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36 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 1 9 education PATHOLOGY PERSPECTIVES Mycoses Abounding By Ruth Werner While fungi resemble plants in some ways, they are not capable of photosynthesis—they cannot generate energy from sunlight. Instead, they derive nutrition from their local environment. This might happen simply by living on an organic surface without disrupting it, but some fungi can damage their hosts by destroying and invading vulnerable tissues. Fungi are inescapable. They can colonize virtually any organic surface. They are on (and in) our food, in our soil, suspended in the air, and inside us. They are found on every continent and in every climate. Some are pathogenic and have the potential to cause problems, some are neutral and don't affect us one way or the other, and some are beneficial to us. For instance, we have colonies of yeasts in our gut that help us derive nutritional components from our food, and they compete with and help balance out our resident gut bacteria, viruses, and other microorganisms. The colonies of fungi in the digestive tract are sometimes referred to as our mycobiome (myco- is the Greek word root for fungus). Many fungi in our environment are our friends. We might savor a pan of sautéed mushrooms or enjoy an omelet seasoned with precious truffles. Members of the fungi family ferment our alcohol and kombucha, raise our dough, and make chocolate palatable. And, of course, certain bread molds give rise to penicillin, the first effective antibiotic. Fungi break down biodegradable materials, and many have symbiotic relationships with humans and other animals. But some fungi can decimate food crops and put livestock at risk, so the widespread use of strong fungicides has become commonplace. This may have given rise to some unintended consequences in some fungal microorganisms, which we will revisit shortly. TYPES OF FUNGAL INFECTIONS In the context of massage therapy and bodywork, fungal infections in humans are important in two contexts: (1) skin infections that are potentially contagious and (2) internal infections that indicate a person may be immune-compromised because of a disease or medication. The Centers for Disease Control and Prevention (CDC) created a list of many types of fungal infections they are tracking that affect humans, and each of those may have several subtypes and involve multiple species of fungi. The complete CDC watchlist of fungal infections can be found in the "CDC List of Fungal Infections" sidebar. I have chosen five topics from the CDC list for this discussion: aspergillosis, candidiasis, dermatophytosis, onychomycosis, and Candida auris. Readers may note that the terminology around fungal infections looks complex: the names are long and strongly tied to Greek and Latin word roots. I have explained some of this vocabulary in the video that accompanies this article. Aspergillosis Aspergillosis is an infection of the lungs with any of 160 types of aspergillus fungi, but the most virulent is called Aspergillus flavus. These airborne spores cause no symptoms in most people, but in others they trigger respiratory allergies: coughing, wheezing, and shortness of breath that doesn't respond to typical allergy treatments. And in some patients, especially those with chronic lung diseases (such as sarcoidosis, chronic bronchitis, or emphysema), this kind of infection can Take a deep breath. Congrats, you just inhaled some fungal spores. Depending on your location and the time of year, you might have inhaled a lot of spores. Scientists estimate that about 10 billion of these microscopic organisms enter our respiratory tract each year, and each one has the potential to set up a life-threatening infection in our sinuses, lungs, bloodstream, or even our brain. Yet, somehow, here we all are. And, if our constitutional health is strong, a fungal infection is extremely unlikely to harm us. In this column, we will take a close- up look at fungal infections—also called mycoses—with a special emphasis on skin conditions and on Candida auris, a relatively new player in systemic fungal infections that is changing the way some health-care facilities manage patient care. WHAT ARE FUNGI? In the classifications of living things, fungi are unique: they are neither plant nor animal, but their own full kingdom of organisms. Under the heading of fungi, we find molds, yeasts, lichens, mushrooms, and truffles. Molds and yeasts are typically microscopic, but in the right conditions, colonies can quickly grow to be visible and obvious.

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