Which body sites are affected by disseminated fungal infections?

Answer

Fungi may simply colonize body sites with no apparent disease, or they may invade, producing a wide variety of syndromes. The development of disease is a result of the susceptibility of the host and the virulence of the pathogen.^[1]

Endemic mycoses with associated dissemination can affect skin (eg, papules, pustules, plaques, ulcers, abscesses, proliferative lesions that may mimic skin cancer as in B dermatitidis infection), bone and joints, and the brain and meninges (meningitis with poor prognosis [10-20%], brain abscess in infection with Aspergillus and Mucor species).

Other affected sites include the following:

Kidneys
Liver and spleen (hepatosplenic candidiasis)
Muscle (Candida species)
Eye (endophthalmitis; in Candida species infection)
Nasal passages and sinuses (Aspergillus and Mucor species)
Bloodstream and bone marrow (septicemia or sepsis syndrome)

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Lamoth F, Alexander BD. Nonmolecular methods for the diagnosis of respiratory fungal infections. Clin Lab Med. 2014 Jun. 34(2):315-36. [Medline].
Restrepo MI, Faverio P, Anzueto A. Long-term prognosis in community-acquired pneumonia. Curr Opin Infect Dis. 2013 Apr. 26(2):151-8. [Medline]. [Full Text].
Mostaghim M, Snelling T, McMullan B, Ewe YH, Bajorek B. Impact of clinical decision support on empirical antibiotic prescribing for children with community-acquired pneumonia. J Paediatr Child Health. 2019 Mar. 55 (3):305-311. [Medline].
Limper AH. The changing spectrum of fungal infections in pulmonary and critical care practice: clinical approach to diagnosis. Proc Am Thorac Soc. 2010 May. 7 (3):163-8. [Medline]. [Full Text].
Smith JA, Kauffman CA. Pulmonary fungal infections. Respirology. 2012 Aug. 17(6):913-26. [Medline].
Chen TC, Ho MW, Chien WC, Lin HH. Disseminated Scedosporium apiospermum infection in a near-drowning patient. J Formos Med Assoc. 2016 Mar. 115 (3):213-4. [Medline].
Garzoni C, Emonet S, Legout L, Benedict R, Hoffmeyer P, Bernard L, et al. Atypical infections in tsunami survivors. Emerg Infect Dis. 2005 Oct. 11 (10):1591-3. [Medline]. [Full Text].
Bochud PY, Chien JW, Marr KA, Leisenring WM, Upton A, Janer M, et al. Toll-like receptor 4 polymorphisms and aspergillosis in stem-cell transplantation. N Engl J Med. 2008 Oct 23. 359(17):1766-77. [Medline]. [Full Text].
Kesh S, Mensah NY, Peterlongo P, Jaffe D, Hsu K, VAN DEN Brink M, et al. TLR1 and TLR6 polymorphisms are associated with susceptibility to invasive aspergillosis after allogeneic stem cell transplantation. Ann N Y Acad Sci. 2005 Dec. 1062:95-103. [Medline].
Gewehr P, Jung B, Aquino V, et al. Sporotrichosis in renal transplant patients. Can J Infect Dis Med Microbiol. 2013 Summer. 24(2):e47-9. [Medline]. [Full Text].
Hung CC, Chang SC. Impact of highly active antiretroviral therapy on incidence and management of human immunodeficiency virus-related opportunistic infections. J Antimicrob Chemother. 2004 Nov. 54(5):849-53. [Medline].
Segal BH, Walsh TJ. Current approaches to diagnosis and treatment of invasive aspergillosis. Am J Respir Crit Care Med. 2006 Apr 1. 173(7):707-17. [Medline].
Cortez KJ, Roilides E, Quiroz-Telles F, Meletiadis J, Antachopoulos C, Knudsen T, et al. Infections caused by Scedosporium spp. Clin Microbiol Rev. 2008 Jan. 21 (1):157-97. [Medline]. [Full Text].
Brunke S, Hube B. Two unlike cousins: Candida albicans and C. glabrata infection strategies. Cell Microbiol. 2013 May. 15(5):701-8. [Medline]. [Full Text].
Garnacho-Montero J, Olaechea P, Alvarez-Lerma F, et al. Epidemiology, diagnosis and treatment of fungal respiratory infections in the critically ill patient. Rev Esp Quimioter. 2013 Jun. 26(2):173-88. [Medline].
Aung AK, Teh BM, McGrath C, Thompson PJ. Pulmonary sporotrichosis: case series and systematic analysis of literature on clinico-radiological patterns and management outcomes. Med Mycol. 2013 Jul. 51(5):534-44. [Medline].
Buchheidt D, Hummel M, Schleiermacher D, Spiess B, Hehlmann R. Current molecular diagnostic approaches to systemic infections with aspergillus species in patients with hematological malignancies. Leuk Lymphoma. 2004 Mar. 45(3):463-8. [Medline].
Lass-Flörl C, Gunsilius E, Gastl G, Freund M, Dierich MP, Petzer A. Clinical evaluation of Aspergillus-PCR for detection of invasive aspergillosis in immunosuppressed patients. Mycoses. 2005. 48 Suppl 1:12-7. [Medline].
White PL, Archer AE, Barnes RA. Comparison of non-culture-based methods for detection of systemic fungal infections, with an emphasis on invasive Candida infections. J Clin Microbiol. 2005 May. 43(5):2181-7. [Medline]. [Full Text].
Herbrecht R, Letscher-Bru V, Oprea C, Lioure B, Waller J, Campos F, et al. Aspergillus galactomannan detection in the diagnosis of invasive aspergillosis in cancer patients. J Clin Oncol. 2002 Apr 1. 20(7):1898-906. [Medline].
Mennink-Kersten MA, Donnelly JP, Verweij PE. Detection of circulating galactomannan for the diagnosis and management of invasive aspergillosis. Lancet Infect Dis. 2004 Jun. 4(6):349-57. [Medline].
Musher B, Fredricks D, Leisenring W, Balajee SA, Smith C, Marr KA. Aspergillus galactomannan enzyme immunoassay and quantitative PCR for diagnosis of invasive aspergillosis with bronchoalveolar lavage fluid. J Clin Microbiol. 2004 Dec. 42(12):5517-22. [Medline]. [Full Text].
Maertens JA, Klont R, Masson C, Theunissen K, Meersseman W, Lagrou K, et al. Optimization of the cutoff value for the Aspergillus double-sandwich enzyme immunoassay. Clin Infect Dis. 2007 May 15. 44(10):1329-36. [Medline].
Penack O, Rempf P, Graf B, Blau IW, Thiel E. Aspergillus galactomannan testing in patients with long-term neutropenia: implications for clinical management. Ann Oncol. 2008 May. 19(5):984-9. [Medline].
Viscoli C, Machetti M, Cappellano P, Bucci B, Bruzzi P, Van Lint MT, et al. False-positive galactomannan platelia Aspergillus test results for patients receiving piperacillin-tazobactam. Clin Infect Dis. 2004 Mar 15. 38(6):913-6. [Medline].
White PL, Backx M, Barnes RA. Diagnosis and management of Pneumocystis jirovecii infection. Expert Rev Anti Infect Ther. 2017 May. 15 (5):435-447. [Medline].
Del Bono V, Mikulska M, Viscoli C. Invasive aspergillosis: diagnosis, prophylaxis and treatment. Curr Opin Hematol. 2008 Nov. 15(6):586-93. [Medline].
Limonta S, Monge E, Montuori M, Morosi M, Galli M, Franzetti F. Lung ultrasound in the management of pneumocystis pneumonia: A case series. Int J STD AIDS. 2019 Feb. 30 (2):188-193. [Medline].
Greene RE, Schlamm HT, Oestmann JW, Stark P, Durand C, Lortholary O, et al. Imaging findings in acute invasive pulmonary aspergillosis: clinical significance of the halo sign. Clin Infect Dis. 2007 Feb 1. 44(3):373-9. [Medline].
Godoy MC, Viswanathan C, Marchiori E, et al. The reversed halo sign: update and differential diagnosis. Br J Radiol. 2012 Sep. 85(1017):1226-35. [Medline]. [Full Text].
Zhan X, Zhang L, Wang Z, Jin M, Liu M, Tong Z. Reversed Halo Sign: Presents in Different Pulmonary Diseases. PLoS One. 2015. 10 (6):e0128153. [Medline]. [Full Text].
Bourcier J, Heudes PM, Morio F, Gastinne T, Chevallier P, Rialland-Battisti F, et al. Prevalence of the reversed halo sign in neutropenic patients compared with non-neutropenic patients: Data from a single-centre study involving 27 patients with pulmonary mucormycosis (2003-2016). Mycoses. 2017 Apr 21. [Medline].
Bergeron A, Porcher R, Sulahian A, de Bazelaire C, Chagnon K, Raffoux E. The strategy for the diagnosis of invasive pulmonary aspergillosis should depend on both the underlying condition and the leukocyte count of patients with hematologic malignancies. Blood. 2012 Feb 23. 119(8):1831-7; quiz 1956. [Medline]. [Full Text].
Kimura M, Maenishi O, Ito H, Ohkusu K. Unique histological characteristics of Scedosporium that could aid in its identification. Pathol Int. 2010 Feb. 60 (2):131-6. [Medline].
Mussini C, Pezzotti P, Miró JM, et al. Discontinuation of maintenance therapy for cryptococcal meningitis in patients with AIDS treated with highly active antiretroviral therapy: an international observational study. Clin Infect Dis. 2004 Feb 15. 38(4):565-71. [Medline].
Donnelley MA, Zhu ES, Thompson GR 3rd. Isavuconazole in the treatment of invasive aspergillosis and mucormycosis infections. Infect Drug Resist. 2016. 9:79-86. [Medline].
Meletiadis J, Mouton JW, Meis JF, Verweij PE. In vitro drug interaction modeling of combinations of azoles with terbinafine against clinical Scedosporium prolificans isolates. Antimicrob Agents Chemother. 2003 Jan. 47 (1):106-17. [Medline]. [Full Text].
Denning DW, Ribaud P, Milpied N, Caillot D, Herbrecht R, Thiel E, et al. Efficacy and safety of voriconazole in the treatment of acute invasive aspergillosis. Clin Infect Dis. 2002 Mar 1. 34(5):563-71. [Medline].
Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med. 2002 Aug 8. 347(6):408-15. [Medline].
Johnson LB, Kauffman CA. Voriconazole: a new triazole antifungal agent. Clin Infect Dis. 2003 Mar 1. 36(5):630-7. [Medline].
Gerber B, Guggenberger R, Fasler D, Nair G, Manz MG, Stussi G. Reversible skeletal disease and high fluoride serum levels in hematologic patients receiving voriconazole. Blood. 2012 Sep 20. 120(12):2390-4. [Medline]. [Full Text].
Maertens J, Raad I, Petrikkos G, Boogaerts M, Selleslag D, Petersen FB, et al. Efficacy and safety of caspofungin for treatment of invasive aspergillosis in patients refractory to or intolerant of conventional antifungal therapy. Clin Infect Dis. 2004 Dec 1. 39(11):1563-71. [Medline].
Avery RK. Aspergillosis in hematopoietic stem cell transplant recipients: risk factors, prophylaxis, and treatment. Curr Infect Dis Rep. 2009 May. 11(3):223-8. [Medline].
Dekkers BG, Bakker M, van der Elst KC, Sturkenboom MG, Veringa A, Span LF, et al. Therapeutic Drug Monitoring of Posaconazole: an Update. Curr Fungal Infect Rep. 2016. 10:51-61. [Medline]. [Full Text].
Benjamin DK Jr, Driscoll T, Seibel NL, Gonzalez CE, Roden MM, Kilaru R, et al. Safety and pharmacokinetics of intravenous anidulafungin in children with neutropenia at high risk for invasive fungal infections. Antimicrob Agents Chemother. 2006 Feb. 50(2):632-8. [Medline]. [Full Text].
Reboli AC, Rotstein C, Pappas PG, Chapman SW, Kett DH, Kumar D, et al. Anidulafungin versus fluconazole for invasive candidiasis. N Engl J Med. 2007 Jun 14. 356(24):2472-82. [Medline].
Turner MS, Drew RH, Perfect JR. Emerging echinocandins for treatment of invasive fungal infections. Expert Opin Emerg Drugs. 2006 May. 11(2):231-50. [Medline].
Kaffarnik M, Utzolino S, Blaich A, Hopt UT. Successful multimodal therapy of invasive pulmonary and central nervous system aspergillosis in a neutropenic surgical patient: case report and review of the literature. Mycoses. 2008 Jan. 51(1):74-8. [Medline].
Hamza NS, Ghannoum MA, Lazarus HM. Choices aplenty: antifungal prophylaxis in hematopoietic stem cell transplant recipients. Bone Marrow Transplant. 2004 Sep. 34(5):377-89. [Medline].
Ullmann AJ, Lipton JH, Vesole DH, Chandrasekar P, Langston A, Tarantolo SR, et al. Posaconazole or fluconazole for prophylaxis in severe graft-versus-host disease. N Engl J Med. 2007 Jan 25. 356(4):335-47. [Medline].
Cornely OA, Maertens J, Winston DJ, Perfect J, Ullmann AJ, Walsh TJ, et al. Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med. 2007 Jan 25. 356(4):348-59. [Medline].
Pneumocystis pneumonia. Centers for Disease Control and Prevention. Available at https://www.cdc.gov/fungal/diseases/pneumocystis-pneumonia/index.html. Accessed: April 26, 2017.

Media Gallery

Chest radiograph showing multiple pulmonary nodules. The patient was treated with corticosteroids for acute graft versus host disease following bone marrow transplantation for chronic myeloid leukemia. The patient smoked marijuana for 2 weeks prior to this chest radiograph being taken. Bronchoalveolar lavage revealed Aspergillus niger and other species on fungal cultures.
CT scan of a patient with invasive aspergillosis showing multiple lung lesions. The cavitary lesion on the left lung shows a ground-glass halo sign.
CT scan of aspergillosis of the lungs showing multiple pleural-based and lung parenchymal lesions.

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Author

Romeo A Mandanas, MD, FACP Research Site Leader, Integris Cancer Institute of Oklahoma

Romeo A Mandanas, MD, FACP is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Blood and Marrow Transplantation, American Society of Clinical Oncology, American Society of Hematology, Oklahoma State Medical Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Novartis Pharmaceuticals; Celgene Corporation, Bristol Myers Squibb, Seattle Genetics.

Coauthor(s)

Dora E Izaguirre Anariba, MD, MPH Physician, Department of Medicine, Wyckoff Heights Medical Center

Dora E Izaguirre Anariba, MD, MPH is a member of the following medical societies: American College of Physicians, American Heart Association, American Medical Association, American Public Health Association, Colegio Medico de Honduras

Disclosure: Nothing to disclose.

Jesus Lanza, MD Fellow in Pulmonary and Critical Care Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Disclosure: Nothing to disclose.

Klaus-Dieter Lessnau, MD, FCCP Former Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory, Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Guy W Soo Hoo, MD, MPH Clinical Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Director, Medical Intensive Care Unit, Pulmonary and Critical Care Section, West Los Angeles Healthcare Center, Veteran Affairs Greater Los Angeles Healthcare System

Guy W Soo Hoo, MD, MPH is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Thoracic Society, Society of Critical Care Medicine, California Thoracic Society, American Association for Respiratory Care

Disclosure: Nothing to disclose.

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