Fighting against fungal infections

Resistance to fungal infections is an emerging public health problem, with recurrent infections noted in those who are immune-compromised, suffering from cancer, organ transplants or severely diabetic in nature. Apart from genetic mutations in the aging body, climate change also plays a major role in recurrent fungal infections along with resistance to antibiotics, making it very important for those in the immune-compromised state to be extra careful, explains Dr Shiva Raju, senior consultant physician and diabetologist at KIMS Hospitals.

Why is there a rise in antibiotic resistance when dealing with fungal infections?
Antibiotic resistance is a serious issue, making it necessary to use higher doses of antibiotics for treating regular infections. Antibiotics are normally used to treat bacterial infections. When they are used in excess, forlonger duration or inappropriately, then fungal infections make their appearance. Resistance of fungal infections is an emerging public health problem. Excess use of anti-fungal medication, low doses and varying durations in treatment lead to fungal resistance. Some fungi are inherently resistant while some acquire resistance through different mechanisms. Azole resistance is very common in the present scenario.

How are fungal infections classified?
Fungal infections are classified as follows:

• Common infections occurring in humans include Candida infections, ringworm and toenail fungal infections
• Infections when travelling to specific areas — Blastomycosis, Histoplasmosis and Coccidioidomycosis
• Infections occurring in people with low immunity — Oral Candidiasis, Vaginal Candidiasis, Aspergillus fumigates and Mucormycosis

Which category and type of fungal infection is becoming a cause of concern in terms of treatment?
Fungal infections which are of particular concern are Candida glabrata, Candida non albicans group, invasive Candidiasis, Aspergillus fumigates and Mucormycosis. These fungal infections are seen more in diabetic, immune-compromised patients, those  suffering from cancer and those who have undergone organ transplants.

Which parts of the body do fungal infections regularly occur in and why?
Common fungal infections that occur are:

• Candida infections: Oral cavity, oesophagus, vaginal (Moniliasis)
• Ringworm infections: Tinea cruris (groin, armpits); Tinea capitis (scalp)
• Toenail infections: Onychomycosis
•  Fungal skin infections etc.

Recurrent fungal infections are seen in both men and women post 40 years of age. Why is this so?
Due to aging, the immunity level decreases, making men and women more susceptible to fungal infections. Some studies have shown genetic mutations in CARD 9 gene make some people susceptible. Family members need to be careful as such mutations lead to invasive fungal infections which are also recurrent in nature and cause death. Patients with HIV, cancer and organ transplants are more susceptible to both recurrent and invasive fungal infections.

Are fungal infections and climate change related to one another?
Yes, there is a correlation between the two. Few fungal infections like nail infections, Tinea cruris etc. occur in particular seasons. Fungi usually grow in damp, moist, dark areas and more so, in the rainy and winter season. Fungal infections impact the body with a change in climate, global warming and varying temperatures. In the rainy and winter seasons, fungi thrive well. Moreover, poor hygiene, diabetes and low immunity are high risk factors.

Are home remedies a good way to deal with fungal infections?
Home remedies are not very helpful in the treatment of fungal infections.

What are the precautions that one must take for preventing fungal infections?
Here are some of the precautions:

• Observe hand hygiene
• Avoid wearing wet clothes to prevent common fungal infections
• Maintain proper hygiene in the surroundings
• Avoid anti-fungals unless indicated as it can cause resistance
• Reduce usage of antibiotics as far as possible
• Develop anti-fungal stewardship programme
• Ensure proper monitoring at regular intervals
• High risk groups like those with low immunity, cancer, HIV and organ transplants need special care and close monitoring as they have a high risk of invasive fungal infections.