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Fungi as Human Pathogens

Introduction
Fungi that are pathogens are usually plant pathogenic Fungi. There are
comparatively few species that are pathogenic to animals, especially
mammals. According to Hawksworth (1992), there are approximate a
little 1.5 million described species of fungi. A little more than 400 of
these species are known to cause disease in animals, and far fewer of
these species will specifically cause disease in people. Many of the
latter will only be superficial types of diseases that are more of a
cosmetic than a health problem. Thus, there are not many species of
fungi that are pathogenic to human that will be fatal. The study of
Fungi as animal and human pathogens is medical mycology. There is also
such a thing as veterinary mycology, but the types of diseases that
are found in your pets often are the same as those that are found in
people. Because of the rarity of human diseases caused by Fungi, most
people have little, if any, knowledge of such diseases.
The diseases of warm-blooded animals caused by fungi are known as
mycoses (sing.=mycosis). Although such diseases are relatively few, the
fungi that cause them have a wide host as well as geographical range.
Most of these diseases are not fatal, but once contracted, they may
forever be a source of constant irritation and can lead to permanent
scaring, which is why they are not such a pretty sight to view.
The successful treatment of fungal diseases is more difficult than
those caused by bacteria. Because bacteria are prokaryotes, the
makeup of their cells are very different than our own eukaryotic cells
and pharmaceutical products, such as antibiotics, are able to
successfully destroy bacteria without harming our cells, tissues and
organs. However, because fungi are eukaryotes, finding a treatment
that will kill the fungus and not harm our own cells is more difficult.
Thus, most chemical treatments are also toxic us as well as the fungus.
The most widely used drug for treating systemic mycosis and other
fungal infections that do not respond to other drugs is Amphotericin B.

Azole drugs are also widely used, but these only inhibited fungal
growth and do not kill the fungus.
History on the Theory of Human Diseases
The history human diseases tells a story that parallels and overlaps
that of plant diseases. Early man viewed disease as a work of demons,
and in many tribal societies, the exorcism of demons was the job of the
shaman, witch doctor, sorcerer, etc. With the development of
agriculture and civilization, more elaborate stories came about. For
example, the Greeks tell of the myth about Pandora opening a box given
to her by Zeus and releasing a host of plagues on mankind. However,
they also created Aesculapius, the god of healing and medicine who had
two daughters, Hygeia and Panacea, who were goddesses of health.
During the 4th Century B.C., Aristotle introduced the theory that life
could arise abiologically, i.e. without parents. This is the theory of
spontaneous generation, a theory that survived well into the 1800s.
As early as 350 B.C., Hippocrates developed a theory that was not
based on superstition and myth. His Humoral Theory suggested that
diseases were the result of disproportionate relationship of body
humors or fluids: blood, yellow bile, black bile and phlegm (saliva). In
order to have good health, each body humor must maintain a certain
proportion with the other body fluids. An individual's humors may
become unbalanced when they becomes ill, with the changing of the
season, over-eating, etc., and the balance in their humors must be
adjusted to bring them back into balance. Adjustments were often
made by inducing an individual to vomit or to draw out "bad blood" by
cutting an artery or vein. Thus, arose the practice of blood letting,
which along with hair cuts, shaves and enemas, was carried out in
barber shops. Even today, barbershops still utilize the red and white
striped pole display as a means of letting the public know that it is a
hair cutting establishment. However, meaning of this barbershop
symbol has nothing to do with hair cutting. The red strip is to indicate
the blood that is bled, the white corresponds to the tourniquet used to
dilate the veins.

Roman scholar, Marcus Terentius Varro (116BC -27BC ) suspected that


disease was caused by little animals in the air. However, because of the
dark age that followed, science progressed little until the 1500s. In
1546, Girolamo Fracastoro gave the first description of typhus and
suggested that this disease could be contracted from one person to
another through direct contact or individuals coming in contact with
inanimate objects referred to as fomite, i.e., linen, eating utensils,
clothing, etc.
In 1688, Francesco Redi, a Florentine scientist, was the first to
challenge the idea of spontaneous generation. It was thought that
maggots and flies arose spontaneously, from rotting animal flesh. Redi
protected the rotted animal flesh from the air and other to sources of
visible infection and observed that maggots and flies did not arise
from the protected meat. His conclusion was that flies and maggots
were present in the unprotected meat, but absent in the protected
meat, because it served as a nesting area for the eggs of the flies as
well as a food source once the eggs hatched. For a detailed description
and illustration of Redi's experiment, see Lecture 02.
In 1674, Anton Van Leeuwenhoek became the first person to see and
describe various microorganisms. He would continue to describe
observations of anything that he could place under the microscope until
just before his death in 1723.
You should also recall that Anton de Bary's demonstration that the
Potato Blight was caused by Phytophthora infestants came a year
earlier than Pasteur's Germ Theory. However, the demonstration that
fungi could cause disease in people preceded even de Bary. In 1835,
Agostino Bassi discovered that a disease of silkworms known as
muscardine could be transferred from silk worm to silk worm and was
caused by a fungus, Beauvaria bassiana, a species that was later named
for Bassi in honor of his discovery. The fungus grows on the silk worm,
covering it with white mycelium, eventually killing it. This is a
significant problem in the silk industry since one infected silkworm can
spread the fungus to all of the other silkworms. It was shortly after
that, in 1841, David Gruby demonstrated for the first time that a

fungus infection of the scalp, called favus, was caused by a fungus (in
Rippon, 1988). The disease is characterized by thick yellow crusts over
the hair follicles. At a time before the use of agar media, Gruby
isolated the fungus causing favus, from infected individuals, grew the
fungus on slices of potatoes and was able to reproduced the favus
disease by carrying out inoculation experiments on healthy tissue. This
experiment demonstrated, for the first time, that a microorganism was
the cause of a human disease (remember Koch's Postulate?). However,
Gruby's research in this areas has mostly been ignored, possibly due to
strong anti-Semitic feelings, in medicine, at that time (Rippon, 1988).
Slow Knowledge of Medical Mycology Advancement
It would appear that with the knowledge gained from the research of
Bassi and Gruby that in the study of diseases, the knowledge of fungal
diseases should have progressed more rapidly than bacterial diseases.
However, that is obviously not the case. Bacterial diseases are by far
more well known. There are several reasons for this disparity in
knowledge. Relative to bacterial diseases, fungal diseases are
infrequent and while some mycoses can be severe to fatal, there have
not been epidemics of such diseases as we have found in bacteria. For
example, bubonic plague was responsible for approximately a third of
the population of Europe, between 1346-1350 and 40% of the
population of Constantinople, in 1542, and while other diseases such as
tuberculosis, malaria, dysentery epidemics were not as severe, they,
too, have caused numerous deaths. The combination of the severity,
frequency and the epidemics that have occurred in bacterial diseases
have, undoubtedly, driven the progress in the study of bacterial
diseases. Another problem that slowed the progress of fungal diseases,
and one that should not be estimated, is the understanding of species
concept in fungi. By 1890 Sabouraud began publishing large numbers of
articles on fungus disorders of the skin which eventually culminated in
an enormous contribution to the field of medical mycology. However,
Sabouraud had difficulty understanding variations in forms fungi can
often exhibit. Some species of fungi can take on several forms, a
phenomenon known as pleomorphism. Thus, some of Sabouraud's
published species as well as those of his contemporaries were merely

different forms of existing species. This resulted in hundreds of


species being described that would later be determined to represent
already published species. Some of these species were based on
careful observations where only slight variations in the form of the
fungus was thought to represent new species, but some newly
described species were also based on inaccurate and incomplete
observations. The complication of nomenclature and classification of
fungi also slowed progress. This was a problem, at that time, since
doctors, were not trained in either mycology nor the systems of naming
and classification of organisms. It would not be until 1934 that species
concepts of dermatophytes would be redefined by Chester Emmons,
according to the Rules of Botanical Nomenclature, and current
mycological standards of spore morphology and the structures on/in
which they were borne. However, with the means of mass producing
penicillin in the early 1940s and discovery of other antibiotics, many of
the very serious bacterial diseases were being controlled. Although, to
some extent, there have are chemical means of controlling some fungal
diseases, they are by no means always successful ones.
What Kind of Fungi Are We Talking About?
There are a number of diseases that specifically cause human diseases.
However, fungi can vary in their host specificity.
The majority of most human pathogenic fungi appear to be soil
inhabiting species where they live as saprobes, but given the
appropriate conditions, i.e. if the person is not healthy, an open wound
is present, direct injection of fungus into your system, a particular
life-style, AIDS, etc., they will aggressively attack people. Thus, many
fungal infections may be due to opportunistic fungi (=facultative
parasites) rather than fungi that specifically cause human diseases.
For example Coprinus cinereus, a common mushroom has been recorded
as causing endocarditis (Speller and MacIver, 1970), Ustilago maydis,
the corn smut is known to cause skin lesions (Review by Lacaz, et al.,
1996) and Schizophyllum commune, a wood decomposing fungus that has
documented to cause several different types of infections, including
meningitis and lung disorder (Reviewed in Kern and Uecker, 1986).

These types of fungi can be more harmful than obligate parasites since
a facultative parasite is not dependent on a live organism and have not
evolved with any particular host, they aggressively attack their hosts,
and there is a greater probability that they will kill their hosts than an
obligate parasite. However, normally these types of fungi will not cause
human mycoses unless their immune system have somehow become
compromised.

Left Image: Coprinus cinereus, from Jason Stajich,


http://farm3.static.flickr.com/2269/1904556823_950
594c954.jpg. Middle Image: Ustilago maydis. Right
Image: Schizophyllum commune, from
http://en.wikipedia.org/wiki/File:Spaltbl
%C3%A4ttlinge.jpg.
We often come in contact with fungi during our everyday routines,
some which are potentially pathogenic to human and others not. We
may be exposed simply by walking by construction areas where the soil
has been disturbed and scattered into the wind by the machinery, we
are constantly exposed while we are hiking, jogging, hunting or fishing.
During recreation when we injure ourselves, such as with puncture
wound, abrasions, burns or even by inhalation of a large number of
harmful spores. Fortunately, most of us have an immune system that
will protect us from such infections by fungi, but some individuals will
contract fungal diseases from such injuries.

So, what kind of fungi can be human pathogens? Probably all fungi can
potentially be harmful, in this respect, if your immune system has been
compromised. Fortunately, for most of us, this is not a problem and the
probability of contracting a serious fungal disease is low relative to
bacterial or viral diseases. However, in recent years, it has become
more of a problem with the rising number of people with compromised
immune systems such as people with AIDS, organ transplants, diabetes
and treatment for various forms of cancer.
Some Fungal Human Pathogens
In discussing fungal diseases, the most convenient way of classifying
them is to categorize them according to the type of infection that has
occurred: 1. Superficial infections, are caused by fungi that attack the
skin or its appendages (nail, feathers and hair). Some examples of
these infection include ringworms, jock-itch and athlete's foot. These
fungi are known as dermatophytes. 2. Systemic infections, diseases
that occur deep within the tissues, involving vital organs and/or the
nervous system, and which may be fatal, but may also be chronic. Entry
into the body is usually through inhalation of spores or open wounds.
Blood circulation or respiratory system may then transmit fungus
throughout body and additional infection of internal organ may occur.
These fungi, are usually saprotrophic fungi, growing in the soil. A third,
Intermediate infection, is sometimes also recognize and is
intermediate between the two just discussed. The infection will occur
below the skin, but will remain localized
Superficial Infections
The superficial mycoses are the most well known since they can be
readily observed. They commonly occur on the hair, nails and skin of
infected individuals. They have been recorded in various compilations
of medical literature for well over a thousand years as ring worm,
athlete's foot, jock itch and piedra. For each type of infection, there
can also be a variety of species that may be causing the disease. Thus,
we will only have a general discussion on this group of diseases.
Ringworm and Related Dermatophytes

Ringworm usually occurs on the exposed parts of the body, forming


circular growths that may appear darker or lighter than the normal
skin color, with symptoms that include skin lesion, rash and itching of
the infected area. Ringworm infections are common where conditions
are unsanitary and crowded with people and has been known since early
historical time. There are indications that ringworm was more
prevalent in the recent past than now because of improvements in
sanitary conditions and health habits. The Greeks called it Herpes
(=circular or ring form) and the Romans associated the disease with
the larval stage of Tinea, the genus for clothes moth. The two names
were eventually combined to "ringworm". Although the actual cause of
ringworm was not known until the early 1800s, the practice of
segregating infected individuals to prevent spread of the disease
indicated that there was knowledge that this disease was contagious
and prevalent, and could be passed from person to person was known
prior to the cause of infection.
It was Gruby that isolated and described one of the ringworm fungi,
Trichophyton, meaning "thread plant", and through inoculation on
healthy parts of the scalp, was able to reproduce the disease. He also
carried out the same experiment with several other human pathogenic
fungi and inoculated himself with the pathogen, as well as others.
Although this was a great accomplishment, Gruby also had a great deal
of luck since, at the time, isolation of specific fungi was not common
practice, and this was also 30 years prior to the development of
techniques to grow fungi and bacteria in pure culture.
According to Ainsworth, more than 350 species of dermatophytes have
been proposed and given approximately 1,000 names, which has caused
some confusion in medical mycology. The proliferation in names have
come about because different researchers have worked with the same
species of a pathogen, in a different place and time, and each were
familiar with that particular isolate of that particular species of
fungus and probably not too familiar with that isolate. They grew it in
culture briefly and published on it. Thus, each newly isolated
dermatophytic fungus was given a name, sometimes according to the
symptoms with which it was associated or according to the part of the

body affected, i.e. top of the head, neck, face, hand, arm, leg and foot,
or even the geographical region, or sometimes just for the sake of
publication (due to the competitiveness of medical schools) . This led to
a great deal of confusion in the understanding of mycoses.
Although the first species were described in the 1840s, they were
little studied until the 1940s, when the United States military
personnel, while fighting in the South Pacific, during WWII,
contracted ringworm and other fungi in the humid tropics (an example
of advancement of knowledge due to driven research). This led to an
intensive study, by the government of such fungi with many species
being reduced to synonyms. For example, 172 species were reduced to
Candida albicans.
Epidemiology of Ringworm
Fungi that cause ringworm are widespread, geographically, and usually
not of major concern, other than as cosmetic problems. However, cases
in which these diseases cause extreme disfigurements and infections
are known to occur, but are rare outside of the tropics, and are
believed to be due to poor diet and unsanitary condition (Christensen,
1965). At one time ringworm was a common disease, particularly of
children of poorer classes. The inferences usually is that this was
mainly a matter of such children being exposed to less soap and water
than were children of the well-to-do. It is probable that deficiency in
diet may also have made them more susceptible. There have been
epidemics of ringworm that have developed in many cities in the United
States. Several species of fungi that cause ringworm are common on
adults, and it seems highly probable that some of them are regularly
present without causing any obvious symptoms. Species that cause
ringworm belong to the genera Trichophyton and Microsporum. These
genera of fungi are somewhat unusual in that they produce asexual
spores, but not sexual spores or at least produce them so infrequently
that they have not been observed. Species of fungi causing ringworm
can be ecologically divided into three groups:

1. Zoophilic or "animal loving." Species infect animals primarily, e.g.


cats, dogs, horses, cows, poultry, but can readily be transmitted

to people. This is probably the most common source of ringworm


in people, and is usually caused by Microsporum canis, a species
usually found on cats and dogs. Animals that are carriers of
ringworm do not necessarily show outward signs of the disease.
Symptomless animals and probably people as well are carriers of
these diseases. The infections are spread mainly by spores, but
mycelial fragment in skin and hair can presumably also occur.
Spores are very long lived and can remain alive for years in
blankets, in clothing, bedding, combs and other grooming tools.

2. Anthropophilic or "man loving." Species infect people and cannot


be transferred to animals.
3. Geophilic or "earth loving." Species occur naturally in soil,
presumably as a saprobe, but is capable of infecting animals and
people. Another words these are facultative parasites!
There must be great differences among individuals in susceptibility to
infection of these ringworm fungi as well as great differences in
susceptibility of an individuals at different times. There are many
questions that remain unanswered concerning this species causing the
various forms of ringworm.
Ringworm infections are conveniently divided into categories, based on
the part of the body that was infected:

Tinea capitis: Ringworm of the scalp, eyebrow and lashes.

Tinea corporis: Ringworm of the body.

Tinea cruris: Ringworm of the groin, perineum and perianal


region. Infections are commonly referred to as "jock itch".

Tinea unguium: Ringworm of the nail.

Tinea barbae: Ringworm of the beard.

Tinea pedis: Ringworm of the feet. Infections are commonly


referred to as athlete's foot.

Tinea manuum: Ringworm of the hand.

Left Image: Example of Tinea capitis. Middle Image:


Example of Tinea corporis. Right Image: Example of
Tinea pedis (Athlete's Foot). All images courtesy of Dr.
Glenn Bulmer, from http://www.medicalmycology.net.
Note that the various "Tinea" names given to the various forms of
ringworms do not constitute species names. A summary of the above
ringworm diseases, based on anatomical locations can be found on the
Medline Plus Health Information. There is also discussion on
treatment for the various types of ringworms that have been omitted
on this web page. Warning, this site has very explicit graphics of
these diseases!
Presumably infection is spread mainly by air-borne spores which is why
veterinarians do not want ring-worm infected animals to remain in their
clinics or hospitals. If this is the case, all of us at one time must be
exposed to infections by various ringworm fungi. Why is it then that
few of us become infected? Why is infection usually localized, e.g.
ringworm of the scalp only occurs in part while most areas are not
affected? Surely, there are enough spores produced that the entire
scalp will be infected. Sometimes one person in a family, or animal in a
herd, will get ringworm and it will not spread to others, whereas other
times it is highly contagious. There is a great deal to be learned about
ringworm.

An interesting disease that is not one of the ringworms is piedra. This


is a disease of the hair where mycelium grows along the shaft of the
hair and often fuses clumps of hair together. Usually occurs in
unsanitary conditions, in tropical countries. To treat piedra the
infected hair is cut or shaved and a topical azole cream, salycylic acid
or 2% formaldehyde is applied to the affected area.
Systemic or Deep-Seated Mycoses
There are a dozen or more species of fungi causing various systemic or
deep-seated mycoses in man and animals. We will discuss several of the
more prevalent species or because of some interesting aspect of the
fungus or disease.

Coccidioides immitis, the cause of Coccidioidomycosis (Valley Fever)


This species is endemic to the southwest, in the United States
(California, eastward through Arizona, New Mexico, and western half
of Texas), Northern Mexico and some areas of Central and South
America. In the United States, it is most commonly recorded from
Kern County, in the San Joaquin Valley of California. Infection may
occur following travel to one of the endemic areas. The first case of
coccidioidomycosis was described in Argentina shortly before 1890;
the patient suffered for seven years before finally dying and by 1915,
there were 40 known cases of this disease, which was thought to be a
rare and universally fatal. However, by this time it was already known
that there was a disease called Valley Fever, which was not associated,
at that time, with C. immitis. It would not be until Dickson (1937) that
it was realized that Valley Fever was just a milder form of
coccidioidomycosis. Dickson & Gifford (1938) carrying out

coccidioidin skin test of long time residents of Kern County

demonstrated that 50-70% have, at some time been infected by this


fungus. The test is like a tuberculosis (TB) test where substances
called antigens that are associated with the disease are injected just
below the skin, of your forearm, and the results read 24 to 48 hours
later. If an infection of C. immitis has occurred, antibodies will be

produced by the body that will react with the antigen that has been
injected, causing a large red swelling in the area of the injection.

Coccidioides immitis is contracted by inhalation of spores and primarily


causes a respiratory disease in animals and people, but from the lungs
it may spread throughout the body by way of the bloodstream and
cause pathologic changes - skin lesions of one sort or another - in just
about all tissues in all parts of the body. In the usual course of events,
infection results in a more or less acute but benign and self-limiting
respiratory disease, but once the patient recovers from this, they are
likely to be permanently immune from further infection. Fiese (1958),
an authority on this disease, says that about 60% of those infected
have few or no symptoms, and 40% have symptoms of varying degrees
of severity; chills, fever, chest pains, coughing, lassitude - symptoms
typical of a dozen other infections as well. These symptoms develop ten
to fourteen days after infection, and may persist for some time, but
eventually, in most cases, the immunological processes of the body take
over and rids it of infection, although lesions and scars in the lungs may
remain. In a relatively few cases (1 in 500) the fungus is disseminated
from the lungs to other parts of the body, and this secondary stage
may result in severe lesions in the skin, bones, and internal organs and
the victim will have massive external and internal lesions and
abscesses. If this stage is reached, it is unlikely that the victim will
recover, death will occur within weeks or after a long and lingering
illness. Sometime the disease proceeds to a fairly advanced stage and
then remains static for years, and it may regress and later reappear.
Amphotericin B is the drug of choice to treat this disease.

Left Image: Positive reaction to


coccidioidin skin test. Middle Image: Skin
lesions from C. immitis infection, from
http://drugster.info/img/ail/1899_1911_2.
jpg. Right Image: Skin lesion from C.
immitis infection on face, courtesy of
Glenn Bulmer.

Histoplasma capsulatum and Histoplasmosis


Histoplasmosis occurs in people and dogs, rarely has it occurred in
other domestic or wild animals. Infection occurs through inhalation of
spores from this fungus. The history of this disease is similar to that
of coccidiomycosis. The first three cases of histoplasmosis was
described in the Panama Canal Zone in 1905 and 1906. The patients
died of massive infections, and in postmortem examination of diseased
tissues, the disease was thought to have been caused by a protozoan
(Darling, 1906). Thus, the name H. capsulatum, which refers to what
was believed to be an encapsulated plasmodium found during the
autopsy. The first case occurring in the United States was recorded in
1926 and by 1934 only six cases had been described in Panama and the
United States, all postmortem.
Until 1940, Histoplasmosis was thought to be a rare and almost
invariably fatal disease, and little attention was paid to it. However, in

1940, many men who were given chest x-rays as part of their physical
examination to determine their fitness for military service, were found
to have calcified pulmonary lesions indicative of healed-over infections,
which is normally a positive test for tuberculosis. The incidence of
these lesions were especially high in men from the Mississippi and Ohio
River valleys; few of these men tested positive for tuberculin test and
so it was unlikely that these lesions were due to tuberculosis
infections. In 1945, Histoplasmin skin test revealed that a large
number of people in some areas of the United States tested positive
for Histoplasmosis, but appeared to be perfectly healthy; at some time
in the past they had been infected with Histoplasma capsulatum
(Christie & Peterson, 1945). It was estimated that as many as 20% of
the population of the United States are or have been infected by this
fungus. The great majority of these either have no symptoms at all or
suffer only miscellaneous aches and pains, with a light cough, perhaps
some dysentery, very much like symptoms of coccidioidomycosis, flu,
and various bacterial infections. The symptoms soon disappear and the
individual is then highly resistant or immune from further infection by
this fungus.
However, again, in a small percentage of cases the fungus spreads, by
way of the blood stream, from the source of the original infection in
the lungs throughout the body, and this may result in massive infection
that is usually rapid and fatal. Thus, the disease is very widespread,
but until 1940, it was thought to be a rare, but fatal disease which was
usually not diagnosed until an autopsy was carried out and may not have
been recognized even then. More cases probably occurred, but because
few pathologists were trained to recognize fungal diseases. Medical
mycology was still a little studied area at this time. As was the case in
coccidioidomycosis, once the disease has been disseminated from the
lungs to the rest of the body, it is likely to be fatal and nothing can be
done.
Although there is a high incidence of this disease, it is not
communicated from animal to animal or person to person or even animal
to people. It seems likely that the infection source is from the soil
where it has been demonstrated to exist as a saprobe. However, it

apparently does not sporulate in soil, but rather only in droppings of


birds and bats. The fungus grows there and presumably sporulates on
the droppings. This is the reason that public parks throughout the
country do not allow people using the park to feed the birds. Large
number of birds feeding in a given area, where there are often a lot of
people, would present an environment where there is greater
probability that someone may catch this disease.
Although this disease is little known, several years ago, on May 25,
1997, Bob Dylan was hospitalized, with histoplasmosis, although his life
was threatened, he apparently was never in danger of dying of this
disease. However, the disease became far better known after he
contracted it. I was still able to find a brief mention of this news story
in the archives of the Los Angeles Times. If you wish to read this
article, click here.

Left Image: Histoplasmosis


infection of gum, from
http://www.doctoribolit.ru/images
/Histoplasmosis/Histoplasmosis04.
gif. Right Image: Skin lesion of
upper lip due to histoplasmosis
infection, from Centers for
Disease Control and Prevention's
Public Health Image Library

#6840.

Blastomyces and Blastomycosis


There are two species of this genus, Blastomyces dermatitidis and B.
brasiliensis that occur in North America and South America,
respectively. These species occur naturally in soil, especially soil in
animal habitats. It is apparently widespread in Kentucky and Arkansas
where infection in dogs is common. Infection is rare in other animals,
but have been recorded in cats, one horse and one sea lion.
Infection apparently comes from spores or mycelium in the soil and any
part of the body may be invaded. Infections usually are first detected
as skin lesions; the lesions may remain localized or may gradually
enlarge. In some case the fungus can spread throughout the whole
body, resulting in extensive ulceration. Males are infected more
frequently than female - in some studies the ratio is 15:1. There is no
effective treatment.
Intermediate Infections
These are diseases that are intermediate between the first two
categories. These fungal infections may extend to a considerable depth
within the tissue, but unlike the systemic diseases will not be
distributed to the rest of the body. One of the most common
intermediate infection is Candida albicans.

Candida albicans and Candidiasis


Candida albicans is a dimorphic fungus. That is, it grows as both
mycelium and yeasts. This is one reason why there were so many names
given to this fungus. This fungus normally occurs in the mouth,
digestive tract, and vagina of perfectly healthy people, but under some
circumstances, and for reasons unknown, it may cause severe and even
fatal infections, with lesions and eruptions of the skin, nails, mouth,
bronchial tubes and lungs. There are suggestions that there are special

strains of this species that are pathogenic. This is suggested by the


fact that this disease can be contagious and epidemics have occurred.
Predisposition may also play a role in infection. Oral infections known as
thrush is relatively common. Infections can occur on various parts of
the body.

Candidiasis infections on various parts of body:


Left Image: On tongue, commonly referred to as
Thrush. Middle Image: On neck. Right Image: Is a
case where it is fatal. Lack of T-Cells allowed
infection to occur on many parts of body. Images
courtesy of Glenn Bulmer, from
http://www.medicalmycology.net.
Chromoblastomycosis
Disease is mostly tropical to subtropical, but was first reported from
Boston in 1915 and may be caused by several species of fungi. Species
causing this disease are mostly soil inhabiting or on decaying vegetation
and typically enter the foot or lower part of the leg through wounds
from walking bare-footed. Early treatment involves excision of
infected area or cryosurgery. Chemical treatments vary in their
success of controlling this disease.

Left Image: Fonsecae pedrosoi


infection of left leg. Right Image:
Same leg after daily treatment with
Itraconazole. Images courtesy of Glenn
Bulmer, from
http://www.medicalmycology.net.

Aspergillus fumigatus and Aspergillosis


Aspergillus fumigatus is a species complex rather than a single species.
It is actually composed of ten species. These species are commonly
found in decaying vegetation, especially when the latter is undergoing
microbiological heating, because this complex is thermophilic, adapted
to growing at high temperatures 50 - 55C (120 -130F).
Aspergillus fumigatus sometimes parasitizes animals, especially birds,
infecting mainly lungs and causing heavy mortality - up to 50% in young
turkeys and up to 90% in young chicks. Heavy losses have also been

reported in herring gulls, ostriches and diving ducks in the wild and in
penguins in zoos. The fungus can also invade the embryos of eggs in
incubators, and probably does the same in eggs in nest in the wild. It
also invade the uterus of pregnant cattle and grows through the
placenta into the fetus, which then dies and is aborted. It has been
estimated that 64% of bovine abortion investigated were due to
infection of A. fumigatus.
In people, the disease can lead to a chronic lung infection which is
apparently very contagious. The fungus is thought to cause death, but
that is not certain. In patients that have died and A. fumigatus has
been isolated, many have also had underlying disease that possibly
lowered their resistance to the fungus. However, it is also possible
that the fungus had lowered their resistance to the other infective
agents. It is difficult to know what came first.