Thursday, 29 May 2008

Old dog gets a new trick - inhaled amphotericin for fungal respiratory infections.

Amphotericin has been used as a treatment for aspergillus infections for many years. It is one of the oldest drugs still in use for this purpose and many alternative antifungals have now been developed that are less toxic. Amphotericin is still very useful in some circumstances and is one of the cheaper drugs useful against aspergillus.
Changing the subject slightly - one of the main suspects why treatment for aspergillus infections of the lungs fail is that the fungus grows in the airspaces of the lungs. Oral and injected antifungals travel through the body via the blood supply - there is very little blood supply to the air spaces of the lungs so antifungals do not get to the fungus.
In addition treatment using oral or injected drugs leads to the drug being dispersed around nearly all of the body. Some parts of the body can be more sensitive to the drug than others so it is only possible to give as much drug that will not damage the most sensitive parts of the body. This can severely limit effectiveness of the treatment.

Much better results might be obtained for a fungal infection of the lungs if the antifungal drug could be applied via the air breathed in - that way the drug could attack all of the fungus in the air spaces AND would only be applied in the limited area of the body it was needed i.e. the lungs. Much less drug would be needed and much more fungus would be attacked - in theory.

This paper is a first successful step in the use of aerosolised amphotericin applied via an inhaler. Patients vulnerable to infection (in this case they had no immune system for a few days - referred to as neutropaenia) where given this medication and far fewer became infected with aspergillus compared with the placebo control.

This is not a new treatment as it has been in use in principle for 5 years or so (e.g. to treat vulnerable CF patients) but this is quite a large study so the result is more convincing than most.

Now let's see if it works on patients already chronically infected - particularly ABPA and aspergilloma patients perhaps?

Thursday, 22 May 2008

Aspergillus Warning for Owners of Air Conditioned Cars

Air conditioning is well established as a potential source of fungal spores in the air of buildings. The units tend to get wet as warm moist air hits cold cooling surfaces, and if that moisture is not efficiently drained away then conditions for fungal growth are quickly established - along with a highly populated source of fungal spores in the warm air that is sucked into the unit.

A car warranty company has recently released a reiteration of established advice to car owners on the best use of air conditioning units in cars to avoid a face-full (or perhaps more sinisterly a lung-full) of spores. They make the point that in these days of high fuel prices people will be more inclined to switch the air-con off in their cars to save on fuel use (an air-con unit can increase fuel consumption by 10-15%).
If air con is left on the assumption is that there will be a steady flow of spores, but if it is switched off for a period of time the spores will build up and be released in a far more concentrated cloud when the unit is activated.

I would say that the situation is more complicated than that - there will only be a problem if the air con unit remains wet for some time for example. Some interesting points are made in this article and some guidance to avoiding fungal contamination of your car air-con is given.

The dynamics of mould contamination from car air-con's is examined in the scientific paper entitled "Effect of air-conditioner on fungal contamination".

The main findings seem to be that using your air conditioning for more than 20 days in the summer increases the amount of fungi in the air of that car some 400% over not using it at all, but less regular use increases that figure only a further 50% (Table 4).After the first blast the amount of fungal spores drops 75% over the next 10 mins (Table 2).

One in four cars tested had 1000 spores per cubic metre of air, while one in eight had over 2000 spores per cubic metre - pretty high figures for a person suffering allergies, ABPA or immune compromised.

Take home message is that if you are vulnerable to fungal spores, rather than run it more frequently turn your car air conditioning off completely. If you must keep cool pay for careful maintenance of the unit and/or ensure HEPA grade filtering is in place!

Friday, 16 May 2008

Orca (Killer whale) killed by Aspergillus

The worlds first captive Orca (named Moby Doll) was kept in captivity in North Vancouver in a dry dock. At that time (1964) little was known about Orca's and it took two months of trial and error to workout that it ate fish!

Observers quickly realised that preconceived impressions that Orca's were simple man eating killers that interfered with fishing were wrong. Orca's were discovered to be intelligent, gentle creatures.
Unfortunately, presumably due to lack of food, Moby Doll fell ill and died less than 3 months after capture. Post mortem revealed the cause of death to be aspergillosis in the creatures lungs - an infection that usually afflicts those with a poor immune system.

Moby Doll marked the beginning of a new era of capturing this animal, especially when it was revealed that a commercial aquarium had been willing to pay $25 000 for the Orca.

Monday, 12 May 2008

Public advised 'old rice not good for health'

Public health information given out in India following a detailed scientific study contains the following worrying phrase: "Old rice cooks well but it may cause severe health problems including poisoning if it is not washed properly."

The suggestion is that there is a practice of storing rice for long periods of time to improve its cooking properties. It follows that this practice is carried out by people who are going to be difficult to reach with the health advice contained in this article. Practices that have been carried out for years tend to be handed down from parent to offspring and in this case they could be playing a mouldy form of 'russian roulette' with their health.
If a batch of stored rice becomes damp it will grow Aspergillus and runs a high risk of becoming contaminated with high levels of mycotoxins - many of which are extremely bad for health.

Unfortunately the article seems to say that washing the rice before use will counteract toxicity, but I think it is far from accepted that a simple rinse in water will remove the mycotoxins - far better to clearly state that damp & mouldy rice should be disposed of.

What if you have no alternative to eating mouldy rice? In this old story from China in 2004 there was a strong suggestion that mouldy rice finds its way back into food for some people - particularly poorly fed migrant workers.

The fact that people are not being reported as dying in large numbers from these contaminated foods may either say that people are dying but mycotoxins are not being identified as the cause - amongst poorly fed workers for example there could be many other health problems causing death - or perhaps ingestion of low to medium amounts of mycotoxins isn't lethal.

What the cumulative effects are of eating mycotoxins regularly are not know (as far as I know). Perhaps a study looking at the frequency of illnesses related to mycotoxins in poorly fed areas is indicated?

Friday, 9 May 2008

New antifungal Micafungin approved in europe

Micafungin chemical structure
Approved for use only against Candida infections. Particularly useful in young children, micafungin also has activity against Aspergillus and indeed is licensed for use against Aspergillus in Japan.
"Micafungin is expected to launch first in the United Kingdom and then across Europe shortly thereafter. The antifungal has been available in Japan since December (Funguard for Infusion), where it has established its therapeutic efficacy against fungal infections caused by Aspergillus and Candida and safety through all therapeutic results. Micafungin has been available in the United States since May 2005 and is now indicated for treatment of patients with candidaemia, acute disseminated candidiasis, Candida peritonitis, and abscesses; treatment of patients with oesophageal candidiasis; and prophylaxis of Candida infections in patients undergoing haematopoietic stem cell transplantation."

Hopefully approval for use against Aspergillus will be forthcoming in the future.

Friday, 2 May 2008

Marijuana users refused transplant

Photo from AP News
Prospective transplant recipients are being turned down in the US if they have a record of smoking marijuana, even if approved to do so by doctors:

"Most transplant centers struggle with the how to deal with people who have used marijuana, said Dr. Robert Sade, director of the Institute of Human Values in Health Care at the Medical University of South Carolina.

"Marijuana, unlike alcohol, has no direct effect on the liver. It is however a concern ... in that it's a potential indicator of an addictive personality," Sade said."

Transplant recipients go through a phase of having their immune systems repressed in order to avoid the new organ being rejected. This means that they are more vulnerable to severe infection by aspergillus - invasive aspergillosis. Marijuana and tobacco can contain high quantities of aspergillus spores along with other fungi - particularly if they have been dried or stored poorly, so inhaling smoke and air through it can include inhaling large amounts of aspergillus spores.

"Dr. Jorge Reyes, a liver transplant surgeon at the UW Medical Center, said that while medical marijuana use isn't in itself a sign of substance abuse, it must be evaluated in the context of each patient.

"The concern is that patients who have been using it will not be able to stop," Reyes said."

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