Geotrichosis is a
mycosis
Fungal infection, also known as mycosis, is a disease caused by fungi. Different types are traditionally divided according to the part of the body affected: superficial, subcutaneous, and systemic. Superficial fungal infections include common ...
caused by ''
Geotrichum candidum''.
Human colonization and disease
''Geotrichum candidum'' is also a frequent member of the human microbiome, notably associated with skin, sputum and feces where it occurs in 25-30% of specimens.
The fungus can cause an infection known as geotrichosis, affecting the oral, bronchial, skin and bronchopulmonary
epithelia.
The inoculum may arise from endogenous or exogenous sources.
In 1847 Bennett described ''Geotrichum candidum'' causing a superinfection in the tuberculous cavity.
Bennett was able to differentiate infection by ''Geotrichum candidum'' from ''
candidiasis'', and diagnose the first case of geotrichosis. Other early medical case reports in 1916 and 1928 also described lung infections.
Most cases affect the bronchopulmonary tree, although other sites can be involved, such as
oral mucosa and
vagina
In mammals and other animals, the vagina (: vaginas or vaginae) is the elastic, muscular sex organ, reproductive organ of the female genital tract. In humans, it extends from the vulval vestibule to the cervix (neck of the uterus). The #Vag ...
.
Skin and gut infections are also known.
Reported cases of geotrichosis have been characterized with symptoms of chronic or acute
bronchitis
Bronchitis is inflammation of the bronchi (large and medium-sized airways) in the lungs that causes coughing. Bronchitis usually begins as an infection in the nose, ears, throat, or sinuses. The infection then makes its way down to the bronchi. ...
. Exogenous geotrichosis may arise from contact with contaminated soil, fruits or dairy products.
* Pulmonary geotrichosis is the most frequent form of geotrichosis. The symptoms appear to be secondary symptoms of tuberculosis. This includes symptoms such as light, thick, grey sputum,
which in some cases may be blood-tinged.
Patients often have a cough that produces clear or yellow sputum.
Another symptom of pulmonary geotrichosis includes fine to medium
rales.
Patients may develop fever, rapid pulse and
leukocytosis.
The condition appears chronic with the presence of a little debilitation and fever.
There is no chest pain and occasional wheezing can occur.
* Bronchial geotrichosis does not involve the lung instead the disease persists within the bronchial. ''Geotrichum candidum'' grows in the lumen of the bronchi. The disease is characterized as an endobronchial infection. Bronchial geotrichosis is similar to the allergic reaction of aspergillosis. Symptoms include prominent chronic cough,
gelatinous sputum, lack of fever and medium to coarse rales.
Patients with the bronchial condition their pulse and respiration are rarely elevated.
Fine mottling may be present in the middle or basilar pulmonary region. Colonization of the bronchi can be associated with ''
Candida albicans'' and usually occur with patients with chronic obstructive lung disease.
* Oral and vaginal geotrichosis is similar to thrush in its appearances and was often confused with this infection. The difference between oral and vaginal geotrichosis can be determined using microscope analysis.
The infected area forms a white plaque and patients usually report burning sensation in the affected areas.
The vaginal geotrichosis is more common in pregnant women and is often associated with
vaginitis.
* Gastrointestinal geotrichosis is enterocolitis associated with glutamic therapy. The symptoms usually stop once the glutamic therapy is discontinued. Establishment of the etiology of the fungi is difficult since ''G. candidum'' is found within the gut normal flora. The difference between normal gut flora form and the disease causing form is the production of toxins.
* Cutaneous geotrichosis has two different types of variants which include superficial and deep infection. The superficial form the infection occurs on skin folds including submammary, inguinal, perianal and interdigital folds. The deep form develops
nodules,
tumours and
ulcers on legs, face and hands.
Geotrichosis can cause a cystic lesion appears as soft tissue on the skin.
Diagnosis
Laboratory culture
The diagnoses of geotrichosis cannot be determined without using culture or microscopic measurements.
The laboratory diagnosis of geotrichosis involves collected fungi samples areas of infections without contamination.
Scraping of the mouth lesions and the ulcers can provide a sample of ''G. candidum.'' Samples can also be collected from
pus and
mucus can be obtained from the feces.
Sputum can be searched for the mucoid-like white flakes for further examination.
Culturing the cylindrical barrel-shaped or elliptical fungi in considerable numbers in oral lesions is an indicator that a patient may have geotrichosis.
Under the microscope the fungi appears yeast-like and septate branching hyphae that can be broken down into chains or individual arthrospores. Arthrospores appear rectangular with flat or rounded ends.
Under the microscope the arthroconidia size range from 6-12μm x 3-6μm. Arthroconidia and coarse true hyphae can be observed can be observed under the microscope.
Another identification method for ''G. candidum'' is selective isolation method. A selection isolation method based on the fungi tolerance to
novobiocin and
carbon dioxide
Carbon dioxide is a chemical compound with the chemical formula . It is made up of molecules that each have one carbon atom covalent bond, covalently double bonded to two oxygen atoms. It is found in a gas state at room temperature and at norma ...
can determine if ''G. candidum'' is the cause of illness.
Diagnostic imaging
X-rays can be used to examine the lung tissue, however it can not be used to positively diagnose geotrichosis. X-rays may show cavitation that is located the walls of the lungs tissues. The lung tissue resemble the early signs of
tuberculosis
Tuberculosis (TB), also known colloquially as the "white death", or historically as consumption, is a contagious disease usually caused by ''Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can al ...
.
The results of an x-ray examination of pulmonary geotrichosis presents smooth, dense patchy infiltrations and some cavities. Bronchial geotrichosis shows peribronchial thickening with fine mottling may be present on middle or basilar pulmonary fields.
Bronchial geotrichosis usually present itself as non-specific diffuse peribronchical infiltration.
Treatment
Geotrichosis generally has a good prognosis and patients generally have successful recovery.
However, there is not a standard treatment for geotrichosis.
There are several types of antimicrobial or antifungal compounds that can be used for geotrichosis treatment.
Another method of treatment involves symptomatic care, bed rest, iodine therapy,
aerosol
nystatin
Nystatin, sold under the brand name Mycostatin among others, is an antifungal medication. It is used to treat ''Candida (fungus), Candida'' infections of the skin including diaper rash, Candidiasis, thrush, esophageal candidiasis, and vaginal ...
and
amphotericin B.
Azole drugs including
isoconazole and
clotrimazole
Clotrimazole, sold under the brand name Lotrimin, among others, is an antifungal medication. It is used to treat vaginal yeast infections, oral thrush, diaper rash, tinea versicolor, and types of ringworm including athlete's foot and jock itc ...
are used for geotrichosis treatment.
Associated treatment for pulmonary geotrichosis includes the use of
potassium iodide,
sulfonamides or
colistin.
The associated
asthma
Asthma is a common long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wh ...
can be treated with desensitization and
prednisolone
Prednisolone is a corticosteroid, a steroid hormone used to treat certain types of allergies, inflammation, inflammatory conditions, autoimmune disorders, and cancers, Electrolyte imbalance, electrolyte imbalances and skin conditions. Some of ...
.
Amphotericin B, clotrimazole and S-fluorocytosine have become more susceptible to ''G. candidum''. Antimycotic resistance can appear due to repeated treatment.
References
External links
{{Mycoses
Mycosis-related cutaneous conditions