A word to the wise (Aspergillosis)

As I accidentally breathed in the blood, fish & bone powder I was feeding my plants yesterday, I was reminded of a case which made the front cover of The Lancet last week entitled: gardening can seriously damage your health.

It highlighted a case report of an unfortunate man who succumbed to aspergillosis, a fungal disease. He acquired this through breathing in the spores & he did that because he had spread a large amount of rotting tree and plant mulch upon his garden which generated clouds of dust, engulfing him. Treated initially for pneumonia, it was unfortunate that his partner didn’t recall this dust cloud until three days into his hospital stay: by then his sputum samples had grown the fungus Aspergillus fumigatus. Apparently his symptoms started within 24 hours of spreading the mulch. Anti-fungal Amphotericin was immediately started but the infection overwhelmed him and he died just 5.5 days after entering hospital and just 12 days after the first signs of breathing distress.

This happened in High Wycombe, a town near me! I hope this mulch wasn’t commercially available.

Aspergillosis and some other fungal infections (cryptosporidium, candida (yeast), coccidiomycosis, fusarium) are, in developed countries, usually opportunistic infections, mainly affecting the immune suppressed (through drug treatment or sometimes genetic makeup). AS we use more immunosuppressive drugs, so they are becoming a problem in hospitals. (It is not known if this unfortunate man had a defect in his immune system.) Of course in the general population, many have had experience of one of the dermatophytes, they aren’t killers but who wants ringworm or athletes foot.

It still amuses me that Texas has a problem with coccidiomycosis: it seems so outlandish. I’m amused because at the time of discovering this fact, I envisioned this vast underground fungal network in the desert just waiting to get you. The reality is more mundane: when conditions are too dry for the filamentous fungi in the soil it produces drought resistant reproductive spores which are released into the air. The unfortunate animal or man passing by breathes in the spores and the fungus then becomes parasitic. You can’t catch it in any other way than to breathe in those spores and then only 60% of people go on to get the disease, and only 5% of these get the chronic and disseminated form which can kill. Its endemic to semi-arid regions of central, south and latin America and of course Texas, Arizona, New Mexico, Utah and parts of California. The offenders are: Coccidioides immitis or C. posadasii.

In tropical developing countries, some of the most common fungal infections are sporotrichosis, paracoccidioidomycosis, cryptococcosis, histoplasmosis, and zygomycosis. Infections are more common in rural areas and are acquired again by breathing in spores or via cuts. AIDS sufferers with their immune system depressed are particularly susceptible.

As I said, I breathed in blood, fish & bone powder…..paranoia could have set in…what about BSE or dust-damaged lungs……but I’m too sensible for that. I’m more likely to get killed crossing the road or be overworked to death. What I will be doing in future is wearing a face mask if I spread dusty rotting tree bark or open the blood fish & bone on a windy day.

Some interesting references on aspergillosis from Global Health now follow. ‘Fraid its grim reading. Global Health has 6270 records on aspergillosis (the disease) and 9848 records on Aspergillus (the organism: there are three species of this genus that cause human cases).

REFERENCES

  1. Gardening can seriously damage your health. Russell K., Broadbridge C., Murray S., Waghorn D., Mahoney A. The Lancet vol 371 No.9629 p2056
  2. Invasive fungal disease in allogeneic hematopoietic stem cell transplant recipients: an autopsy-driven survey. Sinkó, J. et al. Transplant Infectious Disease, 2008, Vol. 10, No. 2, pp. 106-109.
  3. Effect of building construction on Aspergillus concentrations in a hospital Goebes, M. D. Baron, E. J. Mathews, K. L. Hildemann, L. M. Infection Control and Hospital Epidemiology, 2008, Vol. 29, No. 5, pp. 462-464.
  4. Cost advantage of voriconazole over amphotericin B deoxycholate for primary treatment of invasive aspergillosis. Lewis, J. S., II Boucher, H. W. Lubowski, T. J. Ambegaonkar, A. J. Day, D. L. Patterson, T. F. Pharmacotherapy, 2005, Vol. 25, No. 6, pp. 839-846.
  5. Fatal coinfection with Legionella pneumophila serogroup 8 and Aspergillus fumigatus. Guillouzouic, A. et al Diagnostic Microbiology and Infectious Disease, 2008, Vol. 60, No. 2, pp. 193-195.
  6. Epidemiological status of mycoses in the Argentine Republic.(Foreign Title: Situación de las micosis en la República Argentina. Davel, G. Canteros, C. E. Revista Argentina de Microbiología, 2007, Vol. 39, No. 1, pp. 28-33.
  7. Vaccinations with recombinant variants of Aspergillus fumigatus allergen Asp f 3 protect mice against invasive aspergillosis. Ito, J. I. et al. Infection and Immunity, 2006, Vol. 74, No. 9, pp. 5075-5084.
  8. Invasive aspergillosis: clinical manifestations and treatment. Lumbreras, C., Gavaldà, J. Revista Iberoamericana de Micología, 2003, Vol. 20, No. 3, pp. 79-89.
  9. Itraconazole as most useful drug for fungal corneal ulcers. Soma Bandyopadhyay Maiti, P. K. Samajpati, N. Journal of Mycopathological Research, 2002, Vol. 40, No. 2, pp. 139-143.
  10. Endemic mycoses in a cancer hospital. Torres, H. A. Rivero, G. A. Kontoyiannis, D. P. Medicine (Baltimore), 2002, Vol. 81, No. 3, pp. 201-212.
  11. The prevalence of the allergic bronchopulmonary mycosis among patients of chest diseases "lung infection" at Ismailia. El-Razik, M. A. Moustafa, A. F. El-Zoghby, Z. Farghaly, H. African Journal of Mycology and Biotechnology, 2003, Vol. 11, No. 1, pp. 139-154.
  12. The Fungal kingdom: Diverse and Essential Roles in Earth’s Ecosystem. American Academy of Microbiology report (released June 24 2008).

Note: References 9,10,11 are abstracts only available from Global Health online or from the print journals. Reference 8 is from our selected content made freely available through Google.

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