Join us   Log in  

PHARMASPIRE - Volume 14, Issue 03 , 2022 , July-September

Pages: 116-125
Print Article   Download XML  Download PDF

Recent trends in fungal infection management

Author: Gurmeet Singh1, 2, Amandeep Singh2, Raj Kumar Narang

Category: Pharmaceutics


This article provides an overview of the present state of medication therapy for invasive fungal illnesses, as well as research goals for the future new chemical development. Production of orally accessible medicines for the treatment of Candida infections is a key opportunity for novel drugs. In some cases, antifungal resistance is a problem, but it is normally less of a problem than bacterial infections. Improved results will come from earlier and more thorough mycological diagnosis, as well as improvements in underlying risk estimate.

Keywords: Dermatophytes, Dermis, Fungal, Infection

DOI: 10.56933/Pharmaspire.2022.14215



1. Wickes BL, Wiederhold NP. Molecular diagnostics in medical mycology. Nat Commun 2018;9:5135.
2. Wiederhold NP. Emerging fungal infections: New species, new names, and antifungal resistance. Clin Chem 2021;68:83-90.
3. Garber G. An overview of fungal infections. Drugs 2001;61 Suppl 1:1-12.
4. Carvalho A, Pasqualotto AC, Pitzurra L, Romani L, Denning DW, Rodrigues F. Polymorphisms in tolllike receptor genes and susceptibility to pulmonary aspergillosis. J Infect Dis 2008;197:618-21.
5. Bochud PY, Chien JW, Marr KA, Leisenring WM, Upton A, Janer M, et al. Toll-like receptor 4 polymorphisms and aspergillosis in stem-cell transplantation. N Engl J Med 2008;359:1766-77.
6. Bow EJ, Loewen R, Cheang MS, Shore TB, Rubinger M, Schacter B. Cytotoxic therapy-induced D-xylose malabsorption and invasive infection during remission-induction therapy for acute myeloid leukemia in adults. J Clin Oncol 1997;15:2254-61.
7. Bodey GP, Buckley M, Sathe YS, Freireich EJ. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med 1966;64:328-40.
8. Palmer LB, Greenberg HE, Schiff MJ. Corticosteroid treatment as a risk factor for invasive aspergillosis in patients with lung disease. Thorax 1991;46:15-20.
9. Hagen EA, Stern H, Porter D, Duffy K, Foley K, Luger S, et al. High rate of invasive fungal infections following nonmyeloablative allogeneic transplantation. Clin Infect Dis 2003;36:9-15.
10. Elder DE. Lever’s Histopathology of the Skin. Pennsylvania, United States: Lippincott Williams and Wilkins; 2014.
11. Lee AY. Molecular mechanism of epidermal barrier dysfunction as primary abnormalities. Int J Mol Sci 2020;21:1194.
12. Ishida-Yamamoto A, Igawa S, Kishibe M, Honma M. Clinical and molecular implications of structural changes
to desmosomes and corneodesmosomes. J Dermatol 2018;45:385-9.
13. Matsui T, Amagai M. Dissecting the formation, structure and barrier function of the stratum corneum. Int Immunol 2015;27:269-80.
14. Jonca N, Leclerc EA, Caubet C, Simon M, Guerrin M, Serre G. Corneodesmosomes and corneodesmosin: From the stratum corneum cohesion to the pathophysiology of genodermatoses. Eur J Dermatol 2011;21 suppl 2:35-42.
15. Haftek M. ‘Memory’ of the stratum corneum: Exploration of the epidermis’ past. Br J Dermatol 2014;171 Suppl 3:6-9.
16. Kirschner N, Rosenthal R, Furuse M, Moll I, Fromm M, Brandner JM. Contribution of tight junction proteins to ion, macromolecule, and water barrier in keratinocytes. J Invest Dermatol 2013;133:1161-9.
17. Adams MP, Mallet DG, Pettet GJ. Towards a quantitative theory of epidermal calcium profile formation in unwounded skin. PLoS One 2015;10:e0116751.
18. Gunzel D, Yu AS. Claudins and the modulation of tight junction permeability. Physiol Rev 2013;93:525-69.
19. Brandner JM, Zorn-Kruppa M, Yoshida T, Moll I, Beck LA, De Benedetto A. Epidermal tight junctions in health and disease. Tissue Barriers 2015;3:e974451.
20. Breitkreutz D, Koxholt I, Thiemann K, Nischt R. Skin basement membrane: The foundation of epidermal integrity--BM functions and diverse roles of bridging molecules nidogen and perlecan. Biomed Res Int 2013;2013:179784
21. Nyström A, Bruckner-Tuderman L. Matrix molecules and skin biology. Semin Cell Dev Biol 2019;89:136-46.
22. Witte M, Zillikens D, Schmidt E. Diagnosis of autoimmune blistering diseases. Front Med (Lausanne) 2018;5:296.
23. Stemmler S, Parwez Q, Petrasch-Parwez E, Epplen JT, Hoffjan S, et al. Association of variation in the LAMA3 gene, encoding the alpha-chain of laminin 5, with atopic dermatitis in a German case-control cohort. BMC Dermatol 2014;14:17.
24. Kim TI, Park HJ, Won YY, Choi H, Jeong KH, Sung JY, et al. Basement membrane status is intact in urticarial dermatitis vs. adult-onset atopic dermatitis. Ann Dermatol 2018;30:258-61.
25. Schreiner E, Wolff K. The permeability of the intercellular space of the epidermis for low molecular weight protein. Electron microscopic cytochemical studies with peroxidase as a tracer substance. Arch Klin Exp Dermatol 1969;235:78-88.
26. Wolff K, Hönigsmann H. Permeability of the epidermis and the phagocytic activity of keratinocytes: Ultrastructural studies with thorotrast as a marker. J Ultrastruct Res 1971;36:176-90.
27. Briggaman RA, Wheeler CE Jr. The epidermal-dermal junction. J Invest Dermatol 1975;65:71-84.
28. Weeks BS, Ramchandran RS, Hopkins JJ, Friedman HM. Herpes simplex virus Type-1 and -2 pathogenesis is restricted by the epidermal basement membrane. Arch Virol 2000;145:385-96.
29. Kazama T, Yaoita E, Ito M, Sato Y. Charge-selective permeability of dermo-epidermal junction: Tracer studies with cationic and anionic ferritins. J Invest Dermatol 1988;91:560-5.
30. Oh JW, Kloepper J, Langan EA, Kim Y, Yeo J, Kim MJ, et al. A guide to studying human hair follicle cycling in vivo. J Invest Dermatol 2016;136:34-44.
31. Lademann J, Knorr F, Richter H, Blume-Peytavi U, Vogt A, Antoniou C, et al. Hair follicles--an efficient storage and penetration pathway for topically applied substances. Summary of recent results obtained at the center of experimental and applied cutaneous physiology, Charité-universitätsmedizin Berlin, Germany. Skin Pharmacol Physiol 2008;21:150-5.
32. Vogt A, Blume-Peytavi U. Selective hair therapy: Bringing science to the fiction. Exp Dermatol 2014;23:83-6.
33. Zorn-Kruppa M, Vidal-Y-Sy S, Houdek P, Wladykowski E, Grzybowski S, Gruber R, et al. Tight junction barriers in human hair follicles-role of claudin-1. Sci Rep 2018;8:12800.
34. Blume-Peytavi U, Vogt A. Human hair follicle: Reservoir function and selective targeting. Br J Dermatol 2011;165 Suppl 2:13-17.
35. Gorzelanny C, Mess C, Schneider SW, Huck V, Brandner JM. Skin barriers in dermal drug delivery: Which barriers have to be overcome and how can we measure them? Pharmaceutics 2020;12:684.
36. OmidvarA, Brambilla A. A novel theoretical method for predicting the effects of lighting colour temperature on physiological responses and indoor thermal perception. J Build Environ 2021;203:108062.
37. Hao J, Ghosh P, Li SK, Newman B, Kasting GB, Raney SG. Heat effects on drug delivery across human skin. Expert Opin Drug Deliv 2016;13:755-68.
38. Gorzelanny C, Mess C, Schneider SW, Huck V, Brandner JM. Skin barriers in dermal drug delivery: Which barriers have to be overcome and how can we measure them? Pharmaceutics 2020;12:684.
39. Sidoroff A, Halevy S, Bavinck JN, Vaillant L, Roujeau JC. Acute generalized exanthematous pustulosis (AGEP)--a clinical reaction pattern. J Cutan Pathol 2001;28:113-9.
40. Halevy S. Acute generalized exanthematous pustulosis. Curr Opin Allergy Clin Immunol 2009;9:322-8.
41. Hotz C, Valeyrie-Allanore L, Haddad C, Bouvresse S, Ortonne N, Duong TA,et al.Systemic involvement of acute generalized exanthematous pustulosis: A retrospective study on 58 patients. Br J Dermatol 2013;169:1223-32.
42. Sidoroff A, Dunant A, Viboud C, Halevy S, Bavinck JN, Naldi L, et al. Risk factors for acute generalized exanthematous pustulosis (AGEP)-results of a multinational case-control study (EuroSCAR). Br J Dermatol 2007;157:989-96.
43. Versalovic J. Manual of Clinical Microbiology. United States: American Society for Microbiology; 1991.
44. Paulmann M, Mockenhaupt M. Severe drug-induced skin reactions: Clinical features, diagnosis, etiology, and therapy. J Dtsch Dermatol Ges 2015;13:625-45.
45. Pollack M. Pseudomonas aeruginosa. In: Priciples and Practice of Infectious Disease. New York: Churchill Livingstone; 1995. p. 1980-2003.
46. Driscoll JA, Brody SL, Kollef MH. The epidemiology, pathogenesis and treatment of Pseudomonas aeruginosa infections. Drugs 2007;67:351-68.
47. Speert DP, Campbell ME, Davidson AG, Wong LT. Pseudomonas aeruginosa colonization of
the gastrointestinal tract in patients with cystic fibrosis. J Infect Dis 1993;167:226-9.
48. Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European prevalence of infection in intensive care (EPIC) study. EPIC international advisory committee. JAMA 1995;274:639-44.
49. Diekema DJ, Pfaller MA, Jones RN, Doern GV, Winokur PL, Gales AC, et al. Survey of bloodstream infections due to gram-negative bacilli: Frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, and Latin America for the SENTRY antimicrobial surveillance program,
1997. Clin Infect Dis 1999;29:595-607. 50. Foca M, Jakob K, Whittier S, Della Latta P, Factor S, Rubenstein D, et al. Endemic Pseudomonas aeruginosa infection in a neonatal intensive care unit. N Engl J Med 2000;343:695-700.
51. Bristow IR, Spruce MC. Fungal foot infection, cellulitis and diabetes: A review. Diabet Med 2009;26:548-51. Singh, et al.: Fungal infection management 125 Pharmaspire | Vol. 14 | No. 3 | 2022
52. Bjornsdottir S, Gottfredsson M, Thórisdóttir AS, Gunnarsson GB, Ríkardsdóttir H, Kristjánsson M, et al. Risk factors for acute cellulitis of the lower
limb: A prospective case-control study. Clin Infect Dis 2005;41:1416-22.
53. Day MR, Day RD, Harkless LB. Cellulitis secondary to web space dermatophytosis. Clin Podiatr Med Surg
54. Wu BY, Wu BJ, Lee SM, Sun HJ, Chang YT, Lin MW. Prevalence and associated factors of comorbid skin diseases in patients with schizophrenia: A clinical survey and national health database study. Gen Hosp Psychiatry 2014;36:415-21.
55. Mohamed S, Paulsen JS, O’Leary D, Arndt S, Andreasen N. Generalized cognitive deficits in
schizophrenia: A study of first-episode patients. Arch Gen Psychiatry 1999;56:749-54.
56. Jeste DV, Gladsjo JA, Lindamer LA, Lacro JP. Medical comorbidity in schizophrenia. Schizophr Bull 1996;22:413-30.
57. Amin TT, Ali A, Kaliyadan F. Skin disorders among male primary school children in Al Hassa, Saudi Arabia: prevalence and socio-demographic correlates--a comparison of urban and rural populations. Rural Remote Health 2011;11:1517.
58. Zimmo SK, Qadri MA, ElGamal FM, Kordy MN. Prevalence of skin disorders among male primary school children in the city of Jeddah, Saudi Arabia. Saudi Med J 1996;17:56-61
59. Weber NS, Cowan DN, Millikan AM, Niebuhr DW. Psychiatric and general medical conditions comorbid with schizophrenia in the National hospital discharge survey. Psychiatr Serv 2009;60:1059-67.
60. Chen YH, Lee HC, Lin HC. Prevalence and risk of atopic disorders among schizophrenia patients: A nationwide population based study. Schizophr Res 2009;108:191-6.
61. Kumar L, Verma S, Bhardwaj A, Vaidya S, Vaidya B. Eradication of superficial fungal infections by conventional and novel approaches: A comprehensive review. Artif Cells Nanomed Biotechnol 2014;42:32-46.
62. Goldstein AO, Smith KM, Ives TJ, Goldstein B. Mycotic infections. Effective management of conditions involving the skin, hair, and nails. Geriatrics 2000;55:40-2, 45-7, 51-2.
63. Bourlais CL, Acar L, Zia H, Sado PA, Needham T, Leverge R. Ophthalmic drug delivery systems--recent advances. Prog Retin Eye Res 1998;17:33-58.
64. Amichai B, Grunwald MH. Adverse drug reactions of the new oral antifungal agents--terbinafine, fluconazole, and itraconazole. Int J Dermatol 1998;37:410-5.
65. Brodell RT, Elewski B. Antifungal drug interactions. Avoidance requires more than memorization. Postgrad Med 2000;107:41-3.
66. Moossavi M, Bagheri B, Scher RK. Systemic antifungal therapy. Dermatol Clin 2001;19:35-52.
67. Katz HI. Possible drug interactions in oral treatment of onychomycosis. J Am Podiatr Med Assoc 1997;87:571-4.
68. Lazaros GA, Papatheodoridis GV, Delladetsimam JK, Tassopoulos NC. Terbinafine-induced cholestatic liver disease. J Hepatol 1996:24:753-6.
69. Agarwal K, Manas DM, Hudson M. Terbinafine and fulminant hepatic failure. N Engl J Med 1999:340:1292-3.
70. Perveze Z, Johnson MW, Rubin RA, Sellers M, Zayas C, Jones JL,et al.Terbinafine-induced hepatic failure requiring liver transplantation. Liver Transpl 2007;13:162-4.
71. Hainer BL. Dermatophyte infections. Am Fam Physician 2003;67:101-8.