Did you know that “germs” are everywhere? A specific term is ubiquitous, meaning they are everywhere, a part of our environment. Certainly, germ is an antiquated term, referring to microscopic biological organisms. Most people automatically associate this with bacteria, but it can also refer to viral particles and fungal organisms.

The variety of fungal species is tremendous, with estimates claiming there are over 5 million species. A “guesstimate” is an appropriate term since the vast majority of these have not been properly identified or classified by scientists. And only about 300 of these are capable of causing illness in humans. Just as many plants have seeds for propagation, numerous species of fungi are able to form spores, allowing them to, in effect, hibernate for long periods of time.

Fungal infections are extraordinarily common in human beings. In fact, millions of Americans live for many years harboring such a contagion. Statistically, this most often occurs in the form of a fungal nail infection, typically leading to thickening and discoloration. Also common is the build-up of debris under the nail. (Important side note: it’s an established fact, only half of these abnormal nails are the result of a fungal infestation.)

Pertinent to this discussion is the frequently asked question of how or where someone picks up a fungal infection, be it skin, nails or hair. It’s usually impossible to determine where the organisms were picked up. They are slow growing; no evidence of the infection can be visualized often for weeks or even months. But just to be clear; these microorganisms are everywhere. It’s not really a question of when exactly the pathogen was contacted. Moreso, when did the opportunity arise for the fungal organisms to thrive, reproduce, and cause an infection.

As with mushrooms, which are also a type of fungi, the ones that affect people prefer a dark, moist environment. The feet, crammed inside a shoe, wrapped in a sock, is an excellent habitat. Another common site is where there is a fold of skin, making skin to skin contact. In the groin, or those who have obesity, this is frequent and both are sites typical for a fungal infection, as is the axilla (the armpit).

These are resistant infections, difficult to eradicate, and sometimes persisting for years. Depending on the location of the infection and the tissue type, they may not be easily accessed by antifungal medications. When such a contagion develops in the lungs, the afflicted will often never be rid of it. Pertinent to this discussion, this usually occurs in an immunocompromised individual, someone whose natural defenses are impaired (as with an organ transplant, when receiving chemotherapy, or with AIDS, etc.). Genetics also plays a part in one’s susceptibility to these microbes.

Perhaps the most frequently seen site for these infections is in the toenails and these are, in fact, epidemic. Because of numerous factors, including the protection provided by the nail plate, these are particularly challenging infections requiring a devoted and specialized regimen to eradicate. Most do not learn about the methods most effective, especially since too often the cause of the changes is inaccurately identified. Pertinent to a successful treatment plan, the more established the infection, the harder to eradicate. Treat early for success.

Many treatment failures are because of the individual’s failure to appreciate the durability of these organisms. The duration of treatment is critically important and too often the treatment program is short-lived and insufficient. Simply seeing some improvement, some resolution of the visible changes, be it redness, blistering or peeling, that is not enough and not reflective of the continued presence of fungi. Fungal spores can persist for years, undaunted by the passage of time.

A common refrain amongst infectious disease experts is in regards to bacterial resistance. Because our current antibiotics are becoming ineffective, many specialists fear the day when a paper cut could kill you. It has become clear we need to have similar concerns regarding fungal organisms. These too are becoming resistant to our antifungal drugs, reducing the success of our treatment.

A cutaneous fungal infection, meaning one that involves superficial structures, typically skin, will often resolve with a topical medicine. But addressing the environment is vitally important. Because these microbes need a moist locale, keeping the area dry makes a significant difference in the success.

Numerous factors reduce the rate at which we are able to vanquish these infectious organisms. Some of our medications don’t kill fungal cells, potentially allowing recurrence of the infection when the drug is discontinued. As mentioned, many individuals aren’t counseled on the course of treatment and discontinue the pharmaceutical too soon. Additionally, the environment may be difficult to keep clean and dry.

Some of the antifungal medications can be cytotoxic, meaning they can be harmful to the liver, which is often the organ metabolizing the drug. Fortunately, terbinafine, the drug usually prescribed for nail and skin infections, has an excellent “track record.” It rarely causes any liver changes, and when it does, they resolve after discontinuing the med.

Many of us live with a subtle but chronic athlete’s foot infection. These may appear as a mild redness with some flaking. These are frequently asymptomatic until conditions are right, then a more acute presentation may develop, with blistering, draining, and pain. A secondary bacterial infection will frequently result.

Fungal organisms are everywhere, just like bacteria. You cannot erase them from your environment, try as you might. Good hygiene is helpful in these effort, as is the use of foot powders or moisture absorbent insoles. Another effective practice is an occasional inspection of such parts, making certain there isn’t something going on that is asymptomatic. It may not be fun to think about but this is the world we live in. As Jerry Seinfeld once noted “You can’t live in a bubble!”

EDITORS NOTE: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.