Pseudomycoses show the clinical picture of mycoses. Unlike a mycosis, however, a pseudomycosis is not based on a fungal infection but on a bacterial infection. The therapy depends on the pathogen and the pattern of the infestation, but usually includes antibiotics.
What is pseudomycosis?
Mycoses are associated with microorganisms. These are fungal diseases that correspond to an infectious disease. The causative agents of infection are mycelial fungi and yeasts. The process of infection does not necessarily lead to disease. The pathogens of a mycosis spread parasitically in the living tissue. See whicheverhealth for Intrauterine Growth Retardation Meanings.
The clinical picture of mycoses is relatively typical. The infestation usually manifests as red oval or round lesions of the skin or mucous membranes, which are scaled at the edges and are subjectively associated with itching or burning. A pseudomycosis shows the clinical picture of a mycosis, but is not caused by fungi. Colonization can affect the skin, lungs or central nervous system.
In most cases, pseudomycoses are reactions to bacterial pathogens of various types. In addition to nocardia, actinomycetes and bacteria of the species Corynebacterium minutissimum can lead to a mycosis-like clinical picture. In the case of actinomycetes in particular, the infection often corresponds to an endogenous infection.
The bacteria of the normal skin or oral flora penetrate into deeper tissue layers. In extreme cases, pseudomycoses can cause bacteremia and the associated sepsis. Depending on the pathogen, the symptoms and the predominantly affected tissue differ.
Depending on its cause, pseudomycosis is divided into different subgroups. Infections with nocardia and in particular the bacterium Nocardia asteroides cause the so-called nocardiosis, which manifests itself as pseudoomycosis in the central nervous system and in the lungs.
Another causative agent of pseudomycoses are bacterial actinomycetes, which can cause what is known as actinomycosis or fungal disease and manifest themselves in the form of pseudomycosis in various parts of the body. Actinomycoses are divided into cervico-facial, thoracic and intestinal forms depending on the tissue affected and thus the course.
Actinomycetes in particular are similar in their morphology to the shape of fungi and are therefore often referred to as ray fungi. The most common causative agent of these pseudomycoses is the species Actinomyces israelii, which naturally inhabits the human mouth as a commensal. Infections with Corynebacterium minutissimum, which inhabits the normal skin flora and mainly causes skin symptoms similar to mycosis.
With this cause, the pseudomycosis is also referred to as erythrasma. What all pseudomycoses have in common is their bacterial origin, which is the primary criterion for distinguishing them from real mycoses. As a rule, immunosuppressed or otherwise immunodeficient patients are particularly at risk for pseudomycoses.
Symptoms, Ailments & Signs
Patients with nocardiosis show the symptoms of a granulomatous infectious disease and are often affected by pneumonias, brain abscesses, endocarditis, or an empyema. Actinomycoses are also associated with abscess formation. The accumulations of pus from bacteria and dead cells spread to the surrounding tissues, with the tough consistent lesions being framed by connective tissue and granulation tissue.
In addition to the skin, these pseudomycoses can affect the lungs, the chest area, the abdominal organs and mucous membranes, the central nervous system or the face, throat and mouth area. The erythrasma, in turn, typically presents as skin symptoms that appear as sharply demarcated, brownish-red, even areas of skin with fine folds and scales. It is precisely this pseudomycosis that can be accompanied by itching.
This variant is most common in the armpits, groin, scrotum, or between the toes, with infection spreading to other areas of the skin. All bacterial infections can be accompanied by general signs of infection such as exhaustion, fatigue, fever and chills.
If the central nervous system is involved, functional impairment of sensitivity or motor functions may occur. If the bacteria reach the bloodstream, blood poisoning can develop in patients with a poor immune system.
Diagnosis & course of disease
The diagnosis of a pseudomycosis is usually made by cultural evidence of the typical pathogens. However, this detection takes some time, especially in the case of Actinomyces, so that the microscopic view often has to serve as a diagnostic criterion. The involvement of organs and mucous membranes is assessed in more detail using imaging methods.
The prognosis of the patients differs with the type of pathogen and the pattern of infestation. A sepsis can be a life-threatening situation. Untreated nocardiosis is usually fatal. Erythrasma is associated with the best chance of recovery.
In severe cases, pseudomycoses can cause bacteremia and, as a result, sepsis. In bacteremia, bacteria enter the bloodstream. In healthy adults, the pathogens are usually easily destroyed by the immune system. However, in children whose immune systems are not yet fully developed, as well as in seniors and adults with weakened immune systems, elimination of the pathogens is not always successful.
These then reach the organs via the bloodstream and infect them. The result can be severe blood poisoning or septic shock, which leads to circulatory collapse. Both the sepsis and the shock it causes can be fatal for the patient. Chronic erythrasma can develop in diabetics.
This is a form of pseudomycosis that spreads in the body and fat folds of overweight people, with diabetics being particularly affected. The infection manifests itself as scaly, brownish skin lesions that, if left untreated, can give off an unpleasant odor. Treatment with antibiotics is usually successful, but in some patients the disease does not heal. The erythrasma either does not subside completely or recurs at short intervals.
When should you go to the doctor?
The typical skin changes indicate pseudomycosis, which must be examined by a doctor in any case. If you notice scaly or calloused areas of skin in the groin, armpit or scrotum that hardly itch, a doctor’s visit is recommended. Patients at risk include people with obesity, diabetes mellitus, hyperhidrosis and immunosuppression. Affected people should consult their doctor if the symptoms mentioned occur and do not go away on their own within a week or even increase in intensity.
The pseudomycosis is treated by the general practitioner or a dermatologist. You can also go to an internist with your complaints. If the condition has a very negative effect on well-being, a therapeutic consultation can be useful in addition to the medical treatment. The patient should talk to the doctor about the necessary measures and, if necessary, involve other doctors in the treatment. Children should be seen by the pediatrician if the reported symptoms appear and do not go away on their own.
Treatment & Therapy
The causative agent determines the treatment of pseudomycosis. Nocardiosis is treated with antibiotics such as ceftriaxone in combination with aminoglycoside. In the case of actinomycoses, antibiotics in the form of aminopenicillin or tetracycline treatment are sufficient in the early stages, with surgical intervention to open the abscess being necessary in the advanced stage of the disease.
Erythrasma are usually treated locally with miconazole and fusidic acid cream. Benzoic acid and ASA can also be given. Systemic therapy with erythromycin usually lasts two weeks and is associated with optimal healing prospects. A one-dose therapy with clarithromycin is also possible in this variant of pseudomycosis.
Under certain circumstances, photodynamic therapy represents an alternative to pharmacological treatment. This treatment is carried out with red light and is usually combined with the drying of the skin areas involved using moisture-absorbing powder and air-permeable clothing.
In the case of pseudomycoses affecting the central nervous system, a functional impairment can remain even after healing, which is usually counteracted with physiotherapeutic measures.
Since actinomyces in particular often occur during dental surgery, antibiotics are often administered prophylactically before and after major dental surgery. Since pseudomycoses particularly affect immunodeficient patients, strengthening the immune system is also considered a preventive step.
Pseudomycosis is caused by bacteria. The doctor treating you will therefore usually prescribe an antibiotic. The patient’s unconditional help is required here. The antibiotic must be taken regularly and for a certain period of time in order for it to be fully effective. Stopping the drug too soon can lead to complications or relapses.
Diabetics and people who are very overweight often have delayed wound healing. Sore spots in body folds often heal with great difficulty. Treatment with red light is recommended here. Corresponding devices can be obtained relatively cheaply from retailers. Radiation with red light dries out the affected areas of the skin and thereby intensifies the healing process. Medicated powders also help absorb moisture.
To avoid unnecessary sweating, loose, airy clothing made of natural materials should be worn during the infection. As with all infectious diseases, it is important to strengthen and stabilize the immune system. Food rich in vitamins, exercise in the fresh air and moderate physical activity accelerate the healing process. A strengthened immune system helps older people and people with a general immune deficiency to deal with pseudomycosis more quickly.
You can do that yourself
Since pseudomycosis is caused by bacteria, the doctor treating you usually prescribes an antibiotic. Good “compliance” is important here, which means that the patient should follow the doctor’s instructions and take the prescribed antibiotic regularly. This is the only way to ensure the success of the treatment. The medication must also not be discontinued prematurely, as this can lead to relapses or complications.
In the case of diabetics or people who are overweight, it can happen that the sore spots do not heal. The areas are usually in skin or body folds. Additional treatments with red light devices are recommended here , as you can buy them inexpensively everywhere. Red light baths dry the affected skin areas, which contributes to faster healing. This effect can be enhanced with powders that absorb moisture. It is also advisable to wear natural, air-permeable clothing so that the affected body regions do not sweat unnecessarily.
A fresh, vitamin-rich diet, a regular daily routine and lots of fresh air help to stabilize the immune system and thus also to healing. This also applies to regular exercise and moderate sport. Older people or people with a general immune deficiency in particular benefit from an improved immune system, because otherwise the pseudomycosis may not be able to heal completely.