What do you call fungi that make music?


A decomposer. Yes, yes indeed. Kinda like pop music. Except fungi make delicious meals and fascinating diseases. Pop music only makes me puke. Anywho, fungi are interesting organisms. As a kid, I had a serious pulmonary blastomycosis infection which had me in the hospital for a few weeks. The only thing I remember is the huge TV with a Nintendo 64 and Mario Cart that the nurses would wheel into my room at Children's hospital in St. Paul, MN. As I come to have an interest in medicine the long way, I wanna know about fungi. Working in dermatology we see a fair amount of tinea infections. Tinea is caused by dermatophytes which are specialized to attach to our keratinized skin tissue and generally named after the body location; capitis (scalp), faciei (face), pedis (feet) etc, etc, etc....

Generally, OTC anti fungal creams and powders do a great job, unless the patient has treated the itching with a steroid which only makes the whole thing worse. Even for cases that bring a body into the clinic a few weeks of ketoconazole cream normally does the trick. However if the infection is coming from something the patient has or comes in contact with, then it frequently comes back until there is some source control. I'm thinking of locker room floors, showers, and the like. 

OK, so this infection is annoying, but can generally be taken care of. What happens if you had an incurable tinea infection? Sounds like hell to me. Itchy, scaly skin forever. Thanks to our inability to follow directions, unclear guidance, and the need for action over inaction (treatment vs not), we might have that in our future! Yay! The above steroid use for fungal infections is not only useless, it can increase resistance in common skin fungi according to a study in the Indian Dermatology Online Journal and Indian Journal of Pharmacology. So now there are cases of dermatophytes resistant to terbinafine and increasing resistant to our newer antifungals like posaconazole. I dont know which is scarier, incurable fungi or bacteria? Either way we might be doomed but still, I like a challenge. 

I find this subject interesting and will probably talk about it in subsequent posts and really hope as my career begins I can see more of what I am reading about, and work on new solutions. As a nurse and not a doctor, one shout out to those doing the education. Maybe in the future I will delve into the science but for those of us who get a lot of patient contact, let's emphasize education on antimicrobials. Stressing that the full course of whatever the doc has you on should be taken even if you feel better. Washing your hands. Not complaining about being told your kid can't have an antibiotic for a cold until the provider gives in. Thats it, peace out y'all. 

References

Image of Malassezia Furfur from DermNetNZ.org @ https://dermnetnz.org/topics/pityriasis-versicolor

Is Antifungal Resistance a Cause for Treatment Failure in Dermatophytosis: A Study Focused on Tinea Corporis and Cruris from a Tertiary Centre? in the Indian Dermatology Online Journal by Sardana et al. 2018. 

Tinea Corporis from StatPearls at the NIH National Library of Medicine by Yee & Aboud updated 2022.

Topical anti fungal-corticosteroid fixed-drug combinations: Need for urgent action in the Indian Journal of Pharmacology by Rana et al., in 2021.

Use of Topical Steroids in Dermatology: A Questionnaire Based Study from Indian Dermatology Online Journal by Karekar et al., 2020.

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