Recent concepts in fungal involvement in skin and soft tissue infections

Abstract

As the at-risk population expands and new antifungal resistance patterns develop, it is critical to understand and recognize cutaneous manifestations of old and emerging fungal diseases. Purpose of reviewThe aim of this review is to provide an overview of the most frequent and emerging deep cutaneous fungal infections following either primary inoculation or secondary spread after haematogenous seeding in disseminated infections in different geographical areas. Recent findingsFungal skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions based on the site of the infection, route of acquisition of the pathogen, epidemiological setting and the virulence of the fungus in relation to the host. The approach to a patient suspected of having a fungal SSTI is complex and usually poses a major diagnostic challenge. The treatment approach should include attempts at immune reconstitution, targeted antifungal therapy and/or aggressive surgical debridement. SummaryFungal SSTIs can be an important cause of morbidity and mortality in both immunocompromised and immunocompetent patients and are being reported with increasing frequency worldwide.

Prevention and treatment of recurrent cellulitis

“…Of note that poor glycemic control with high level of glycated hemoglobin (>7.5%) has been significantly associated with a 1.4-fold increased risk of cellulitis [10] Patients with cancer or history of cancer have an increased risk of RC, since surgery, radiotherapy and lymph nodes resection have lymphedema as a potential consequence. Of note that in cancer patients RC can occur in atypical sites and neutropenia may predispose to infections from atypical pathogens [11] Peripheral vascular disease, chronic kidney disease, chronic obstructive pulmonary disease, liver disease, homelessness and presence of foreign bodies are other risk factors for RC [2]…”

“…Patients with cancer or history of cancer have an increased risk of RC, since surgery, radiotherapy and lymph nodes resection have lymphedema as a potential consequence. Of note that in cancer patients RC can occur in atypical sites and neutropenia may predispose to infections from atypical pathogens [11]…”

Skin and soft tissue infections in solid organ transplants

“…Fungal SSTIs can be an important cause of morbidity and mortality in SOT patients and are being reported with increasing frequency worldwide [70 ▪▪ ]. Fungal SSTIs can be classified on the basis of their invasiveness in local superficial mycoses, subcutaneous mycoses and skin lesions in the context of disseminated fungal infection with multiorgan involvement [4,71,72].…”

“…Superficial SSTIs with Candida spp. are the most frequent form of clinical presentation, whereas skin lesions are rare and usually associated with disseminated candidiasis [70 ▪▪ ].…”

UV C Light from a Light-Emitting Diode at 275 Nanometers Shortens Wound Healing Time in Bacterium- and Fungus-Infected Skin in Mice

“…Studies have shown that the prevalence of superficial mycosis worldwide is as high as 20% to ~25%, indicating that fungi have partially replaced bacteria as the main pathogens ( 19 – 21 ). Untreated aggravation of deep SSTIs by Candida albicans can cause rapid necrosis of tissues and organs or spread into the blood, resulting in fungal septicemia and sepsis and even threatening the patient’s life ( 22 ). The situation of fungal infections is increasingly serious.…”