At times, children may become infected with fungi that only rarely infect people. In many instances, the children most susceptible to these infections have weakened immune systems because of cancer, chemotherapy, corticosteroids, organ transplantation, or an HIV infection. However, even children with normal disease-fighting systems can get these infections by breathing in the fungi. Certain organisms can enter the body through cuts or abrasions in the skin. Here are some brief descriptions of some of the fungal diseases that your child could develop. In some cases, they occur so uncommonly that treatment recommendations are not clear, especially for children. Ask your pediatrician for a referral to a pediatric infectious disease specialist if your youngster is diagnosed with one of the following fungal infections:
Hyalohyphomycosis
Fungi from the Fusarium species may cause this infection. These fungi can enter the body through the respiratory tract, sinuses, or skin. It may cause signs and symptoms associated with a sinus infection (sinusitis), a urinary tract infection, a blood infection, or meningitis. These infections may occur in children with weakened immune systems. Your pediatrician will diagnose hyalohyphomycosis by taking a blood culture or tissue specimen and having it tested in the laboratory. High-dose amphotericin B or fluconazole have been used in treating hyalohyphomycosis. Malassezia species cause a common, superficial skin infection known as tinea versicolor or pityriasis versicolor. The skin of the face, torso, arms, and neck is covered with many round and scaly red areas. These areas fail to tan during the summer, but are relatively darker in the winter. The infection is most common in teenagers and young adults. Your pediatrician will make the diagnosis based on the appearance of the rash. A culture can be taken, if needed. Selenium sulfide lotion or shampoo is used for treatment. Ketoconazole shampoo is also effective, as are several other antifungals that are applied directed onto the affected area. Oral antifungals such as ketoconazole, fluconazole, and itraconazole have been shown to be effective in adults. These drugs are used less commonly in children.
Penicilliosis
Children infected with HIV may be susceptible to a fungal disease called penicilliosis caused by Penicillium marneffei. This fungus is found in soil and decaying vegetation as well as in the air. It can cause signs and symptoms such as lung inflammation (pneumonitis) and acne-like skin lesions on the face, torso, arms, and legs. Your pediatrician may have a blood culture or tissue sample tested in the laboratory as part of the diagnostic process. Amphotericin B or itraconazole are commonly prescribed treatments for penicilliosis.
Phaeohyphomycosis
Phaeohyphomycosis is a large category of fungal infections that are caused by organisms from the Bipolaris, Curvularia, Exserohilum, Pseudallescheria, and Scedosporium species. These infections often involve the skin and, in some cases, the nasal passages and sinuses. They also can infect the brain, bones, and heart (endocarditis). Superficial infections can occur in children with healthy immune defenses, while more serious infections occur in children with weakened immune systems. To make the diagnosis, your doctor will order tests that examine affected tissues under the microscope. The pediatrician may also take cultures of the tissue to try to grow the fungi in the laboratory. Your child’s doctor will recommend treatment with medicines such as itraconazole or amphotericin B or the surgical removal of infected tissue.
Trichosporonosis
Children with weakened immune systems are susceptible to trichosporonosis, which can infect the lung, heart, or bloodstream. The fungus Trichosporon beigelii, which can produce skin lesions on the torso, face, and arms, causes trichosporonosis. Other symptoms include a cough, fever, and bloody sputum. This organism is found in soil and can enter the body through the respiratory tract, gastrointestinal system, or skin wounds.When it infects humans, it is potentially life threatening. Treatment typically involves the use of amphotericin B or fluconazole.
Zygomycosis
As with many other fungal infections, zygomycosis is most likely to occur in children with weakened immune systems. It may develop in children with leukemia, lymphoma, or diabetes and those who have used nonsterile bandages on wounds or cuts. Zygomycosis is caused by fungi from the Rhizopus, Mucor, Absidia, and Rhizomucor species and can cause nose and sinus infections. Affected children may have a fever, nasal congestion, and sinus discomfort. If the infection spreads, it can affect the lungs and brain and, in the worst cases, cause pneumonia, infection of the brain, seizures, paralysis, and death. This infection is diagnosed with laboratory tests examining nasal discharges and phlegm, as well as by conducting biopsies of, for example, lung lesions. Treatment includes surgical removal of the infected tissue, if possible, and use of medicines such as high-dose amphotericin B.