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Invasive fungal infections in patients with chronic mucocutaneous candidiasis
Abstract:
Patients with chronic mucocutaneous candidiasis have persistent Candida infection of nails, skin, and mucous membranes, but rarely, if ever, does an invasive fungal infection develop. We describe two patients with chronic mucocutaneous candidiasis who died of fungal infection; one had C albicans meningitis and the second had Cryptococcus neoformans meningitis. The cases of four other patients with chronic mucocutaneous candidiasis and invasive fungal infection, three with crytococcosis and one with histoplasmosis, have been reported previously. Immunological profiles on these six patients revealed no differences from those of other patients with chronic mucocutaneous candidiasis without invasive fungal infection. Three of the four patients who received amphotericin B were cured of their infection; three patients died, including one patient with overwhelming cryptococcosis who had received intensive antifungal therapy and transfer factor.
Insights
Patients with chronic mucocutaneous candidiasis rarely develop invasive fungal infections. However, this study details six cases, including two new ones, where invasive fungal infections led to fatalities, highlighting a critical, albeit uncommon, risk.
Area of Science:
- Infectious Diseases
- Immunology
- Mycology
Background:
- Chronic mucocutaneous candidiasis (CMC) typically involves superficial Candida infections.
- Invasive fungal infections are considered rare in CMC patients.
- Previous reports of invasive fungal infections in CMC are limited.
Purpose of the Study:
- To report new cases of invasive fungal infections in CMC patients.
- To analyze the immunological profiles of CMC patients with invasive fungal infections.
- To discuss the outcomes and treatment of invasive fungal infections in this population.
Main Methods:
- Case series reporting on two new patients with CMC and invasive fungal infections.
- Review of previously reported cases of CMC with invasive fungal infections.
- Immunological profiling of affected patients.
Main Results:
- Two new cases presented with fatal invasive fungal infections (Candida albicans meningitis and Cryptococcus neoformans meningitis).
- A total of six CMC patients with invasive fungal infections were analyzed (three cryptococcosis, one histoplasmosis).
- Immunological profiles showed no significant differences between CMC patients with and without invasive infections.
Conclusions:
- Invasive fungal infections, though rare, can be fatal in CMC patients.
- Standard immunological assessments may not predict the risk of invasive fungal infections in CMC.
- Antifungal therapy, including amphotericin B, showed variable success; some patients died despite intensive treatment.