Mycosis

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Classification according to ICD-10
B35 - B49 Mycoses
B49 Unspecified mycosis
ICD-10 online (WHO version 2019)

As mycosis (from ancient Greek μύκης mykes , German , mushroom ' ), fungal disease or fungal disease called it one by fungi caused infectious disease . The term fungal infection is also often used in the sense of “fungal disease”, although the process of infection by fungi does not have to lead to a disease and is therefore to be distinguished from mycosis in the exact usage of the language. The pathogens can be mycelial fungi and yeasts (see also candidiasis ). In mycosis, the pathogens spread parasitically on or in the living tissue of humans , animals or plants .

In medicine, for uniform therapies often simplifies between D ermatophyten (filamentous fungi), H efen (yeasts) and S chimmelpilzen distinguished (so-called DHS system). According to the localization, mycoses can be divided into superficial and systemic mycoses. Superficial mycoses include fungal infections of the skin (caused by dermatophytes ), nails and mucous membranes.

Actinomycoses are not mycoses .

Infection and Infectious Disease

Infection of the host begins with the attachment or penetration of pathogenic fungi or spores (parts of the fungus that are capable of growth and reproduction).

If the fungus begins to grow in the host and the host suffers damage with corresponding symptoms , the infection results in a fungal disease called mycosis. However, it is possible that the affected host successfully defends itself against the fungus during the infection, so that no symptoms appear (so-called inapparent infection ).

Mycoses in humans

Up to 1.5 million people die each year from fungal infections.

Superficial mycoses

Mycoses of the skin and skin appendages

In people with a healthy immune system , mycoses of the skin ( dermatomycosis ) , hair or nails are mostly caused by dermatophytes . These fungi, which mostly belong to the Ascomycetes division or are anamorphic ( Fungi imperfecti ), are transmitted indirectly from person to person via skin flakes. They can cause chronic skin mycoses on any part of the body. The scientific name of these mycoses is dermatophytosis or "tinea".

Yeast diseases are candidiasis or Malassezia infections .

The sporotrichosis is a zoonotic disease and affects people other than the dogs and especially cats.

The Phaeohyphomycosis mainly affects pets.

Mycoses of the mucous membranes

Mucosal mycosis of the palate

In people with a healthy immune system , mycoses of the oral mucous membranes are rare. Mycoses of the genital organs are more common (see vaginal fungal infection ).

Mycoses of the mucous membranes are mostly caused by fungi of the genus Candida , especially Candida albicans . Candida albicans and other Candida species are anamorphic (imperfect) fungi that are found on the mucous membranes of the digestive tract (e.g. tongue) in many people. Such a disease is almost always a sign of a weakened immune system and these pathogens are therefore referred to as "weakness parasites". This mycosis appears on the mucous membranes as a white coating with surrounding reddening, which is known as thrush (for more information see candidiasis ).

Systemic mycoses

Systemic mycoses are also known as systemic mycoses. In humans, these are mycoses, in which the pathogen - usually via the lungs - has entered the bloodstream and has attacked internal organs. Systemic mycoses in humans are extremely serious diseases that are very difficult to control and can lead to death. They usually only affect people with a very weak immune system, such as: B. patients after an operation , after a transplant , after chemotherapy or patients with immunodeficiency diseases such. B. AIDS . This is called an “opportunistic” infection because the pathogen “takes advantage of the good opportunity”, so to speak. Pathogens are, for example, Cryptococcus neoformans and various aspergillus .

While more Candida infections occur in surgical patients, Aspergillus species predominated in people with underlying hemato-oncological diseases in 2009. Even less common fungi such as Zygomycetes and Fusarium play a role.

Various clinical studies suggest that “opportunistic” fungal infections are increasing in their threat potential (status 2009).

Systemic mycoses also include those caused by so-called "primary pathogenic" fungi. These are fungi that can cause severe systemic mycoses even in people with a largely healthy immune system, e.g. B. blastomycosis or histoplasmosis . However, these pathogens do not occur in Europe.

diagnosis

The diagnosis of mycoses is usually made by taking samples and then rearing (cultivating) the pathogen. This cultivation is necessary to identify the pathogen, but it often takes a long time and is difficult. For this reason, treatment usually cannot (and must not) be waited until the type of pathogen has been clearly identified. The so-called native preparation is usually used to detect mycosis . For example, a flake of skin from the affected area is examined microscopically (see dark field microscopy ). The detection of hyphae secures the suspicion of a mycosis, but only the culture provides information about the type of pathogen. Therapy is therefore usually started before the pathogen is determined and is based on the experience of the attending physician. It is important to agree with the treating doctor that the culture will not be destroyed after the type has been determined. This is still required to determine the resistance of the pathogen to antimycotics and thus to facilitate the choice of the preparation. Unfortunately, even dermatologists refrain from determining resistance, often for cost reasons, and treat with broad spectrum antimycotics that are more stressful to the body. The distinction to macroscopically similar diseases such as erythrasma caused by bacteria can be carried out with the help of a Wood lamp , the erythrasma here glows coral red in contrast to the fungus.

therapy

For therapy are antifungals available. For mycoses of the skin, they are applied locally to the skin as a cream or ointment. For yeasts, azoles (clotrimazole) or nystatin are the first choice, while for dermatophytes, ketoconazole and terbinafine are used.

In the case of mycoses of the mucous membranes, the antifungal agent - depending on the affected mucous membrane - is brought to the destination in the form of ointments, lozenges, juices or suppositories. Above all, antifungal agents that do not get into the bloodstream should be used in order to minimize side effects. Systemic treatment - d. H. treatment with antifungal drugs that enter the bloodstream should only be used if local therapy does not work. In the case of stubborn subungual fungal infections, the combination of local and systemic antifungal agents is often promising. However, this is an off-label use of the drug, which is not approved.

An antifungal combination therapy (with various substances) - apart from the addition of flucytosine (e.g. in cryptococcal and candida meningitis) - does not have sufficient evidence.

In the case of systemic mycoses, the antimycotics usually have to be administered intravenously. In addition to the antimicrobial activity, it is important to know the different physicochemical properties and side effect profiles of the various substances.

The following groups of substances can be used:

  • Polyenes (e.g. amphotericin B)
  • Azoles (many substances; e.g. fluconazole, voriconazole, posaconazole)
  • Candine (e.g. caspofungin)

Mycoses in animals

Mycoses in amphibians

The Chytridiomykose is a fungal disease in amphibians , which by the excitation Batrachochytrium dendrobatidis is caused. Since the end of 1998 it has been discussed for the first time in connection with the global amphibian decline ( global amphibian decline ), although this is controversial as a monocausal cause. What is certain is that over a third of all amphibian species worldwide are threatened with extinction and that more than 120 species have irrevocably disappeared since 1980.

Intestinal mycoses in rodents

Mycoses in plants

The most common plant diseases are fungal diseases (mycoses). Since fungi do not contain chlorophyll, they are saprophytic or parasitic. Only the parasitic fungi cause mycoses.

Important mycologists and pioneers in mycosis research

See also

literature

  • Heinrich Dörfelt , H. Hecklau: The history of mycology. Schwäbisch Gmünd 1998.
  • Werner Heinz: Fungal infections. In: Marianne Abele-Horn (Ed.): Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , pp. 269-287.

Web links

Wiktionary: Mykosis  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ Renate Wahrig-Burfeind (Ed.): True. Illustrated dictionary of the German language . ADAC-Verlag, Munich 2004, ISBN 3-577-10051-6 , pp. 590 .
  2. ^ O. Braun-Falco, G. Plewig, HH Wolff: Dermatology and Venerology. 3., rework. Springer: Berlin [et al.] 1984.
  3. ↑ Entry on Pilz in Flexikon , a Wiki of the DocCheck company , accessed on November 25, 2015. (Section "Classification")
  4. ↑ Study: Mushrooms kill up to 1.5 million people a year. In: Spiegel Online. December 19, 2012.
  5. ↑ Werner Heinz: infections caused by fungi. 2009, p. 269.
  6. ↑ K.-D. Entian et al: Identification of new antibiotic agents. In: BIOspectrum. Volume 6, 2009, pp. 408-410.
  7. ↑ Werner Heinz: infections caused by fungi. 2009.
  8. ↑ Berger et al .: Chytridiomycosis causes amphibian mortality associated with population declines in the rain forests of Australia and Central America. In: Proc Natl Acad Sci USA. 1998 Jul 21; 95 (15), pp. 9031-9036. PMID 9671799 .
  9. ^ I. Di Rosa et al.: Ecology: the proximate cause of frog declines? In: Nature. 2007 May 31; 447 (7144), pp. E4-E5. PMID 17538572
  10. ^ RA Alford et al.: Ecology: Global warming and amphibian losses. Nature. 2007 May 31; 447 (7144), pp. E3-E4. PMID 17538571
  11. ^ SM Whitfield et al .: Amphibian and reptile declines over 35 years at La Selva, Costa Rica. In: PNAS. 2007 May 15; 104 (20) PMID 17449638