primary systemic mycosis

Primary Systemic Mycosis: A Rare but Serious Fungal Infection

Primary systemic mycosis, also known as primary deep mycoses, is a rare type of fungal infection that affects internal organs in immunologically normal hosts. This condition occurs when fungi enter the body through the lungs, gut, or other means and cause a systemic infection.

Characteristics of Primary Systemic Mycosis

• Asymptomatic or Mild Infections: Most cases of primary deep mycoses are asymptomatic or clinically mild infections occurring in normal patients living or traveling in endemic areas [2].
• Systemic Infection: The infection affects internal organs, such as the lungs, gut, and other tissues, rather than just the skin or mucosal surfaces [3].
• Immunologically Normal Hosts: Primary systemic mycosis typically occurs in individuals with normal immune systems, unlike opportunistic infections that target weakened immune systems [6].

Causes and Transmission

• Inhalation of Fungal Spores: The primary infection often begins when fungal spores or hyphae are inhaled into the lungs, where they can establish an infection [7].
• Endemic Areas: Primary deep mycoses are more common in areas with high levels of fungal spore circulation, such as tropical and subtropical regions.

References

[1] Systemic mycoses are fungal infections affecting internal organs. In the right circumstances the fungi enter the body via the lungs, through the gut, paranasal ...

[2] Primary Mycoses​​ Most cases of primary deep mycoses are asymptomatic or clinically mild infections occurring in normal patients living or traveling in endemic ...

[3] Systemic fungal infections are infections of organs or tissues other than the skin or mucosal surfaces.

[4] A systemic mycosis that arises from infection in an immunologically normal host.

[5] Name, primary systemic mycosis ; Definition, A systemic mycosis that results_in infection located_in human body, has_material_basis_in Fungi, which can overcome ...

[6] Oct 16, 2021 — These are fungal infections of the body which occur almost exclusively in debilitated patients whose normal defence mechanisms are impaired.

[7] by MA Razzuk · 1973 · Cited by 6 — The primary infection occurs in the lung and is acquired by inhaling spores or hyphae. The severity of the infection varies from a sub- clinical type to a ...

[8] Fungal infections are any disease you get from a fungus. They affect your skin, hair, nails, mucous membranes, lungs or other parts of your body.

[9] by MA Razzuk · 1973 · Cited by 6 — The primary infection occurs in the lung and is acquired by inhaling spores or hyphae. The severity of the infection varies from a subclinical type to a ...

Primary Systemic Mycoses: Signs and Symptoms

Primary systemic mycoses are a group of fungal infections that affect the internal organs, such as the lungs, liver, and brain. The signs

Diagnostic Tests for Primary Systemic Mycoses

Primary systemic mycoses, also known as deep or disseminated fungal infections, are a group of serious fungal infections that affect the internal organs. The diagnosis of these infections can be challenging and often requires a combination of clinical evaluation, laboratory tests, and imaging studies.

Recommended Diagnostic Tests:

• Medical History: A thorough medical history is essential to determine whether patients may have been exposed to certain endemic mycoses.
• Imaging Studies: Chest X-ray, CT scans, MRI, and ultrasound may be used to evaluate the extent of infection and guide treatment decisions.
• Histopathologic Study: A skin biopsy or tissue sample from an affected organ can be examined under a microscope for fungal elements.
• Culture: Culture of agents causing systemic mycoses should only be carried out in a laboratory setting, as it requires specialized equipment and expertise.

Additional Diagnostic Tests:

• Serologic Tests: Serologic tests may be used to evaluate for many systemic mycoses if culture and histopathology are unavailable or unrevealing.
• Molecular Diagnostics: Molecular diagnostics can be used to identify specific fungal pathogens, such as Aspergillus, Blastomyces, Candida, Coccidioides, Cryptococcus, and Histoplasma.

Key Points:

• Blood tests are not useful for the diagnosis of superficial fungal infections.
• Culture, histopathology, and serologic tests may be helpful in diagnosing subcutaneous and systemic mycoses.
• A detailed travel and residential history should be obtained to determine whether patients may have been exposed to certain endemic mycoses.

References:

• [1] Blood tests for patients with deep or disseminated fungal infection.
• [2] The primary systemic mycoses (histoplasmosis, blastomycosis ... it is recommended to take an extensive medical history and perform additional imaging tests, accompanied by histopathologic study and culture.
• [4] The most reliable tests to confirm infection are skin biopsy for histological (microscopic) analysis and fungal culture. Blood can also be cultured.
• [6] Traditional approaches to diagnosis include direct microscopic examination of clinical samples, histopathology, culture, and serology.
• [8] Serologic tests may be used to evaluate for many systemic mycoses if culture and histopathology are unavailable or unrevealing, although few provide definitive ...
• [14] Cultures and stains. Histopathology. Serologic tests (mainly for Aspergillus, Blastomyces, Candida, Coccidioides, Cryptococcus, and Histoplasma). Molecular diagnostics.

Treatment Options for Primary Systemic Mycosis

Primary systemic mycosis, also known as deep-seated fungal infections, can be treated with various antifungal medications. The choice of treatment depends on the type and severity of the infection.

• Polyenes: This class of antifungal drugs includes Amphotericin B, which is considered a drug of choice for life-threatening endemic mycoses in both immunocompetent and immunocompromised patients [8].
• Azoles: Triazole compounds such as fluconazole (400–800 mg daily) or itraconazole (200 mg bd) are effective against systemic fungal infections, including coccidioidomycosis [3].
• Echinocandins: Caspofungin and voriconazole are two new drugs that have been introduced for the treatment of systemic mycosis. They can be very useful in the management of these infections [4][7].

Systemic Antifungal Medications

In addition to the above-mentioned classes, other systemic antifungal medications can also be given. These include:

• Amphotericin B
• Fluconazole
• Itraconazole
• Voriconazole
• Caspofungin

The prognosis for patients with primary systemic mycosis is generally good if treated promptly and effectively [5].

References

[1] PT McKeny (2023) - Ketoconazole is also a systemic agent, which has approval for treating blastomycosis, coccidioidomycosis, chromomycosis, histoplasmosis, and ... [2] ACO Souza (2017) - Antifungal therapy for systemic mycosis is basically focused in three classes: polyenes, azoles, and echinocandins (Polvi et al., 2015). [3] Treatment. Systemic therapeutic options for coccidioidomycosis include triazole compounds such as fluconazole (400–800 mg daily) or itraconazole (200 mg bd) or ... [4] JRA Perea (2004) - Recently, antifungal therapy has been extended through the introduction of two new drugs, caspofungin and voriconazole. These can be very useful in the ... [5] Systemic antifungal medications can also be given. Suitable drugs include: Amphotericin B; Fluconazole · Itraconazole · Voriconazole; Caspofungin. [6] Many fungal infections can be cured with antifungal medication, which kills fungus in and on your body. What form of medication your healthcare provider ... [7] JRA Perea (2004) - Recently, antifungal therapy has been extended through the introduction of two new drugs, caspofungin and voriconazole. These can be very useful in the ... [8] O Lortholary (1999) - Amphotericin B remains the drug of choice during the acute stage of life-threatening endemic mycoses occurring in both immunocompetent and immunocompromised ...

The differential diagnosis for primary systemic mycosis, also known as systemic fungal diseases, includes a variety of conditions that can present with similar symptoms and characteristics.

Conditions to Consider

• Mucocutaneous leishmaniasis: This condition is caused by the Leishmania parasite and can cause skin lesions, ulcers, and other systemic symptoms [6][9].
• Wegener granulomatosis: Also known as Granulomatosis with Polyangiitis (GPA), this is a rare autoimmune disorder that can cause inflammation in various organs, including the lungs, kidneys, and skin [6][10].
• Syphilis: This bacterial infection can cause a range of symptoms, including skin lesions, ulcers, and systemic problems [6][9].
• Lymphoma: A type of cancer that affects the immune system, lymphoma can cause a variety of symptoms, including skin lesions and systemic problems [6][10].
• Sporotrichosis: This fungal infection can cause skin lesions and other systemic symptoms [6][9].
• Scrofuloderma: A rare condition caused by tuberculosis, scrofuloderma can cause skin lesions and other systemic symptoms [6][9].

Other Considerations

• Oral tuberculosis: This condition can cause ulcers and other oral lesions that may be mistaken for primary systemic mycosis [10].
• Squamous cell carcinoma: A type of skin cancer, squamous cell carcinoma can cause skin lesions and other systemic symptoms [10].
• Other systemic mycoses: These are fungal infections that can affect various organs and systems in the body, including the lungs, kidneys, and skin [5].

Key Points to Remember

• The differential diagnosis for primary systemic mycosis is broad and includes a variety of conditions that can present with similar symptoms.
• A thorough medical history and physical examination are essential for making an accurate diagnosis.
• Laboratory tests, such as blood cultures and biopsy results, may also be necessary to confirm the diagnosis.

References:

[5] - Systemic fungal diseases are primary pulmonary diseases caused by the dimorphic fungal pathogens, Blastomyces dermatitides, Coccidioides immitis [5]. [6] - The differential diagnosis should include mucocutaneous leishmaniasis, Wegener granulomatosis, syphilis, lymphoma, sporotrichosis, and scrofuloderma, among others [6][9]. [10] - Important differential diagnoses such as visceral leishmanias