Mycosis (Fungal Infections)

Mycosis is a prevalent condition that affects millions of people worldwide. It is caused by fungi, which are living organisms that obtain their nutrients by decomposing organic matter or by forming symbiotic relationships with other organisms. While many fungi are harmless to humans, some can cause infections, ranging from mild to severe. In this article, we will explore the various aspects of mycosis, including its types, symptoms, diagnosis, treatment, and prevention.

What is Mycosis?

Mycoses or fungal infections are diseases caused by fungi, which include yeasts and molds. These infections commonly affect the skin, nails, and mucous membranes, but they can also spread to deeper tissues and internal organs. While some fungal infections are mild and limited to the outer layers of the body, others can become severe, especially in individuals with weakened immune systems. Fungi thrive in warm, moist environments, making areas like the feet, armpits, and groin more susceptible to infections. In addition, fungal infections can occur in the mouth (oral thrush), throat, lungs (such as aspergillosis), urinary tract, and even the bloodstream in severe cases. Prompt diagnosis and appropriate antifungal treatment are essential for managing these infections effectively.

Mycoses are broadly categorised into three main groups based on the depth and extent of the fungal invasion. These include:

1. Superficial fungal infections: These fungal infections are limited to the outermost layers of the skin and its appendages, such as hair and nails. These infections are usually not serious and can be treated with topical antifungal medications. Some common examples of superficial fungal infections include:

• Ringworm (tinea): A dermatophyte infection that can affect various parts of the body, such as the skin (tinea corporis), scalp (tinea capitis), groin (tinea cruris), and feet (tinea pedis).
• Onychomycosis: A fungal infection of the nails, typically caused by dermatophytes, resulting in thickening, discolouration, and separation of the nail from the nail bed.
• Candidiasis: A yeast infection caused by Candida species, which can affect the skin, mucous membranes, and internal organs. Superficial candidiasis includes conditions like oral thrush and vaginal candidiasis.
• Tinea versicolour/pityriasis versicolour: A superficial infection caused by Malassezia, characterised by patches of discoloured skin, often on the trunk and upper arms.

2. Subcutaneous fungal infections: These fungal infections involve the tissues beneath the skin and are often more challenging to treat than superficial infections. These infections typically occur when fungi enter the body through a cut, puncture wound, or other breaks in the skin. Some key examples of subcutaneous fungal infections include:

• Sporotrichosis: Caused by the fungus Sporothrix, this infection usually enters the body through a cut or puncture wound and can cause painful ulcerations and nodules along the lymphatic vessels.
• Chromoblastomycosis: A chronic infection of the skin and subcutaneous tissue, characterised by warty lesions, caused by various fungi, including Fonsecaea and Cladophialophora species.
• Eumycetoma: A chronic, progressive infection that affects the subcutaneous tissue and can extend into deeper structures, including bone. It is caused by various fungi and can lead to severe deformity and disability if left untreated.

3. Deep fungal infections: These fungal infections are serious and potentially life-threatening conditions that can affect internal organs. These infections occur when fungi invade deeper tissues and spread through the bloodstream. Some examples of deep fungal infections include:

• Histoplasmosis: Caused by the fungus Histoplasma, this infection primarily affects the lungs but can spread to other organs, such as the liver, spleen, and central nervous system.
• Coccidioidomycosis: This infection is caused by Coccidioides fungi and can cause flu-like symptoms, pneumonia, and, in severe cases, disseminated disease affecting multiple organs.
• Blastomycosis: Caused by the fungus Blastomyces, this infection can affect the lungs, skin, and other organs, leading to a range of symptoms, from mild respiratory illness to severe systemic disease.
• Aspergillosis: An infection caused by Aspergillus fungi, which can cause various respiratory conditions, from allergic reactions to invasive pulmonary disease, particularly in immunocompromised individuals.
• Candidal urinary tract infection: An infection of the urinary tract caused by Candida fungi, which can lead to painful urination, frequent urges to urinate, and, in severe cases, kidney damage.
• Invasive candidiasis: A severe systemic infection caused by Candida fungi that can affect various organs, including the bloodstream, heart, brain, and eyes, particularly in hospitalised and immunocompromised patients.
• Pneumocystis pneumonia: A serious lung infection caused by the fungus Pneumocystis jirovecii, primarily affecting individuals with weakened immune systems, such as those with HIV/AIDS or undergoing chemotherapy.
• Mucormycosis: A rare but severe infection caused by fungi in the order Mucorales, which can affect the sinuses, lungs, skin, and brain, often in individuals with diabetes or compromised immune systems.
• Cryptococcosis: An infection caused by the fungus Cryptococcus neoformans, which can affect the lungs and central nervous system, particularly in people with weakened immune systems.

The symptoms of mycosis can vary depending on the type of fungal infection and the area of the body affected. Some common symptoms include:

• Red, itchy patches: These may appear suddenly and can be quite uncomfortable, often indicating an inflammatory response to the fungal infection.

• Scaly or flaky areas: Skin may begin to shed in patches, leading to a rough texture and visible flakes.

• Blisters or pustules: Fluid-filled bumps can develop, which may break open and cause further irritation.

• Discolouration of nails: Infected nails often turn yellow or white, indicating fungal growth beneath the nail. The nail may become unusually thick and prone to breakage, making it difficult to maintain.

• Persistent cough: This can be a sign of lung involvement, often caused by inhaling fungal spores.

• Shortness of breath: Difficulty breathing may occur as the infection affects lung function.

• Chest pain: Discomfort or pain in the chest can indicate inflammation or infection in the lung tissue.

• Fever and chills: Elevated body temperature is a common response to infection, often accompanied by shaking chills.

• Weight loss: Unexplained weight loss may occur due to the body’s increased metabolic demands in fighting the infection.

• Nausea and vomiting: This can occur due to irritation in the digestive tract from the fungal overgrowth. Some individuals may experience vomiting as a result of the body’s attempt to expel irritants.

• Diarrhoea: An increased frequency of loose stools may occur, disrupting normal digestion.

• Abdominal pain: Discomfort or cramping in the abdomen can be a result of gastrointestinal inflammation or irritation.

• Headaches: These can arise from increased pressure or irritation in the central nervous system.

• Confusion: Cognitive changes may occur, impacting clarity of thought and awareness.

• Seizures: In severe cases, fungal infections may provoke seizures due to inflammation in the brain.

Mycosis fungoides progresses through several stages, which are crucial for determining the prognosis and treatment plan. The staging is based on the extent of skin involvement and the presence of lymph node or systemic involvement. Here, T means tumour, N means node, M means metastasis, and B refers to the presence of Sézary cells in the blood. The stages include:

• Stage IA (T1, N0, M0, B0, or B1): Less than 10% of the skin surface is affected by patches or plaques, with no tumours, no lymph node involvement, no systemic involvement, and a low number of Sézary cells in the blood.

• Stage IB (T2, N0, M0, B0, or B1): 10% or more of the skin surface is affected by patches or plaques, with no tumours, no lymph node involvement, no systemic involvement, and a low number of Sézary cells in the blood.

• Stage IIA (T1 or T2, N1 or N2, M0, B0 or B1): Patches or plaques cover any percentage of the skin surface, with abnormal lymph nodes but no systemic involvement and a low number of Sézary cells in the blood.

• Stage IIB (T3, N0 to N2, M0, B0 or B1): Presence of one or more tumours, with or without lymph node involvement, no systemic involvement, and a low number of Sézary cells in the blood.

• Stage III (T4, N0 to N3, M0, B0 or B1): Erythroderma (redness and scaling of the entire skin surface), with or without lymph node involvement, no systemic involvement.

• Stage IVA and IVB: These stages involve systemic involvement, with a high number of Sézary cells in the blood and involvement of lymph nodes and other organs.

As mycosis fungoides progresses through these stages, the symptoms become more severe and the prognosis worsens.

Mycosis, or fungal infections, can be caused by various factors, including:

• Weakened immune system: Conditions that impair the immune system, such as HIV/AIDS, diabetes, cancer, or the use of immunosuppressive medications, can increase the risk of developing mycosis.
• Warm, moist environments: Fungi thrive in warm, humid conditions. Wearing tight, non-breathable clothing or spending prolonged periods in damp areas can create an ideal environment for fungal growth.
• Poor hygiene: Inadequate personal hygiene, such as not washing regularly or failing to dry skin thoroughly, can contribute to the development of fungal infections.
• Contact with infected individuals or animals: Some types of mycosis, such as ringworm (tinea), can be transmitted through direct contact with infected people or animals.
• Prolonged antibiotic use: Antibiotics can disrupt the natural balance of microorganisms on the skin and in the body, allowing fungi to overgrow and cause infections.
• Hormonal changes: Hormonal fluctuations, such as those experienced during pregnancy or menstruation, can alter the body's pH levels and make individuals more susceptible to fungal infections.
• Underlying medical conditions: Certain medical conditions, such as diabetes or peripheral vascular disease, can impair circulation and increase the risk of fungal infections, particularly in the feet.

Cracked heels occur when the skin on the feet becomes dry, thickened, or damaged. Several factors contribute to this condition, from dehydration to underlying medical conditions. Below are some of the common risk factors:

1. Dehydration

Lack of adequate hydration can lead to dry and flaky skin, especially on the soles of the feet. Since the skin here naturally has fewer oil glands, it is more prone to moisture loss, making dehydration a primary cause of cracked heels.

2. Athlete's Foot

Athlete’s foot is a fungal infection that presents as a scaly, itchy rash. The infection can cause excessive dryness and peeling if left untreated, leading to cracked heels.

3. Eczema (Atopic Dermatitis)

Eczema is a chronic skin condition characterised by dry, inflamed, and irritated skin. It can cause the skin on the feet to lose moisture and become prone to painful fissures.

4. Uncontrolled Diabetes

Diabetes can lead to nerve damage (neuropathy), which affects the ability of the feet to produce sweat. This lack of moisture increases the risk of developing thickened skin, calluses, and cracks.

5. Hypothyroidism

An underactive thyroid slows down metabolism, reducing oil production in the skin. This can cause excessive dryness, making the feet more susceptible to cracks and fissures.

6. Palmoplantar Psoriasis

This is a specific type of psoriasis affecting the palms and soles. It can cause painful pustules (lesions), thick calluses, and deep cracks in the heels.

7. Juvenile Plantar Dermatosis (Sweaty Sock Syndrome)

This condition affects children between the ages of 3 and 14 years, causing red, dry, and scaly patches on the soles of the feet. It is often linked to excessive sweating and friction from footwear.

8. Sjögren’s Syndrome

An autoimmune disorder that attacks moisture-producing glands, leading to dry skin, including on the feet. The lack of natural lubrication can result in cracked heels.

9. Obesity

Excess weight increases the pressure on the heels, causing the skin to expand and crack. Studies suggest that obese individuals are more prone to developing thickened and fissured skin on the feet.

10. Pregnancy

Hormonal changes, weight gain, and increased pressure on the feet during pregnancy contribute to dry skin, making pregnant women more susceptible to cracked heels.

11. Aging

As people age, their skin becomes thinner, less elastic, and produces fewer natural oils. This results in dryness, making older individuals more prone to developing cracked heels.

12. Other Contributing Factors

Several lifestyle and environmental factors also increase the likelihood of cracked heels, including:

• Living in dry or cold climates
• Taking long, hot showers that strip the skin of moisture
• Wearing ill-fitting or open-back footwear that exposes heels to friction
• Standing for prolonged periods, especially on hard surfaces
• Engaging in high-impact activities like running, jogging, or climbing
• Jobs that involve repeated foot pressure, such as construction work or athletics

Preventing mycosis involves a combination of good hygiene practices and lifestyle modifications. Here are some effective strategies to reduce the risk of fungal infections:

• Regularly wash your skin with soap and water, especially after exercising or sweating.
• Dry your skin thoroughly, particularly in areas prone to fungal growth, such as between the toes and under the breasts.
• Fungi thrive in moist environments, so it's essential to keep your skin dry. Use powder in areas where skin rubs against skin, like the groin or under the arms.
• Choose loose-fitting, lightweight clothing made from natural, breathable fabrics like cotton.
• Avoid tight, restrictive clothing that traps moisture against the skin.
• When using public showers, locker rooms, or swimming pools, wear flip-flops or sandals to prevent contact with contaminated surfaces.
• Do not share towels, hairbrushes, or other personal items that can harbour fungi.
• Eat a balanced diet, get regular exercise, and manage stress to support your immune function.

Diagnosis of Cracked Heels

Cracked heels are often diagnosed based on a physical examination, but further tests may be required to identify any underlying medical causes. A doctor may conduct the following diagnostic procedures:

1. Medical History and Physical Examination

• The doctor will visually inspect the feet for dryness, fissures, and thickened skin.
• They may ask about footwear choices, foot hygiene, and past treatments.
• Walking style and foot positioning may also be assessed to determine any mechanical issues contributing to heel cracks.

2. Laboratory Tests

While laboratory tests are not always required, they can help identify underlying health conditions causing persistent cracked heels. These may include:

• Complete Blood Count (CBC): Checks for signs of infection or inflammation.
• Blood Glucose Test: Determines if diabetes or impaired glucose metabolism is affecting skin health.
• Nutritional Tests: Identifies deficiencies in vitamins A, C, D, or E, which play a crucial role in maintaining healthy skin.

3. Pedobarographic Studies

These foot pressure studies analyse weight distribution on the feet, identifying high-pressure areas that may contribute to heel fissures.

4. Skin Biopsy

In cases where an underlying skin disorder is suspected, a small tissue sample may be taken and examined under a microscope to rule out infections, psoriasis, or eczema.

5. Imaging Tests (If Necessary)

Though not commonly required, imaging techniques may be used to assess deeper skin structures and bone involvement:

• Dermoscopy: A magnified skin examination to detect fungal infections or dermatological conditions.
• Wood’s Lamp Examination: Uses ultraviolet light to diagnose fungal infections or skin conditions.
• X-rays: Help identify bone deformities that may contribute to pressure-related cracks on the heels.

By identifying the root cause of cracked heels, doctors can recommend appropriate treatments, whether through lifestyle modifications, topical treatments, or medical interventions.

The treatment and management of mycosis depends on the specific type of fungal infection and its severity. Here are some common treatment options:

• Topical antifungal medications: For superficial mycoses like athlete's foot, jock itch, and ringworm, topical antifungal creams, lotions, or sprays are often effective. These may contain ingredients like clotrimazole, miconazole, terbinafine, or ketoconazole.
• Oral antifungal medications: For more extensive or resistant infections, oral antifungal medications may be necessary. These include medicines like terbinafine, itraconazole, and fluconazole. Oral antifungals are typically taken for several weeks to months, depending on the infection. Be sure to complete the full course of treatment, even if symptoms improve.
• Lifestyle modifications: In addition to medication, making certain lifestyle changes can help manage and prevent recurrent fungal infections. Keep the affected area clean and dry, wear loose, breathable clothing, and avoid sharing personal items like towels or razors. If you have athlete's foot, use moisture-wicking socks and shoes that allow your feet to breathe.
• Follow-up care: After completing treatment, follow up with your doctor to ensure the infection has cleared. In some cases, maintenance therapy with topical or oral antifungals may be recommended to prevent recurrence.

If you have been diagnosed with a fungal infection, here are some tips to manage your condition and prevent recurrences:

• Follow the prescribed treatment plan diligently, completing the full course of medications even if symptoms improve.

• Practice good hygiene, especially in affected areas. Keep the skin clean and dry.

• Avoid sharing personal items like towels, hairbrushes, or nail clippers to prevent the spread of infection.

• Wear loose, breathable clothing to minimise moisture retention, which can promote fungal growth.

• Protect your feet by wearing well-fitting, breathable shoes and clean, dry socks. Go barefoot at home when possible.

• Manage underlying health conditions that may increase your risk of fungal infections, such as diabetes or a weakened immune system.

• Avoid walking barefoot in public spaces like locker rooms, showers, or pools to reduce exposure to fungal spores.

If you suspect you have a fungal infection or mycosis fungoides, it is important to see a doctor promptly. Persistent symptoms such as itching, redness, or rash that worsen despite self-care measures warrant medical attention. If you experience severe symptoms like pain while eating, white patches in the mouth, or discoloured and thick nails, consult your doctor immediately. Early diagnosis and treatment are key to effectively managing mycosis and preventing complications.

• Mycosis refers to fungal infections that can affect various parts of the body, including the skin, nails, hair, and internal organs.

• Common types of mycosis include dermatophytosis, candidiasis, aspergillosis, and mycosis fungoides.

• Symptoms of mycosis vary depending on the type and location of the infection but may include skin rashes, itching, nail changes, and respiratory issues.

• Treatment for mycosis depends on the type and severity of the infection and may include topical or oral antifungal medications, as well as more complex therapies for deep or severe infections.

• Living with mycosis requires good hygiene, environmental protection, symptom monitoring, and adherence to prescribed treatment regimens.

• Seeking prompt medical attention for suspected fungal infections is essential, particularly for individuals with weakened immune systems or persistent symptoms.