Today marks the end of Fungal Disease Awareness Week, sponsored by the Centers for Disease Control and Prevention. The CDC organized this week to raise awareness about the importance of recognizing serious fungal diseases early enough in the course of a patient’s illness to provide life-saving treatment.
Fungal Disease Awareness Week highlights the grave reality some fungal diseases go undiagnosed and cause serious infections in people in the United States and around the world, leading to illness and even death. Increased awareness about fungal diseases is one of the most important ways to improve early recognition and reduce delays in diagnosis and treatment. A key clue to when a sick person may have a fungal infection is that he or she is being treated with medications for other types of infection without expected improvement.
Healthcare providers and their patients are encouraged to Think Fungus when symptoms of infection do not get better with treatment. Fungal diseases range from relatively minor superficial and mucosal infections to severe, life-threatening systemic infections. Delayed diagnosis and treatment can lead to poor patient outcomes and high medical costs. The overall burden of fungal diseases in the United States is challenging to quantify because they are likely substantially underdiagnosed.
It is estimated that fungal diseases cost more than $7.2 billion in 2017, including $4.5 billion from 75,055 hospitalizations and $2.6 billion from 8,993,230 outpatient visits. Hospitalizations for Candida infections (n=26,735, total cost $1.4 billion) and Aspergillus infections (n=14,820, total cost $1.2 billion) accounted for the highest total hospitalization costs of any disease. Over half of outpatient visits were for dermatophyte infections (4,981,444 visits, total cost $802 million), and 3,639,037 visits occurred for non-invasive candidiasis (total cost $1.6 billion).
Fungal diseases are often misdiagnosed as their symptoms sometimes resemble other conditions. For example, Valley fever — an inhaled fungal infection that incites cough, fever and a distinctive rash on the upper body or legs — is often misdiagnosed as bacterial pneumonia. While an estimated 150,000 cases of Valley fever occur every year, only 10,000 cases are diagnosed.
About 46,000 healthcare-associated invasive fungal infections occur in the U.S. annually. Growing drug resistance is also making certain fungal strains more difficult to treat.
The fungus is among us.
Fungi are everywhere. There are millions of distinct species of fungi on Earth, but only about 300 of those are known to make people sick. Fungal infections are often caused by microscopic fungi that are common in the environment. Fungi live outdoors in soil and on plants and trees as well as on many indoor surfaces and on human skin.
Mild fungal skin infections can look like a rash and are very common. For example, ringworm is a skin infection that’s caused by a fungus, not a worm! Fungal infections in the lungs can be more serious and often cause symptoms that are similar to other illnesses, such as the flu or tuberculosis.
Fungal meningitis and bloodstream infections are less common than skin and lung infections but can be life-threatening. Because the symptoms of fungal infections can be similar to other illnesses, proper diagnosis and treatment are often delayed. The more you know about fungal infections and your chances of getting one, the better prepared you can be to protect your health.
10 questions you can use to understand fungal infections, learn how you can get sick, and know what you need to do to stay healthy.
Where do you live and travel? Fungi that can cause serious infections are more common in some parts of the United States and world. For example, the fungus that causes Valley fever (also called coccidioidomycosis) is found mainly in the southwestern United States. Histoplasmosis and blastomycosis occur most often in the eastern United States. These infections usually cause a lung infection that is often mistaken for flu or a bacterial infection.
What types of activities are you doing? Harmful fungi can be found in air, dust, and soil. Histoplasma grows especially well in soil that contains bird or bat droppings. Activities like digging, gardening, cleaning chicken coops, and visiting caves can result in you breathing in fungi that may cause infection.
Do you have a dog or cat? People can get ringworm from their pets. Dogs and cats with ringworm sometimes have circular, hairless patches on their skin or other types of rashes. Adult animals do not always show signs of ringworm infection.
Have you recently taken antibiotics? Antibiotics can make women more likely to get vulvovaginal candidiasis, also known as a vaginal yeast infection. Women who are pregnant and have weakened immune systems also are more likely to get this condition. Men also can get genital candidiasis.
Are you taking any medications that affect your immune system? Medications used to treat conditions like rheumatoid arthritis or lupus may weaken your immune system and increase the chance of getting a fungal infection.
Are you living with HIV/AIDS? People living with HIV/AIDS may be more likely to get fungal infections. Two well-known fungal infections associated with HIV/AIDS in the United States are oral candidiasis (thrush) and Pneumocystis pneumonia. Worldwide, cryptococcal meningitis is a major cause of illness in people living with HIV/AIDS.
Will you be hospitalized? In the United States, one of the most common bloodstream infections in hospitalized patients is caused by a fungus called Candida. Candida normally lives in the gastrointestinal tract and on skin without causing any problems, but it can enter the bloodstream during a hospital stay and cause infection.
Have you recently had a transplant? People who have recently had an organ transplant or a stem cell transplant have a greater chance of developing a fungal infection while their immune systems are weakened. Doctors prescribe antifungal medication for some transplant patients to prevent fungal infections from developing.
Are you receiving chemotherapy or radiation treatments? Cancer treatment, such as chemotherapy and radiation, weakens your immune system and may increase the chance you will get a fungal infection.
Do you have symptoms of pneumonia that are not getting better with antibiotics? Fungal infections, especially lung infections like Valley fever, histoplasmosis, and aspergillosis, can have similar symptoms as bacterial infections. However, antibiotics don’t work for fungal infections. Early testing for fungal infections reduces unnecessary antibiotic use and allows people to start treatment with antifungal medication, if necessary.
Anyone can get a fungal infection, and fungal diseases impose a considerable economic burden on the healthcare system. Since they are often under-diagnosed, it is important to learn more about the signs, symptoms, and treatment of fungal infections and get prevention tips by visiting CDC’s fungal diseases website and by talking with your healthcare provider.
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Adapted from the CDC pages on fungal infections.
 Estimation of direct healthcare costs of fungal diseases in the United States
Kaitlin Benedict Brendan R Jackson Tom Chiller Karlyn D Beer
Clinical Infectious Diseases, ciy776, https://doi.org/10.1093/cid/ciy776
Published: 10 September 2018