Moulds

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Mildew; Molds; Moulds; Mushrooms

Definition
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Predominantly saprophytic, more rarely parasitic fungi. These include the Aspergillus species, the mucoraceae and the geotrichosis. Their role in the development of infections is sometimes assessed differently. Frequently occurring in company of dermatophytes and yeasts. Rarer pathogens of nail mycoses and interdigital mycoses. Type I sensitization to molds can lead to rhinoconjunctival or bronchial symptoms.

Cave! Do not eat blue cheese if you are allergic to penicillin.

S.a.o. Cephalosporiosis, verticilliosis, hemisporosis, peyronellaeosis, mycelium, chromomycosis, black piedra.

Pathogen
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Heterogeneous group of filamentous fungi (Fungi) together, which in the majority belong to the taxonomic groups

  • the ascomycetes (tubular fungi)
  • and
  • Zygomycetes (Yoke fungi)

...belong. For the classification of mushrooms, essentially the same rules apply as for plants. Natural relationships should form the basis of a classification. Systematic units help to create order. The species serves as a basis. A species summarizes morphologically identical, sexually compatible individuals. Closely related species are united in a genus (genus). The genus name (e.g.: Aspergillus) is always prefixed to the name of the species (e.g.: niger). A species may be further subdivided into subspecies, varieties, forms and breeds. Moulds grow at temperatures of 0 to 60°C, the fastest between 20 and 25°C. Moulds can continue to grow on foodstuffs even at temperatures as low as -10°C. Moulds feed on organic molecules (e.g. carbohydrates, fats, proteins), which are found in food, in the soil, in wood, in dust grains, etc.

Occurrence/Epidemiology
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Pathogenicity: For humans, some mould species have pathogenic significance due to their occurrence and growth (e.g. Aspergillus fumigatus). As saprophytes (opportunistic infections by mould species, especially in immunocompromised people (risk group 1-3) or in onychomycosis).

Mould allergy: Furthermore, moulds play a role as producers of allergens and mycotoxins (e.g. in food: aflatoxin, deoxynivalenol, fumonisin, griseofulvin, ochratoxin, patulin, penicillin, satratoxin, trichothecenes, zearalenone). There is sufficient evidence of potential mould allergens for the following diseases: allergic asthma and rhinitis, exogenous allergic alveolitis, respiratory infections.

Food refiners: Moulds also play a role as food refiners, e.g. the brush mould species Penicillium roqueforti and Penicillium camemberti, which are named after their use in the production of Roquefort and Camembert cheeses. A mould (Botrytis cinerea) is also used in wine production for refinement (noble rot) of the grapes.

Prodients of mycotoxins: Mycotoxins are toxic metabolic products of moulds. About 200 different toxins are known; they are produced by slightly more than 300 species of fungi. Mycotoxins are toxic for humans (even for animals at the same temperature) even in small doses. In Central Europe the importance of mycotoxins is increasing. This is due to food imports from areas with a warm and humid climate. They are threatened by mould infestation at all stages of production, from agricultural production to food processing and storage. In addition, toxin-forming moulds, especially Fusarium (see below Fusarium), spread in temperate latitudes. The most important mycotoxin groups and their formers are:

  • Mycotoxins of Claviceps species (group of ergot alkaloids)
  • Mycotoxins of Fusarium species (zearalenone; fusarenone)
  • Mycotoxins from Penicillium species (luteoskyrin, patulin -on fruit varieties)
  • Mycotoxins of Aspergillus species(aflatoxins, sterigmatocystine, ochratoxin). Aflatoxins, are a frequent cause of food poisoning. However, they can also cause unspecific health problems such as headaches, aching limbs and irritation of the mucous membranes via the ambient air.

Producers of medicines: Certain mould species produce starting products for medicines (e.g. antibiotics (penicillin types), immunosuppressants (cyclosporine, mycophenolic acid) or cholesterol-lowering agents (e.g. lovastatin).

Therapy
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For moulds, testing can be carried out in reference centres in relevant individual cases. In addition, the identification of the species provides important information on therapeutically suitable antimycotics.

Polyenantimycotics: Conventional Amphotericin B is a broad-spectrum antifungal agent suitable for the therapy of both mould and yeast infections. Liposomal amphotericin B is considered equivalent to the conventional variant with regard to the achievable therapeutic efficacy. Clear advantages with regard to tolerability and toxicity are offset by the very high costs of this preparation.

Azoles: Fluconazole is suitable for the therapy of Candida and Cryptococcus infections. C. glabrata and C. krusei are often considered resistant. Voriconazole is also effective against C. glabrata and C. krusei and moulds. The spectrum of action of posaconazole is wider compared to voriconazole due to its efficiency in infections with zygomycetes (Rhizopus, Mucor etc.).

Echinocandine: Caspofungin is effective against candida and mould infections. Caspofungin is not effective with Cryptococcus species and zygomycetes (Rhizopus, Mucor etc.). Anidulafungin and Micafungin have a similar spectrum of action to caspofungin.

Literature
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  1. Gallagher JC et al (2003) Antifungal pharmacotherapy for invasive mould infections. Expert Opinion Pharmacother 4: 147-164
  2. Desoubeaux G et al (2013) Cutaneous mucormycosis caused by Rhizopus microsporus. Ann Dermatol Venereol 141:201-205
  3. Montealegre F et al (2004) Comparative prevalence of sensitization to common animal, plant and mould allergens in subjects with asthma, or atopic dermatitis and/or allergic rhinitis living in a tropical environment. Clin Exp Allergy 34: 51-58
  4. Refai M (1992) Differentiate moulds. Mould dialogue 2: 29-30
  5. Tessari G et al (2014) Opportunistic deep cutaneous mycoses insolid
    organ transplant recipients. G Ital Dermatol Venereol 149:417-422

  6. Wegmann T (1988) Medical Mycology - a practical guide. Editiones Roche, Basel
  7. Williams K et al (2013) Voriconazole-associated cutaneous malignancy: a literature review on photocarcinogenesis in organ transplant recipients. Clin Infect Dis 58:997-1002

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Last updated on: 29.10.2020