Fungal infections can range from superficial annoyances like athlete’s foot to serious, life-threatening conditions. Treatment depends on the type of fungus causing the infection, the location in the body, and the severity of symptoms. Here is an overview of how serious fungal infections are diagnosed and treated.
What are the common types of serious fungal infections?
Some of the most concerning fungal infections include:
- Aspergillosis – Caused by Aspergillus fungi, often affects the lungs and can spread to other organs
- Blastomycosis – Caused by Blastomyces fungi, often affects the lungs
- Candidiasis – Caused by Candida fungi, can affect the blood, heart, brain, eyes, bones, and other organs
- Coccidioidomycosis – Caused by Coccidioides fungi, often begins in the lungs
- Cryptococcosis – Caused by Cryptococcus fungi, often begins in the lungs and spreads to the brain
- Histoplasmosis – Caused by Histoplasma fungi, often affects the lungs and can spread through the body
- Mucormycosis – Caused by Mucor fungi, often begins in the sinuses or lungs
- Pneumocystis pneumonia – Caused by Pneumocystis fungi, affects the lungs
These serious fungal diseases can affect different parts of the body and spread to the brain, eyes, heart, bones, and other vital organs if not treated promptly.
How are serious fungal infections diagnosed?
Diagnosing a serious fungal infection often involves:
- Medical history – The doctor will ask about symptoms, recent illnesses or injuries, travel locations, medications, and risk factors like a weak immune system.
- Physical exam – The doctor looks for signs of infection like fever, cough, shortness of breath, headache, or lesions on the skin or in the mouth.
- Imaging tests – Chest X-ray, CT scan, or MRI can detect fungal infections in the lungs, sinuses, or other areas.
- Lab tests – Samples of blood, mucus, cerebrospinal fluid, or biopsy tissue are sent to the lab to identify fungal organisms.
Identifying the specific type of fungus causing the infection is crucial for selecting the appropriate anti-fungal medication.
What anti-fungal medications treat serious fungal infections?
Common anti-fungal drugs used for serious fungal infections include:
| Medication | Delivery Method | Uses |
|---|---|---|
| Amphotericin B | Intravenous (IV) infusion | Aspergillosis, blastomycosis, candidiasis, coccidioidomycosis, cryptococcosis, histoplasmosis |
| Fluconazole | Oral tablet or IV | Candidiasis, coccidioidomycosis, cryptococcosis |
| Itraconazole | Oral capsule | Aspergillosis, blastomycosis, histoplasmosis |
| Ketoconazole | Oral tablet | Candidiasis, coccidioidomycosis |
| Posaconazole | Oral tablet | Aspergillosis, candidiasis, cryptococcosis, mucormycosis |
| Voriconazole | Oral tablet or IV | Aspergillosis, candidiasis, fungal infections of the brain or central nervous system |
The doctor will select the antifungal medication based on the type of fungus, the location of the infection, and how severe the symptoms are. IV amphotericin B is often used initially for serious fungal infections affecting internal organs.
What other treatments are used for serious fungal infections?
In addition to antifungal medications, other treatments may include:
- Surgery – To remove infected tissue, drain fluid collections, or reduce pressure from a fungal abscess or mass.
- Hyperbaric oxygen therapy – Delivers pure oxygen at high pressure to enhance immune function and wound healing.
- Growth factors – Substances that boost the production of white blood cells to help fight the infection.
- IV fluids and nutrition – To stabilize, hydrate, and provide optimum nutrition for recovery.
These supportive therapies help manage complications, minimize damage, and give antifungal medications the best chance of success.
How long is treatment for a serious fungal infection?
The duration of treatment depends on:
- The type and severity of fungus causing the infection
- How early it was diagnosed and treated
- How well the infection responds to initial treatment
- Whether the immune system is weakened or compromised
- If the fungus has spread to other organs and body sites
For example, mild lung aspergillosis may require 4-6 weeks of antifungal medication. But invasive aspergillosis affecting multiple organs may require 3-6 months of IV and oral antifungal drugs to fully resolve.
Fungal infections of the brain or spinal cord often need long-term antifungal treatment for 6-12 months. And fungal endocarditis infection of the heart may require 1-2 years of antifungal therapy.
Doctors will monitor with regular lab tests, scans, and exams to determine if and when antifungal medications can be stopped.
What are the risks of stopping treatment too soon?
Stopping antifungal treatment too soon carries risks including:
- Recurrence – The fungal infection may return and require re-treatment.
- Spreading – The fungus could spread from the lungs or sinuses into the brain, blood, and other areas.
- Permanent damage – Untreated infection can destroy lung tissue, erode bone, damage the heart valves, or create abscesses.
- Drug resistance – Some fungal strains could develop resistance to antifungal drugs requiring different medications.
- Sepsis – Fungal pathogens in the bloodstream can lead to dangerous sepsis and septic shock.
- Death – Invasive, disseminated fungal infections have a high mortality rate if not adequately treated.
That’s why following the full antifungal treatment regimen as prescribed is extremely important, even after initial symptoms improve.
What are the side effects of anti-fungal medications?
Common side effects of anti-fungal drugs include:
- Nausea, vomiting, diarrhea
- Appetite loss
- Rash or hives
- Headaches
- Dizziness
- Fever or chills
IV amphotericin B can cause more severe side effects like:
- Kidney damage
- Anemia
- Electrolyte abnormalities
- Nerve damage (numbness, tingling)
- Liver dysfunction
- Allergic reaction
Doctors monitor lab results closely when using IV amphotericin B. Lower doses or alternative antifungals may be used in those at higher risk of complications.
Oral antifungals like fluconazole, itraconazole, and posaconazole are much less toxic but can still cause upset stomach, diarrhea, headache, or rash in some people.
Talk to your doctor right away if side effects are severe or affect your ability to eat, drink, sleep, or function normally.
What happens after treatment for a fungal infection?
After completing treatment for a fungal infection:
- Expect follow-up appointments to monitor your recovery with exams and imaging/lab tests.
- Call your doctor if original symptoms return or worsen.
- See your doctor as directed for blood tests to check white blood cell counts, kidney/liver function, electrolytes, etc.
- Discuss any lingering side effects from antifungal medications.
- Report use of any new prescribed or over-the-counter medications.
- Have any underlying medical conditions treated that may have contributed to fungal infection risk.
- Consider steps to boost immune function with rest, diet, stress management, exercise if cleared by your doctor.
Even after successful treatment, some fungal infections like aspergillosis can return, especially if the immune system remains impaired. So continued monitoring and preventative steps may be needed long term.
How can serious fungal infections be prevented?
To help prevent serious fungal infections:
- Wash hands frequently and disinfect shared surfaces in high risk environments like hospitals.
- Control underlying conditions like diabetes, cancer, and HIV that weaken immunity.
- Limit exposure to sources of fungal spores like compost, bird/bat droppings, rotting wood, hay.
- Get prompt treatment for fungal sinus or toenail infections before they can spread.
- Take antifungal prophylaxis medications if prescribed for high risk groups.
- Monitor organ transplant recipients, chemotherapy patients, and ICU cases closely for fungal infections.
- Practice good health habits with nutrition, sleep, stress control, and exercise.
While not every fungal infection can be prevented, managing risk factors and getting early treatment can reduce the chances of serious illness.
Conclusion
Serious fungal infections require aggressive treatment with IV and oral anti-fungal medications, often for prolonged periods to prevent recurrence, spread, and complications. Close monitoring and follow up care are crucial to ensure complete recovery. Preventing fungal infections is also key for those with weakened immune systems. With prompt therapy and lifestyle adjustments to support immunity, the prognosis for recovery from life-threatening fungal infections can be very good.