What Is Medical Mycology?
Medical mycology is the branch of microbiology that focuses on the study of fungi and their role in causing diseases in humans and animals. This specialised field explores the various ways fungi, which include yeasts, moulds and slime, and mushrooms, can lead to infections ranging from superficial skin conditions to life-threatening systemic diseases.
While fungi are often overlooked compared to bacteria and viruses, they play a significant role in public health, particularly in immunocompromised individuals where fungal infections can be severe and challenging to treat. The medical mycology field not only seeks to improve the diagnosis and treatment of fungal infections, but also to advance our knowledge of fungal biology and its interactions with the human body.
The importance of medical mycology has grown as the number of people at risk for serious fungal infections has increased, largely due to factors like the widespread use of immunosuppressive therapies, the growing population of individuals with chronic conditions, and the emergence of drug-resistant fungal strains.
Fungi are responsible for a wide range of diseases, from common skin conditions like athlete’s foot and ringworm to more serious infections such as Candida and Aspergillus, particularly in immunocompromised individuals. Some fungal pathogens, including Candida and Aspergillus, are part of the normal flora in humans, making them difficult to detect when they become disease-causing.
The Overlooked Field of Medical Mycology
Medical mycology, which focuses on fungal infections in humans and animals, is often neglected within the broader field of microbiology. This discipline originated in the early 19th century in Italy with the discovery of tinea favosa. (Espinel-Ingroff 1996)
Although literally billions worldwide are affected by fungal infections, with potentially fatal consequences, medical mycology remains an overlooked area of microbiology. Despite its critical importance, medical mycology is often underfunded and under-researched, leaving gaps in our understanding and treatment of fungal diseases. (Rodriguez et al., 2020)
Each year, over 150 million severe fungal infections occur globally, leading to around 1.7 million deaths, with these numbers steadily increasing due to recent social and medical developments. (Kainz et al., 2020)
The widespread and long-term use of antifungal drugs, especially in high-risk patients, has contributed to the rise of drug-resistant fungi, such as the highly virulent Candida auris. As fungal infections continue to pose a growing global threat, this blog post emphasises the urgent need for more effective research to combat these infections and their impact.
Alarmingly, the global death toll from fungal infections exceeds that of more well-known diseases like malaria, breast cancer, and prostate cancer, and is comparable to the mortality rates of tuberculosis (TB) and HIV. (Global Action For Fungal Infections – GAFFI)
Key Fungal Pathogens and Their Impact
Candida species are ubiquitous in nature and are often found on plants, as well as within the human body. These organisms can act as opportunistic pathogens, particularly in individuals with weakened immune systems. While Candida albicans is the most common species, others such as Candida tropicalis, Candida glabrata, Candida krusei, Candida parapsilosis, and Candida pseudotropicalis can also cause significant health issues.
Aspergillus species are another major concern, with only a few of the hundreds of species, including A. fumigatus, A. flavus, A. niger, and A. terreus, linked to human disease. These fungi are particularly dangerous for immunocompromised patients, where they can cause severe and often fatal infections.
Key Points:
Evolution of Antifungal Therapies
The development of antifungal treatments began in the late 19th century, with the first documented case of blastomycosis marking the beginning of medical mycology in the United States. Throughout the 20th century, significant progress was made in understanding fungal pathogens, developing diagnostic tests, and classifying fungi.
Early antifungal treatments, like potassium iodide, had limited effectiveness. However, the discovery of nystatin in the 1950s and the introduction of topical agents like miconazole and clotrimazole in the 1960s marked significant advances in therapy. The 1990s saw a major breakthrough with the introduction of fluconazole, a broad-spectrum antifungal agent that transformed treatment options.
Ongoing Challenges and Future Directions
Despite these advancements, medical mycology remains underfunded and underdeveloped. There are currently no vaccines or immunotherapies available for fungal infections, and the range of antifungal drugs is still limited. The emergence of multidrug-resistant fungal species poses a significant global health threat.
In the UK, the research community is small, with only a few specialised centers dedicated to medical mycology. However, recent advances have provided hope for the future. Understanding the immuno-pathology of fungal diseases, the genetic predispositions to fungal infections, and the interplay between the microbiome and immune responses has improved. These insights could lead to the development of vaccines, immunotherapies, and personalised treatment approaches in the future.
Key Points:
Medical Mycology Pioneer
Dr. John Rippon – Medical Mycologist
Mycologist: a mycologist is person who studies and works with fungi, living organisms that includes slime, mould, yeast, and mushrooms.
Medical Mycologist: a medical fungal microbiologist, a scientist who isolates and identifies fungi and their effects on human and animal health.
Dr. John Rippon Ph.D. (1932-2019 ) was among the foremost medical mycologists of recent times, having written seven books and more than 80 scientific publications on medical mycology. He was among the first mycologists to see the importance in fungi that infected people. Dr. Rippon was the first medical doctor to describe vaginal yeast infection in the medical literature. (Homei et al., 2013)
Dr. John Rippon was renowned for authoring the seminal textbook “Medical Mycology: The Pathogenic Fungi and the Pathogenic Actinomycetes” in 1974, before the AIDS crisis increased the prevalence of fungal infections. Dr. Rippon’s work became an invaluable resource for medical professionals confronted with unfamiliar infections caused by fungi. By the time the third edition was published in 1988, it had become the global gold standard in the field, translated into multiple languages.
Dr. Rippon was a man with a high-level or research expertise. His contributions to mycology were recognised with the establishment of the John Rippon Award for Medical Mycology in the Mycological Society of America, where he was also honored as a Distinguished Mycologist.
Here are some of his achievements:
Candida Albicans Accounts For Most Fungal Disease
The many clinical manifestations of Candida infection are incredibly variable. Candida albicans however accounts for the majority of diseases caused by yeast, according to John Rippon Ph.D., in his book the definitive text on medical mycology “Medical Mycology”.
Dr. Rippon mentioned a revival of interest in candida after the 1940s, and explained this was mainly due to the widespread use of broad-spectrum antibiotics, causing a surge of research, along with the inevitable widespread resistance to fungal treatments.
At the same time, an increase in the use of antibiotic drugs, corticosteroid therapy and chemotherapy was occurring; thus the incidence of human fungal infection skyrocketed.
Before the AIDS epidemic began, Rippon wrote the first edition of “Medical Mycology: the Pathogenic Fungi and the Pathogenic Actinomycetes” in 1974, as more people were becoming susceptible to fungal diseases.
Rippon’s recognition of the value in studying medically important fungi became very important, in the early 1980’s, because the AIDS epidemic became apparent. Systemic Candidiasis was becoming an increasing cause of mortality as increasing amounts of people were becoming very immune-compromised due to AIDS. When dealing with infections they had never encountered before, medical practitioners and specialists found Rippon’s compilation of research to be a huge help.
Medical experts and mycologists today still covet Rippon’s long-out-of-print textbook because of his expert writing style and painstaking attention to detail. The Mycological Society of America recognised John as a Distinguished Mycologist. John received invitations to teach and talk all over the world as a guest professor due to his successes and distinctive skills.
Eric Bakker N.D.
Greetings! I am a naturopathic physician from New Zealand. Although I’ve retired from clinical practice since 2019, I remain passionate about helping people improve their lives. You’ll find I’m active online with a focus on natural health and wellbeing education through my Facebook page and YouTube channel, including this website.
