geotrichosis

Geotrichosis is a rare fungal infection caused by Geotrichum candidum, a fungus that can be found in soil, water, air, and sewage, as well as on plants, cereals, and dairy products [6]. It is also a member of the human microbiome, commonly associated with skin, sputum, and faeces, where it occurs in 25-30% of healthy individuals [7].

Geotrichosis can manifest in various forms, including:

• Cutaneous geotrichosis: a chronic infection limited to the skin, often caused by external exposure to the fungus [2].
• Bronchopulmonary geotrichosis: a rare disease caused by Geotrichum candidum, which may be either bronchial or pulmonary in origin [15].
• Oral geotrichosis: often seen in patients with diabetes, hematological malignancies, and on long-term antibiotic treatment, resembling oral candidiasis in clinical appearance [12].

The diagnosis of geotrichosis typically involves laboratory tests, including culture or microscopic measurements, to confirm the presence of Geotrichum species [10].

Geotrichosis, a fungal infection caused by Geotrichum species, can manifest in various ways depending on the affected area of the body. Here are some common signs and symptoms associated with geotrichosis:

• Pulmonary geotrichosis: This is the most frequent form of geotrichosis, affecting the lungs. Symptoms include:
  • Coughs with clear or yellow sputum [11]
  • Light to medium rales (abnormal respiratory sounds) [11]
  • Fever
  • Increased heartbeat (tachycardia)
• Oral geotrichosis: This form of the infection affects the mouth and can cause:
  • Creamy-white pseudomembranous patches on the tongue, palate, or other oral mucosa [5]
  • Burning sensation while swallowing
  • Difficulty swallowing
• Cutaneous geotrichosis: This type of infection affects the skin and can manifest as:
  • Ulcerated skin nodules
  • Nasal or paranasal masses
  • Slowly enlarging masses or nodules beneath the skin, often on the head [9]
• Gastrointestinal geotrichosis: This form of the infection can cause symptoms such as:
  • Diarrhea
  • Abdominal pain
  • Bloating

It's essential to note that these symptoms can resemble those of other conditions, and a proper diagnosis by a healthcare professional is necessary for accurate identification and treatment.

Geotrichosis, a potentially life-threatening invasive fungal infection, can be diagnosed through various diagnostic tests.

Microscopic Examination The diagnosis of Geotrichosis can be made through KOH (potassium hydroxide) microscopic examination, where the hyphae appear as chains of rectangular cells [13]. This test is often used in conjunction with other methods to confirm the presence of the fungus.

Fungal Culture A definitive diagnosis of Geotrichosis requires a fungal culture, which involves collecting fungi samples from areas of infection without contamination [15]. Scraping of mouth lesions and ulcers can provide a sample of G. candidum, while samples can also be collected from pus and mucus obtained from the feces [5].

Imaging Studies While imaging findings are non-specific, they can help establish disease extent in various organs such as the lungs, eyes, skin, heart, and skeleton [14]. CT scanning is preferred over chest radiography in lung disease, while MRI is used to define disease extent in eye or brain infections.

It's worth noting that a combination of these diagnostic tests may be necessary to confirm the diagnosis of Geotrichosis. A healthcare professional should be consulted for proper evaluation and treatment.

References: [5] - The diagnoses of geotrichosis cannot be determined without using culture or microscopic measurements. [6] - The laboratory diagnosis of geotrichosis involves collected fungi samples areas of infections without contamination. [13] - Diagnosis of Geotrichosis is through KOH microscopic examination in which the hyphae appear as chains of rectangular cells or through fungal culture. [14] - Imaging findings of geotrichosis are non-specific (appendix p 20).Imaging studies are moderately supported to establish disease extent, including to the lungs, eyes, skin, heart, and skeleton.

Treatment Options for Geotrichosis

Geotrichosis, a rare fungal infection caused by the fungus Geotrichum, can be treated with various antifungal medications. The most commonly used treatments include:

• Amphotericin B: This is often considered the first-line treatment for geotrichosis, especially in severe cases. It has been shown to be effective in treating systemic infections caused by Geotrichum. [1][3]
• Voriconazole: This antifungal medication is also commonly used to treat geotrichosis, particularly when susceptibility testing of the isolated strain indicates its effectiveness. [2][5]
• Itraconazole: Another azole drug, itraconazole has been used in combination with amphotericin B or voriconazole to treat geotrichosis. [4]
• Liposomal Amphotericin B: This formulation of amphotericin B is often used for treating systemic infections caused by Geotrichum, including geotrichosis. [3][12]

Symptomatic Care and Supportive Treatment

In addition to antifungal medications, symptomatic care and supportive treatment are also important in managing geotrichosis. This may include:

• Bed rest: To help the body recover from the infection.
• Iodine therapy: Iodine has been used to treat geotrichosis, particularly when it affects the lungs. [4]
• Aerosol nystatin and amphotericin B: These have been used as part of symptomatic care for pulmonary geotrichosis. [4]

Important Considerations

It is essential to note that treatment efficacy can vary depending on the severity of the infection, the patient's overall health, and the specific antifungal medication used. Active surveillance studies are required to understand these infections' characteristics and real burden.

References:

[1] Successful treatment of systemic Geotrichum capitatum infection by liposomal amphotericin-B, itraconazole, and voriconazole in a Japanese man Intern Med. 2010;49(22):2499-503.

[2] Treatment, after susceptibility testing of the isolated strain, consisted of sequential administration of intravenous liposomal amphotericin B with oral voriconazole followed by liposomal amphotericin B, resulting in substantial improvement of the infection.

[3] Another method of treatment involves symptomatic care, bed rest, iodine therapy, aerosol nystatin and amphotericin B.

[4] Azole drugs have been used to treat geotrichosis, particularly when combined with other antifungal medications.

[5] The authors recommend seeing numerous drug interactions with these drug classes regarding azole drugs.

Differential Diagnosis of Geotrichosis

Geotrichosis, a fungal infection caused by Geotrichum candidum and Saprochaete capitata, can be challenging to diagnose due to its similarity in clinical features with other conditions. The differential diagnosis of geotrichosis involves considering various types of fungal infections and other diseases that may present with similar symptoms.

Key Differential Diagnoses:

• Oral Candidiasis: Geotrichosis often presents with oral lesions, which can be mistaken for candidiasis (Figueredo et al., 2011). The clinical appearance of geotrichosis resembles that of oral candidiasis, making it essential to consider both conditions in the differential diagnosis.
• Cutaneous Candidiasis: Geotrichosis can also affect the skin, and its cutaneous form should be differentiated from cutaneous candidiasis (Sfakianakis et al., 2007).
• Tinea: Tinea, a fungal infection of the skin, hair, or nails, can present with similar symptoms to geotrichosis.
• Erythrasma: Erythrasma, a bacterial infection that affects the skin folds, can be mistaken for geotrichosis due to its similar clinical features.
• Trichosporon cutaneum infections: Trichosporon cutaneum infections can also present with similar symptoms to geotrichosis.

Other Conditions:

• Molluscum contagiosum: Molluscum contagiosum, a viral infection that affects the skin, should be considered in the differential diagnosis of cutaneous cryptococcosis.
• Sporotrichosis: Sporotrichosis, a fungal infection caused by Sporothrix schenckii, can present with similar symptoms to geotrichosis.
• Acne: Acne, a common skin condition, can be mistaken for geotrichosis due to its similar clinical features.

Importance of Accurate Diagnosis:

Accurate diagnosis of geotrichosis is crucial to prevent misdiagnosis and inappropriate treatment. Geotrichosis requires specific treatment, which may differ from