Cutaneous Fungal Infections in the Oncology Patient

Abstract

There are two main types of fungal infections in the oncology patient: primary cutaneous fungal infections and cutaneous manifestations of fungemia. The main risk factor for all types of fungal infections in the oncology patient is prolonged and severe neutropenia; this is especially true for disseminated fungal infections. Severe neutropenia occurs most often in leukemia and lymphoma patients exposed to high-dose chemotherapy. Fungal infections in cancer patients can be further divided into five groups: (i) superficial dermatophyte infections with little potential for dissemination; (ii) superficial candidiasis; (iii) opportunistic fungal skin infections with distinct potential for dissemination; (iv) fungal sinusitis with cutaneous extension; and (v) cutaneous manifestations of disseminated fungal infections. In the oncology population, dermatophyte infections (i) and superficial candidiasis (ii) have similar presentations to those seen in the immunocompetent host. Primary cutaneous mold infections (iii) are especially caused by Aspergillus, Fusarium, Mucor, and Rhizopus spp. These infections may invade deeper tissues and cause disseminated fungal infections in the neutropenic host. Primary cutaneous mold infections are treated with systemic antifungal therapy and sometimes with debridement. The role of debridement in the severely neutropenic patient is unclear. In some patients with an invasive fungal sinusitis (iv) there may be direct extension to the overlying skin, causing a fungal cellulitis of the face. Aspergillus, Rhizopus, and Mucor spp. are the most common causes. We also describe the cutaneous manifestations of disseminated fungal infections (v). These infections usually occur in the setting of prolonged neutropenia. The most common causes are Candida, Aspergillus, and Fusarium spp. Therapy is with systemic antifungal therapy. The relative efficacies of amphotericin B, fluconazole, itraconazole, voriconazole, and caspofungin are discussed. Recovery from disseminated fungal infections is unlikely, however, unless the patient's neutropenia resolves.

Clinical characteristics and treatment outcome of Stevens-Johnson syndrome and toxic epidermal necrolysis

“…These epidermal detachments are considered life-threatening (2) and are most frequently manifested by adverse drug reaction. In addition to occurring as a reaction to drugs, these skin eruptions are also associated with underlying infectious diseases, and include the cutaneous manifestations of disseminated candidiasis (3,4), Mycoplasma pneumoniae (5), Chlamydia pneumoniae (6), cytomegalovirus infection (7) and human immunodeficiency virus (8,9). The mortality rates of these skin eruptions have been reported to range from 16 to 25% (10)(11)(12)(13).…”

Infectious diseases detection by microarray: An overview of clinical relevant infections

“…Candidiasis and aspergillosis are the most common IFIs in patients receiving immunosuppressive treatment for cancer or organ transplantation. Aspergillus, Rhizopus, and Mucor fungi species can be fatal in oncology patients causing cutaneous fungal infections [37]. Also, aspergillosis has showed a high mortality rate, up to 90%, for patients with hematological malignancies [38].…”

Hematolojik Malinite Olan Hastalarda Yüzeyel Fungal İnfeksiyonlar: Vaka Kontrollü Çalışma

“…Uzun süreli antifungal kullan›m› funguslarda direnç geliflimine ve f›rsatç› funguslar›n ortaya ç›kmas›na neden olur. fiu ana kadar literatürde yer alan çeflitli çal›flmalarda farkl› immunsupresif hasta gruplar›nda geliflen fungal flora ve bu funguslar›n yapt›klar› yüzeyel infeksiyonlar incelenmifltir [6][7][8][9][10][11] . Bu çal›flmada Hematoloji Bilim Dal›'nda yatarak tedavi gören 80 hematolojik malinite olan hastan›n çeflitli vücut bölgelerin-deki fungal flora incelendi.…”

“…Dermatofitlerden ise Trichophyton mentagraphytes %5 oran›nda izole edilmifltir. Dermatofit olmayan bu küfler, hastalar›n hastanede yat›fl süreçlerinde maruz kald›klar› do¤ada, havaland›rma sistemlerinde, toprakta ve inflaat malzemelerinde yayg›n olarak bulunan f›rsatç› funguslard›r 7 . Dermatofit türü funguslar›n izolasyon s›kl›¤› kontrol grubundan daha fazla de¤ildi.…”