Fungal Infection of the Umbilicus: Omphalomycosis
A fungal infection of the umbilicus is called omphalomycosis, which is a specific type of fungal infection affecting the umbilical region. While bacterial infections of the umbilical area are commonly referred to as omphalitis, fungal infections of this same region are specifically termed omphalomycosis.
Clinical Presentation
Fungal infections of the umbilicus typically present with:
- Erythema and inflammation around the umbilical region
- Purulent or malodorous discharge that may be yellowish or white
- Tenderness or pain in the umbilical area
- Possible nodular formations in severe cases
- Pruritus (itching) around the affected area
Causative Organisms
The most common fungal pathogens causing omphalomycosis include:
- Candida species (especially Candida albicans)
- Aspergillus species
- Trichosporon species
- Fusarium species (in immunocompromised individuals)
Risk Factors
Several factors increase the risk of developing umbilical fungal infections:
- Poor hygiene of the umbilical area
- Excessive moisture retention in the umbilical region
- Obesity with deep umbilical folds
- Immunocompromised states
- Diabetes mellitus
- Recent antibiotic therapy (disrupting normal flora)
- Foreign bodies in the umbilicus (such as omphaloliths or "belly button bezoars") 1
Diagnosis
Diagnosis of omphalomycosis involves:
- Visual examination of the umbilical area
- Culture and microscopic examination of discharge material
- Potassium hydroxide (KOH) preparation to identify fungal elements
- In severe cases, imaging studies (ultrasound or CT) to rule out deeper infection
Treatment
Treatment of omphalomycosis should be targeted based on the causative organism:
Topical antifungal agents:
- For mild to moderate infections
- Options include azoles (clotrimazole, miconazole) or nystatin
- Apply 2-3 times daily until clinical resolution
Systemic antifungal therapy for severe or resistant cases:
Adjunctive measures:
- Keep the umbilical area clean and dry
- Use of antiseptic solutions for cleansing
- Removal of any foreign bodies or debris from the umbilicus
Special Considerations
Neonatal Fungal Infections
In neonates, fungal infections of the umbilical cord are referred to as Candida funisitis when they affect the umbilical cord before birth 3. These present as:
- Small, circumscribed, yellow-white nodules on the umbilical cord surface
- Microscopically visible subamnionic microabscesses
- Often associated with chorioamnionitis
Adult Omphalomycosis
In adults, omphalomycosis may be associated with:
- Urachal remnants that can become infected 4
- Accumulation of keratin and sebaceous material (omphaloliths)
- Hair accumulation in the umbilicus (omphalotrich or trichomphalith) 1
Complications
If left untreated, omphalomycosis can lead to:
- Spread of infection to surrounding tissues
- Cellulitis of the abdominal wall
- Systemic fungal infection in immunocompromised individuals
- Rare but serious complications including necrotizing fasciitis
Prevention
Preventive measures include:
- Regular cleaning and drying of the umbilical area
- Avoiding excessive moisture in the umbilical region
- Proper management of underlying conditions like diabetes
- Prompt treatment of any umbilical discharge or inflammation
Early recognition and appropriate treatment of omphalomycosis are essential to prevent complications and ensure complete resolution of the infection.