House Call: Fungal infections stubborn, treatable
A fungal infection can range from mild to severe, and can be life threatening, requiring hospitalization and possibly many months of one or more antifungal medications to eliminate the infection.
A life threatening fungal infection probably sounds odd to you because the most common fungal infections are of the skin, vagina and mouth, such as athlete’s foot, jock itch, ringworm, vaginal yeast infections and oral thrush. Skin infections can usually be prevented or cleared up by keeping the area clean and dry. Most are treatable with medications you can buy without a prescription. Sometimes stubborn fungal infections require prescription antifungal medication, so see your health care provider if yours does not clear up with home treatment. Read more details about fungal skin infections and other skin infections in my column from Nov. 22, 2011.
Although more severe fungal infections do not happen often, they are worth knowing about because they are usually treatable when diagnosed.
We breathe in mold spores daily without becoming ill. There are many types of mold spores you can breathe in, but few ever cause infections. When infection happens, you may have fever, cough, headache and mild muscle aches. These usually resolve without any treatment in healthy people. More severe infection can happen to anyone, but is most likely in people who are pregnant, HIV-positive, have diabetes, are on chemotherapy or steroids or otherwise have a weakened immune system.
One infection you may have heard of is Valley fever. Coccidioides spores, which cause Valley fever, occur naturally in the soil in the Southwest, and Central and South America. An outbreak last spring affected 28 people in California. We do not have Valley fever in the Northwest, but if you travel to one of the places mentioned above, avoid breathing a lot of outdoor dust. If you develop cough, headache, rash on upper trunk or extremities, muscle aches, or joint pain (especially knees and ankles) one to three weeks afterward, see a health care provider and tell them about your recent travels, especially if you are sick for more than a week or are at risk for severe disease. Treatment does not always mean medication, but people who are of Asian or African ancestry have less immunity to this infection and may require prescription antifungal medication.
Histoplasmosis is a fungal infection that is common in the Mississippi and Ohio River Valley areas. It usually develops after exposure to bat or bird droppings. Symptoms are similar to pneumonia, but with a dry cough. See a health care provider if you have been exposed to droppings during travel and become ill within two to three weeks.
Another rare fungal infection (Cryptococcosis) is caused by C. gattii spores, which occur naturally in the Northwest. Cryptococcosis causes cough, fatigue, fever, and headache anywhere from 2 to 14 months after exposure. Infection sometimes affects the central nervous system and causes meningoencephalitis with fever, headache, stiff neck, vomiting and altered mental status. Treatment requires six months or more of prescription antifungal medication. Because Cryptococcosis is increasing in frequency lately, health care providers are required to collect information on each case, and report it to local public health authorities. If you have this infection, you will be asked questions to help us learn how to protect others.
You can get more detailed information about these and many other types of fungal infections from the Centers for Disease Control and Prevention website ( http://www.cdc.gov/fungal/).
Dr. Alisa Hideg is a family medicine physician at Group Health’s Riverfront Medical Center in Spokane. Her column appears every other Tuesday in the Today section.