Medical mycology

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The Medical Mycology is that portion of the field of medicine , which with the role of fungi in the context of the development of diseases employed. Medical mycology developed in the 19th century. The proof of a filamentous fungus as a causative agent of a skin fungal disease by Schönlein was groundbreaking . Today it is an interdisciplinary field of medicine, which is supported in particular by dermatologists , hemato-oncologists , gynecologists and medical microbiologists . The German-speaking Mycological Society was founded in 1961 as an interdisciplinary specialist society for medical and veterinary mycology in German-speaking countries .

Research subject

Fungal diseases ( mycoses ) are of the greatest importance in medical mycology . These are diseases that go back to damage to the host by the pathogens present . Components of mushrooms can also cause poisoning (mycotoxicoses) or allergic diseases (mycoallergoses).

In terms of numbers, the mycoses are in the foreground. They basically occur in humans and animals. In humans, the fungal infections of the skin and the mucous membranes close to the skin are in the foreground . In terms of numbers, the most important skin fungal disease and at the same time the most common pathogen-related disease in the population (in terms of prevalence) is the fungal disease of the space between the toes caused by filamentous fungi (" athlete's foot "). According to their shape, medically relevant mushrooms can be divided into elongated (thread) and spherical (yeast) mushrooms. The causative agents of athlete's foot in the space between the toes are usually filamentous fungi of the dermatophyte type . The most important species is Trichophyton rubrum . Yeasts are important in connection with fungal diseases of the mucous membranes close to the skin, especially the oral cavity (oral candidiasis , thrush) and the vagina (vulvovaginal candidiasis). Almost all women will experience vulvovaginal candidiasis once in a lifetime , with some experiencing it repeatedly (recurrent vulvovaginal candidiasis). The yeast disease of the oral cavity occurs mainly in infancy and in old age, and also in the case of acquired immune deficiency as part of the HIV infection.

Medically the most important yeast in local yeast diseases is Candida albicans . In many people, this germ colonizes the digestive and genital tracts without any noticeable symptoms of illness. Candida albicans, but also other fungi such as Aspergillus species and cryptococci, can cause mycoses of internal organs. General blood poisoning ( sepsis ) from fungi is also possible; Candida albicans is the third most common cause of sepsis today.

Particularly at risk from life-threatening fungal diseases are people with weak immune systems in intensive care units , as well as patients with tumor diseases who are treated with anti-tumor drugs. Patients with a drug-related immune deficiency, for example in the context of avoiding transplant rejection, are also particularly at risk. Fungal diseases can either be dangerous in themselves or cause dangerous secondary diseases. The fungal disease of the space between the toes promotes the occurrence of bacterial secondary diseases ( sore rose on the lower leg).

Diagnosis

The diagnosis of fungal diseases is traditionally based on the microscopic examination of suitable patient material (skin flakes, etc.) and the culture on suitable nutrient media such as Kimmig agar . Molecular diagnostics based on the polymerase chain reaction have recently become possible. This applies equally to fungal diseases of internal organs as to skin fungal diseases. If a fungal disease of internal organs is suspected, tests for antibodies or fungal components in the blood ( antigen ) also play a role.

Treatment of mycoses

Over the past 50 years, great strides have been made in the treatment of human fungal infections. The treatment of fungal diseases of the skin and mucous membranes close to the skin is based largely on the use of preparations of the azole , allylamine and hydroxypyridone type . In the treatment of internal organ fungal diseases, polyenes such as amphotericine B are used, as well as azoles such as fluconazole and voriconazole and, more recently, candins.

See also

Web links

literature

  • HC Korting, W. Sterry: Therapeutic methods in dermatology. Dermatics and cosmetics. Thieme, Stuttgart 2001, ISBN 3-89412-342-7 .
  • M. Schaeffer-Kurepkat, HC Korting: Voriconazole. (= The Critical Drug Monograph. 01). ABW, Berlin 2004, ISBN 3-936072-34-5 .
  • HC Korting, R. Callies, M. Reusch, W. Sterry: Dermatological quality assurance. Guidelines and recommendations. 4th edition. ABW, Berlin 2005, ISBN 3-936072-37-X .
  • H. Hof: Mycology for Physicians. Thieme, Stuttgart 2003, ISBN 3-13-132131-8 .
  • A. Rüschendorf: Medical mycology. Lehmanns Media LOB, Berlin 2005, ISBN 3-86541-097-9 .
  • A. Birkfeld: Mushrooms in medicine. Westarp, Hohenwarsleben 2003, ISBN 3-89432-597-6 .
  • H.-J. Tietz, H. Ulbricht: Human pathogenic fungi of the skin and mucous membranes. Collection, cultivation, differentiation. Schlütersche, Hannover 1999, ISBN 3-87706-540-6 .
  • M.-H. Schmid-Wendtner: Terbinafine. (= The Critical Drug Monograph. 02). ABW, Berlin 2006, ISBN 3-936072-44-2 .
  • H.-J. Tietz, W. Sterry: Antimycotics from AZ. Application and pharmacology at a glance. 4th edition. Thieme, Stuttgart 2006, ISBN 3-13-137794-1 .