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Resources Barter, Devra M., et al. 2019. "Candida Bloodstream Infections Among Persons Who Inject Drugs—Denver Metropolitan Area, Colorado, 2017– 2018." Morbidity and Mortality Weekly Report 68, no. 12: 285–88. Beach, Emily. 2018. "Fungus Vs. Mold." Sciencing. Centers for Disease Control and Prevention (CDC). 2018a. "Candida auris: A Drug-Resistant Germ That Spreads in Healthcare Facilities." Centers for Disease Control and Prevention (CDC). 2018b. "Infection Prevention and Control for Candida auris. candida-auris/c-auris-infection-control.html. Centers for Disease Control and Prevention (CDC). 2019a. "Aspergillosis." Centers for Disease Control and Prevention (CDC). 2019b. "Tracking Candida auris." Hassan, Mohamed I Abdelwahab, and Kerstin Voigt. 2019. "Pathogenicity Patterns of Mucormycosis: Epidemiology, Interaction with Immune Cells and Virulence Factors." Medical Mycology 57, Suppl 2: S245–56. Lesher, Jack L., Jr. "Tinea Corporis Treatment and Management: Medical Care, Surgical Care, Complications," 2018. https://emedicine. Mole, Beth. 2017. "We Inhale up to 10 Billion Mold Spores Daily; Here's Why You Haven't Died Yet." Ars Technica. science/2017/09/moldy-mayhem-can-follow-fl oods-hurricanes-heres-why-you-likely-wont-die. Richtel, Matt, and Andrew Jacobs. 2019. "A Mysterious Infection, Spanning the Globe in a Climate of Secrecy." New York Times, April 9, 2019, sec. Health. Sam, Qi Hui, et al. 2017. "The Fungal Mycobiome and Its Interaction with Gut Bacteria in the Host." International Journal of Molecular Sciences 18, no. 2. Seladi-Schulman, Jill. 2018. "Candida Albicans: Infections, Symptoms, and Treatments." Medical News Today. articles/322722.php. Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 39 IMPLICATIONS FOR MASSAGE THERAPY Fungi are everywhere; they are virtually unavoidable. This turns out to be a good thing, since helpful fungi are key players in healthy digestion and other physiological functions. Even when they are out of optimal balance, most fungal infections are not threatening to fundamentally healthy people. Internal infections of the lungs or other organs indicate that the person has compromised immune system function, but in those circumstances, the fungi are unlikely to be transmitted directly from one person to another—they are not directly contagious. This doesn't preclude the transfer of fungal parasites from surfaces, however. As we saw, this is an important issue with Candida auris. If a client has a diagnosed fungal infection of the skin (such as a ringworm lesion or athlete's foot), then we need to observe basic precautions: we avoid the lesion (which should be covered), and we use standard hygienic practices to safeguard ourselves and other clients. If an infection is widespread and not clearly localized, this may mean delaying an appointment until treatment has been successful. We must also take care not to risk spreading a fungal infection from one area of the body to another—this is particularly relevant for athlete's foot. Massage therapists who work in hospitals or with very frail clients are likely to see more extreme and potentially threatening fungal infections than those who work in other settings. These infections may involve the lungs or other internal organs, and the skin as well. In this situation, it is important to be aware of what hygienic protocols are being used for the patient—and to communicate any observations about skin health to the health-care team. The CDC emphasizes the importance of excellent hand hygiene in the context of working with patients who may carry fungal infections. We can't get away from fungi, nor do we need to. But we do need to create an environment that limits the risk of our clients (or ourselves) going home with new, unwelcome passengers. Fungi are yet another reason to do a "hygiene audit" and examine our standard practices for how we manage our work environment. Do you see any changes you want to make? Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology (available at, now in its sixth edition, which is used in massage schools worldwide. Werner is available at or Watch "Fungus"

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