Fungi form a separate group in the classification of Earth’s life, distinct from both plants and animals, which differ from other organisms in several major respects, the most important being that fungi cannot photosynthesise. They obtain their nutrients by secreting enzymes for external digestion and absorbing the nutrients, the most common example being rotting plants. Another important difference is that fungi cells are encased within a rigid cell wall, comprised of chitin and glucan. These features contrast with animals, which have no cell walls, and plants, which have cellulose as the major cell wall component. Thirdly fungi has no tissue differentiation into organs.
While there may be upwards of 5 million species of fungi, only about 100,000 of them have been identified and described. Of those, fewer than 500 have been associated with human disease, and no more than 100 are capable of causing infection in otherwise normal individuals. The remainder are only able to produce disease in already ill patients that are immunocompromised. There are three main forms of fungi for the purposes of medical mycology: yeasts, moulds and dimorphic i.e. a combination of the two.
Many fungal pathogens that affect humans change their growth form during the process of infecting tissue. These dimorphic pathogens change from a multicellular form in the natural environment to a single-celled form. As with other microbial infections, the diagnosis of fungal infection relies upon a combination of clinical observation and laboratory investigation. Superficial and subcutaneous fungal infections often produce characteristic lesions that suggest a diagnosis, but laboratory input can assist the clinician’s confidence.
The successful laboratory diagnosis of fungal infection depends on the collection of adequate clinical specimens for investigation. Inappropriate collection or storage of specimens can result in misdiagnosis.
In addition to specifying the source of the specimen, the clinician should provide information on any underlying illness, recent international travel, and the patient’s occupation. This information will help the laboratory to anticipate which pathogens are most likely to be involved and choose the most appropriate test.
Laboratory methods for the diagnosis of fungal infections are based on three approaches:
- the microscopical detection of the etiologic agent in clinical material
- isolation and identification of the pathogen in culture
- the detection of a serologic response to the pathogen or some other marker of its presence, such as a fungal cell constituent or metabolic product.
In the future, the ability to detect fungal DNA in clinical material will provide experts in medical mycology new diagnostic tools and greater confidence in identifying fungal
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Invasive fungal infections can be a significant problem in patients. They are common, difficult to diagnose, and associated with high mortality. Modern medicine has paralleled the emergence of invasive fungal infections, particularly with the advent of HIV, immunosuppressive and immunomodulatory therapy, solid and stem cell transplants, frequent use of broad-spectrum antibiotics, an aging population with extended duration in hospital, extensive abdominal surgeries, the common use of invasive devices, and lifestyle diseases such as diabetes. Fungi can infect these patients easily as they adjust to previously known hostile human tissue environments and possibly acquired virulence factors while passing through soil amoebae. This has led to a significant rise in the number of opportunistic fungal infections.
Experts in mycology can offer opinions on the source and type of fungal infections, whether it be in a hospital environment, contraction in the workplace, or contamination of food or other produce. Experts may be required to provide opinion in cases involving:
- Medical malpractice
- Side effects during treatment
- Wrongful medication
- Insurance issues
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