Caregivers 101: Seniors and Fungal Disease

August 14-18, 2017 is America’s first Fungal Disease Awareness Week, organized by the Centers For Disease Control (CDC) to spread the word about serious fungal diseases. If your first thought of fungi is mushrooms and a pretty lame pun, then you’re not informed about the fungal diseases that lurk in the environment, in our immune systems, and in hospitals. Caregivers, home care aides and loved ones are particularly impacted by the danger of fungal conditions because certain medications, frequent hospital or medical facility visits, and unrelated diseases that impair the immune system, are risk factors for serious fungal infections. The more caregivers know about fungal infections, the less their loved ones will suffer from misdiagnosed conditions and unnecessary exposure to fungi.

Fungi are a natural part of our environment, found in the soil, on plants and trees, on indoor surfaces, and even on human skin. Fortunately, while there are approximately 1.5 million different species of fungi on Earth, only about 300 can make people sick. Mild fungal skin infections usually look like a rash and are very common. Other fungal infections, that occur in the lungs, in the bloodstream and even in spinal fluid, are much more serious and often present as other kinds of illness. This means that doctors often treat something the patient does not have, and so proper diagnosis and medication are often delayed. There are three main situations that you put you at risk of a fungal infection in daily life:

1. Environment: nature is full of tiny things that want to hurt us, and fungal diseases lurking in nature are no exception. Where possible avoid dust storms, construction sites, chicken coops, and dirt or manure piles, and if you venture out into the great outdoors, cover up.
   1. Coccidioides is found in dry soil that, when disturbed, throws spores into the air. Histoplasmosis is a lung infection caused by spores found in the droppings of birds and bats.
   2. Ringworm, which affects dogs and cats, also affects humans! It’s not a worm at all, but rather a fungal infection.
2. Immune system:
   1. Certain medications impair your immune system so that it is unable to resist exposure to usually harmless fungi. If you take one of the following medications, then take environmental precautions against fungal infection:
      1. Corticosteroids taken by mouth, such as cortisone, budesonide, prednisone, and several others.
      2. Inhaled corticosteroids, mostly used to treat asthma, such as beclomethasone, budesonide, fluticasone, and several others.
      3. TNF inhibitors such as adalimumab, certolizumab pegol, etanercept, golimumab, and infliximab.
   2. HIV/AIDS patients have compromised immune systems that leave them vulnerable to thrush, pneumocystic pneumonia, and cryptococcal meningitis.
   3. Transplant recipients have to take immune-suppressant drugs to facilitate the acceptance of the new organ, and this suppression leaves them vulnerable to fungal infections
   4. Chemotherapy and radiation impair the immune system, and increase the risk of fungal infection.
3. Hospitals and other medical facilities: we’ve all heard horror stories about flesh-eating bacteria, but by far the most common fungal infection in hospitals comes from inside your body. These are the most common healthcare-associated infections:
   1. Candida, or yeast, is found all through the healthy human gastrointestinal system, and on the skin, with no detrimental effects. But when candida enters the bloodstream, then it causes an infection called candidemia. Surgery, catheters, cuts and wounds, and the equipment found in the ICU can all transmit normally-harmless candida from someone else’s skin into your body. Infants and seniors are particularly susceptible to candidemia, and it is so widespread that some strains are now resistant to anti-fungal drugs.
   2. Fungal meningitis develops when a fungal infection in the bloodstream or near the brain or spine spreads into the spinal cord fluid. Patients who are being treated for some other kind of fungal infection can develop fungal meningitis when the original infection starts to spread around the body.

Anyone not living inside a sterile bubble can get a fungal infection, ranging from the mild to the life-threatening. Anti-fungal medications are effective in a huge majority of cases, but some strains are resistant and the problem is growing. Seniors need to take precautions against fungi because of demographic risk factors: weaker immune systems, problematic medications like steroids, more frequent hospital visits, and invasive procedures like transplants and surgeries. When symptoms that resemble pneumonia or the flu don’t respond to antibiotics, a fungal infection could be the culprit.