrumental and laboratory diagnostics.

Treatment and prevention

Keratomncosis

The treatment of multicolored lichen is local. Fungicidal and keratolytic agents are rubbed into the skin of the affected area: 60% aqueous sodium hyposulfate solution for 2-3 minutes, and after the formation of small crystals, they are treated with a 6% solution of undiluted hydrochloric acid. The course lasts 5-6 weeks (Demjanovich method). An important condition is the treatment of diseases of the internal organs and sweating. After 1-2 months (after the clinical picture subsides), the course of treatment is repeated. Prevention is the disinfection of clothing and linen.

Treatment procedures with a pedestal include daily washing of the head with a hot solution of mercuric chloride 1: 1,000 or sublimate vinegar, followed by combing the hair with a frequent comb and washing the hair with hot water and soap. A quick recovery occurs when shaving hair from damaged parts of the head.

Dermatomycosis

The treatment of epidermophytosis is local and general. Lubricate the foci with 1-2% iodine tincture for 3-5 days, then 3-5% sulfur-tar ointment for 2-3 weeks. Nipagin and nipazole in aerosol form are effective. Inside take a 10% solution of calcium chloride and antihistamines.

The forecast is favorable. Prevention: thorough treatment, contact examination, sanitary and hygienic measures in the outbreak.

In terms of drug treatment of foot mycoses, cold lotions of a 1-2% solution of resorcinol, a solution of potassium permanganate 1: 6000 - 1: 8000 are shown. After the fungal nature of the disease is established, fungicidal liquids, ointments and other dosage forms are used: 1-2% alcohol solution of aniline dyes, 2% tincture of iodine, nipagin, acetic acid. Ointments should contain undecylenic acid, nipagin, nipazole, sulfur (from 3 to 10%), tar (2-10%), salicylic acid (2-3%). Be sure to prescribe desensitizing therapy: 10% calcium chloride by mouth or intramuscularly, diphenhydramine, pipolfen and other sedatives (valerian, motherwort). Vitamins of group B, vitamin C. Treatment of nails is carried out using a keratolytic patch, fungicidal fluids and ointments.

Forecast: the disease often takes a chronic course with exacerbations in the spring-summer period.

Mandatory treatment of trichophytosis with griseofulvin (tab. 0.125) at the rate of 15 mg / kg per day. The daily dose is prescribed daily until the first negative test for hair and hair mushrooms, which is observed on the 15-25th day from the start of treatment. Then the antibiotic is prescribed every other day in the same dose for 2 weeks, and then 1 time in three days for 2 weeks. Locally, iodine-ointment therapy of the foci is carried out: 3-5% tincture of iodine in the morning, and sulfuric-salicylic or sulfur-tar ointment is applied and gently rubbed at night. The hair on the head before the start of treatment is cut with a machine, then shaved once a week until the end of treatment. Given the clinical picture, symptomatic treatment is performed.

The prognosis in most cases is favorable. The exception is cases of trichophytosis of the scalp, when treatment is started late, as in this case, extensive cicatricial changes are formed.

Prevention: screening, health education.

Patients with localized lesions under microscopy on the scalp and multiple lesions on the body should be treated permanently. Griseofulvin is prescribed in a daily dose of 22 mg / kg every other day (for 2 weeks) until a negative test for mushrooms (3 negative tests for mushrooms with an interval of 5-7 days). If it is not possible to use griseofulvin, a 4% epiline patch is used.

When only smooth skin is affected, 2-5% iodine, fungicidal solutions (mycoseptin, salifungin, nitrofungin) are used in the morning and sulfur-salicylic ointment in the evening. To treat damage to cannon hair, a 5% griseofulvin patch is used, and electrocoagulation is used to remove single luminous hair on the head. To increase immunity, bacterial pyrogens (pyrogenal, prodigiosan), gamma globulin injections, and vitamin B1 are used. Nutrition should be complete, high-calorie. The prognosis in most cases is favorable. Preventive measures include examining the contacts every 5 days.

The treatment of favus is carried out with griseofulvin, as with trichophytosis, and iodine-ointment therapy is also used.

Without treatment, the disease can last for decades and lead to complete baldness. With internal forms, the prognosis is usually unfavorable. Prevention: all contacts are regularly and carefully examined to identify atypical forms.

In the settlements where the patient is identified, mass repeated examinations of the population should be carried out within 3 years. Final and ongoing disinfection in the outbreak is carried out.

Candidomycosis

Mild forms of candidal lesions of the skin and mucous membranes can result in self-healing. The chronic candida process requires serious drug therapy in combination with patient care measures. An important condition for successful treatment is enhanced nutrition, which should correspond to the age of the patient, contain a sufficient amount of proteins and vitamins. It is necessary to cancel antibacterial drugs, eliminate dysbiosis, make up for the lack of hormones, and conduct a course of general strengthening therapy. The following drugs are indicated from medications: nystatin, levorin, amfoglucamine, mycoheptin, amphotericin B. Nystatin and levorin are used for external and visceral (internal) candidiasis in a dose of 500 thousand to 1 million units per day with two to two 2-3-week courses with 7 day break. As dosage forms of these drugs for external use, 5% ointments, lotions, suspensions and solutions are used.

Respiratory damage is an indication for the administration of inhalations of the water-soluble sodium salt of levorin. Amphoglucamine, mycoheptin, amphotericin B are prescribed for visceral granulomatous lesions. Immunotherapy of candidal diseases is carried out using killed vaccines and soluble fractions of fungi.

For the treatment of superficial foci or common forms, sodium caprylate solution, 1-2% iodine solution, alcohol-water solutions of eosin (in 20% alcohol), Whitefield sulfur-salicylic ointment, and Castellany fuchsin mixture are used. The mucous membranes are treated with a 10% solution of borax in glycerin, a Lugol solution on glycerin, a 1-2% solution of drinking soda for 5-7 days. In the future, the course of treatment is continued for 2-3 weeks with a preventive purpose. In severe cases, topical administration of nystatin in age doses is indicated. The defeat of the vagina is an indication for the appointment of washing or tamponade with a 2% solution of borax, 10% solution of sodium bicarbonate, Lugol's solution.

The prognosis in the presence of superficial candidal lesions and intensive care is favorable, with a septic course - always cautious.

Blastomycosis

Treatment of cryptococcosis should be comprehensive. Important importance should be given to enhanced patient nutrition (diet poor in thiamine). The only treatment is the administration of amphotericin B (intravenous drip at the rate of 0.2-1 mg per day for 3-4 months) and surgical intervention (removal of localized cryptococcal foci).

Of the medicines for North American blastomycosis, the use of amphotericin B is indicated intravenously in a daily dose of 12.5-50 mg, repeated courses of nystatin at 4-5 million units per day for 3 weeks. Desensitizing therapy is carried out by subcutaneous administration of gradually increasing doses of the vaccine, starting from 0.1-0.2-0.3 to 1 ml every 2 days at a dilution of 1: 100 (if an allergic reaction is measured 2 cm2),

1: 1000 (if an allergic reaction is measured 3 cm2) and 1: 10 000 cm2 (if the reaction exceeds 3 cm2). Good results are obtained when using iodine therapy in conjunction with x-ray irradiation, application of CO2 to the foci and surgical intervention. The prognosis for skin forms is favorable, and for disseminated ones, it is doubtful. The duration of the disease in most cases is at least 2 years.

Treatment for dermal lesions of South American blastomycosis includes daily administration of the antibiotic saramycin at a rate of 4 mg / kg subcutaneously. Limited foci are subject to curettage; pockets are excised. Strict adherence to bed rest is shown. In visceral and mixed forms, the administration of amphotericin B is prescribed in combination with certain sulfa drugs (sulfapyridine, sulfadiazine, etc.).

Treatment of keloid blastomycosis is ineffective. The appointment of antifungal drugs is indicated inside (nystatin, levorin) or intravenously (amphotericin B). Iodine preparations are used as drug therapy for affected skin areas.

Therapeutic measures for coccidioid mycosis are complex and aimed at increasing the body's defenses. Vitamin therapy is indicated throughout the entire period of the disease. Of the antifungal agents, amphotericin B is administered intravenously, into the spinal canal. Repeated transfusions of blood, blood substitutes, plasma, protein hydrolysates give some effect. Surgical intervention is resorted to in the presence of abscessed soft coccidioma, pulmonary hemorrhage, the peripheral location of caverns with a breakthrough in the pleura, with an increase in caverns and with their secondary infection, for excision of fistulous passages, opening of abscesses.

Rare mycoses

Treatment of rhinosporidiosis includes surgical removal of polyposis foci with subsequent electrocoagulation of tissues to prevent relapse.

Locally for chromomycosis, ointments of the following composition are used: salicylic acid (1.0 g), benzoic acid (2.0 g), precipitated sulfur (3.0 g), calciferol (3 ampoules of 600 thousand units), petrolatum (15, 0 g), lanolin (15.0 g). A positive effect is observed when using vitamin D courses of 2 months with an interval of 2-3 weeks for 3-6 months. Severe course is an indication for the administration of amphotericin B intravenously drip at the rate of 1.0-1.5 g / kg per day. In some cases, resort to surgical intervention (excision, curettage, diathermocoagulation).

Histoplasmosis

The main treatment method is restorative therapy, good nutrition, multivitamins. Of the symptomatic agents, analgesics, antipyretic, sedatives and antihistamines are used. In severe cases of the disease, the use of antifungal agents in long courses (inside, intravenously) is indicated.

Mold fungal infections

The treatment of mold mycoses has general principles. Antifungal therapy in generalized forms includes intravenous drip administration of amphotericin B. In pulmonary infections, inhalations with sodium salt of nystatin or levorin are indicated, amphoglucamine, mycoheptin, gamicin and other drugs of the same group are prescribed inside. In the presence of local lesions, fungicidal agents are used. In some cases (the formation of caverns and cavities, fistulas) resort to surgical intervention.

Sporotrichosis

In the treatment of sporotrichous infection, a significant place is given to iodine preparations in large doses (3-6 g of potassium iodide per day for 4-5 months). In severe cases, intravenous administration of a 10% sodium iodide solution of 5-10 ml daily is indicated. After parenteral administration of the drug, potassium iodide is used for 4-6 weeks. As an additional therapeutic agent, they use 0.2-1.3 ml spirotrichin in a 1: 1000 dilution (specific immunogenic therapy). In severe cases of the disease, a course of antifungal therapy is carried out (nystatin, levorin, amphotericin B). Surgical intervention is resorted to with the formation of non-healing ulcers, with necrotization of the lymph nodes. Papillomatous lesions are removed by cryotherapy, radiotherapy and electrocoagulation.

By: Dr. Hooman-Khorasani