Thursday, 31 May 2012

Confusion About Moulds in Damp Homes

A recent news story shows that there is some cause for concern about how public housing stock in the UK is maintained with regard to damp and mould.

The UK government Secretary of State for Communities and Local Government, Mr Andrew Stunell, in answer to a written Parliamentary Question asked by Thurrock MP Jackie Doyle-Price stated, “Damp and mould growth is a category 1 hazard. Councils are under a duty to take action in such cases”.

Belhus ward local councillors, Charles and Wendy Curtis state “We feel we have to point out that this {Toxic Black Mould} is not a Category 1 hazard, but a Category 4."
“There is a major difference and, put simply, Category 1 is a risk to life, Category 4 is not”.

Who is right? It depends on several factors. Damp homes are known to promote asthma amongst young occupants. Moulds are increasingly thought to affect asthma severity and promote attacks. Severe asthma can be fatal.

The UK government has put in place tools that are to be used to to make assessments on the fitness for use of housing stock that is not occupied by its owner - Housing Healthand Safety Rating  System (Housing Act 2004) - despite this there still seems some confusion when it comes to calculating levels of hazard with regard to moulds.

There does seems to be a fundamental problem - tenants will look at the property they are renting and see mould growth, particularly in the cold of winter - and tend to blame the landlord. Mould growth means that there is a damp problem.

 Damp has many causes - direct water penetration through defective walls, roofs or guttering, damp moving up a wall if waterproofing that isolated walls from the ground is inadequate and so on. It is reasonable to assume that these are the concern of the landlord. However another major source of moisture is the tenant - when people cook, bathe, shower, dry clothing or just breathe they introduce litres of water into the building every day - this must be removed and not allowed to settle on walls or other surfaces - usually by adequate ventilation. Unfortunately there has been a lot of effort recently to limit ventilation as a means to maximise energy use efficiency - ventilation can mean lost heat that has to be replaced.

 Tenants will protest (often reasonably) that they cannot dry clothing outside, that tumble drying is expensive and dry clothes on radiators while not opening windows - trapping tens of litres of water inside a property. Once night falls and the heating switches off the temperature in the rooms drops - at a critical temperature all that water will start to drop out of the air and onto handy adjacent surfaces. Result = damp & mould.

It is in a landlords interest to provide means to dry clothes & cook without introducing excess water into the air. It is in the tenants interest to ensure as little water escapes into the house as possible. Both are probably blaming the other, both probably lack good information on what to do.

This is where all parties need to cooperate and expert mediators are needed. This is a complex problem that needs intervention and regulation by a third party expert in damp prevention but with no vested interest. The starting point is probably to assume no fault on either tenant or landlord until it has been properly assessed what the problem is in each case and what action is needed.

This may be expensive to solve but it certainly isn't a problem that is going to go away by itself. Both parties are going to have to accept that the prevention of damp is a far more important issue than it has been and invest accordingly.

Sudden Mould Death?

This recent story of an 80 year old man suddenly falling victim to what seems to be invasive aspergillosis (though this has not been confirmed) is the latest in a small number of reported cases where an individual is accidentally exposed to a large number of spores and then quickly succumbs to an aggressively invasive Aspergillus infection. The victims are apparently healthy with a normal immune system.

We have to balance these cases with the huge number of people who are exposed to high levels of Aspergillus spores as part of their occupations - in the main they are farmers working with grain and hay. These people do not seem to be at risk of death as few cases are reported - though of course some may not be diagnosed.

We discussed one way a person with a normal immune system may become overwhelmed last week.

The likelihood is that each person that has died has an important, possibly quite specific defect in their immune system that leaves them vulnerable to attack. Age may be another factor as we do know the elderly have a less efficient immune system compared with younger adults but it certainly isn't the only factor. The National Aspergillosis Centre in the UK and others are carrying out research into what makes people vulnerable to infection by Aspergillus (see talk by Paul Bowyer, Principle Scientist) and seem to have made significant progress in considering multiple possible genetic pathways but there is much more to do.

Regardless it is currently impossible to identify individuals vulnerable to being overwhelmed by Aspergillus, so it is important we work to maximise awareness when carrying our risky tasks in the vicinity of moulds and/or working with hazardous materials e.g. turning over compost, opening bags of compost, opening bags and spreading bark chippings and more.

Wednesday, 30 May 2012

Fungal Friends - How an Aspergillosis Patient Might See Things In Verse

Written by the National Aspergillosis Centre Manager Chris Harris, this poem has resulted from many conversations with many hundreds of patients

Things have been wrong for quite some time
Some days I struggle, some days I’m fine
I’m breathless, tired and ask for tests 
To see what is happening with my chest
They tell me I have some fungal spores
But do not understand the cause
So I ask around and make a fuss
And discover a fungus called Aspergillus

I use the clever search engine to find out the facts
Which directs me to experts at a place called “NAC”
I ask my doc if he will send me there 
Though still want him to share my care
He agrees it would be nice to be helped 
To unravel the mystery that has developed
So he sends me off to visit the team
And asks me to tell him what knowledge I glean

I meet the doc and tell my tale 
Of how my strength continues to fail
Fit as a fiddle I used to be
Now I have trouble making tea
My chest is tight and I cough a lot
The nurse then tells me to spit in a pot
For some special test to see what it grows
Funny named fungus that few of us knows

What did I do in my fitter days?
Cos now they are spent having frequent x-rays
Blood tests are taken for more special tests
Which leaves my arm in need of a rest
But although I feel like I want to curse
I would be lost without my specialist nurse

The doc keeps an eye on my CT scan
To check and see if my cavity has gone
He sends me away with a cocktail of medicine 
And they ask me to fill their questionnaire in

At the start of the month I can meet others like me
To share our experiences over a nice cup of tea
Speakers and staff tells us the latest news 
And our friends on the web are asked their views
It’s good to know that fungus is widely debated
And makes my family and me feel less isolated
So while I know I have to keep coming back
I’m so glad to be part of the place called “NAC”

Chris Harris May 2012

We will be holding an Aspergillosis Patients Support Meeting on 7th June 2012 (a week tomorrow) where a professional poet will be giving a talk on creative writing and Chris will be doing a reading of her work.
To listen in and text chat go to

Friday, 25 May 2012

Antibiotic Use Favours the Development of Resistance to an Antifungal

It has long been proposed that we should minimise the use of antibiotics for fear of promoting the growth of bacteria resistant to treatment with those antibiotics. This is not easy to achieve as some doctors feel heavily pressurised to prescribe antibiotics when they are not strictly needed e.g. when a patient clearly has a viral rather than bacterial infection.

Something similar is also being attempted for people who need treatment using antifungal medication as it is quite well understood that if someone has had treatment with an azole antifungal then they are more likely to have a Candida (yeast) infection that is resistant to Fluconazole should they be at risk in the near future (e.g. well-defined risk factors, include prolonged hospitalization, abdominal surgery, antibiotic treatment, neutropenia and central venous catheterization). If doctors know that a patient has been exposed to an azole in the recent past then they will often choose a different treatment for their Candida infection.

It now seems that doctors may have to also consider the recent use of antibiotics prior to the use of some antifungal drugs. A study on the fungus Candida  has shown that prior treatment of a patient using four different antibiotics increases their chance of having an infection by Candida that is resistant to Fluconazole. Doctors may now have to take this into consideration when they have patients at risk of Candida infection.

How could this happen? Antibiotics and antifungals are usually quite different and bacteria and fungi are very different organisms.
The author have 4 suggestions:

  1. by altering the resident gut flora, antibacterials may selectively impair colonization resistance in a way that favors gastrointestinal colonization with drug-resistant Candida species (1)
  2. many antibacterial agents have some degree of antifungal activity (2), which could explain selective pressure similar to that induced by azole exposure. 
  3. some antibacterials directly modulate azole resistance by inducing the expression of efflux pump-encoding genes (3). 
  4. the immunomodulatory effects of antibacterial drugs might predispose for certain fungal pathogens. For example, sulfonamides were shown to have both inhibitory and stimulatory effects on the host response against Candida spp. (45), whereas fluoroquinolones had no effect at therapeutic concentrations (6).

What does all this mean for Aspergillus?

Fluconazole is used against Aspergillosis under some circumstances but it is not the most commonly used antifungal for this infection. People taking antibiotics would probably take similar antibiotics to those used in the study too. Aspergillus is similar to yeast in some ways as both are fungi, but they are not similar in many ways too - some antifungals are more useful in yeast than they are in Aspergillus, so we cannot assume that Aspergillus antifungal resistance will increase after antibiotic treatment, Aspergillus does not tend to colonise the gut like Candida does.

This is an interesting precedent for antifungals that might apply to Aspergillus. Time and more experiments  will tell all.

Wednesday, 23 May 2012

How Some People May Become Infected with Aspergillus

There has been a fairly long standing observation that under some circumstances people with a completely normal immune system who are able to fight off infection (unlike those who are heavily immunocompromised such as those undergoing treatment for some cancers) can become infected with tragic consequences. In the cases I am referring to the unfortunate person has accidentally inhaled a large number of spores of the fungus Aspergillus fumigatus (or similarly temperature tolerant species) and rapidly died.

We all breathe in large numbers of fungal spores every day so how could this happen?

In many cases the fungi we breathe in are unable to grow at our body temperature, so those are unlikely to cause infection. In other cases the fungal material is highly allergenic, so it is possible that they could cause an allergic or asthmatic attack (which can also have serious consequences) but still could not cause infection.

However  if the fungal strain is able to grow at our body temperature it still has to overwhelm one of our deadliest allies - our neutrophils that line our lungs consuming any stray fungal spores or hyphae

This video shows mouse neutrophils (green cells) moving 
through lung cells (red) engulfing fungal spores (blue dots)

A recent paper using cells isolated from birds shows that macrophages (part of the same type of defence system as neutrophils) are only able to provide protection up to a point. When too many spores are present (many 1000's) they become overwhelmed and they are unable to kill the spores that they 'eat'. The spores start to germinate instead inside the macrophages and quickly kill the cells - they are effectively past one of the first lines of defence against infection.

It seems fairly clear then that all of us have a highly efficient immune system capable of killing millions of fungal spores, but once a certain number of thermotolerant spores is inhaled perhaps the fungi can win the race for supremacy. 

It must be said that death from inhaling even quite large numbers of spores is extremely rare and that we have other mechanisms to eliminate spores, but this might be a clue as to why occasionally they aren't enough. Always be careful when opening bags of compost or other plant materials e.g. bark chippings.

Monday, 21 May 2012

Vaccination Protects Mice Against Systemic Aspergillosis

The development of a vaccine for aspergillosis has been a dream for some time in our efforts to protect those vulnerable to invasive aspergillosis. We have mentioned this several times over the last year or so:

These studies offer some evidence to suggest that a vaccine will be of use to people with a limited immune system so should be of benefit to people undergoing some type of treatment to cancer as well as other transplant patients.

 In another initial step a group led by Dr David Stevens has demonstrated that a vaccine made from fungal cell wall components (mannans) is very effective in mice at reducing mortality and fungal burden. This is particularly interesting as they have refined the technique by linking it to other proteins to make it much more active (40x more) compared with using mannan alone.

Mannan is a component of fungal cell walls and has no equivalent in mammalian cells, therefore a vaccine should help protect treated people against all fungi not just Aspergillus, and should have minimal potential for toxicity.

This study must now be repeated in humans and if successful and we see similar results then an effective vaccine could well be on its way to act as a prophylactic for people undergoing  therapy that involves making them more vulnerable to infection, and in time perhaps even people we may be able to start identifying as vulnerable using personal genome screening.

Friday, 18 May 2012

Happy Birthday Dr Bill Frankland

Dr Bill Frankland
Dr Bill Frankland was 100 years old on 19th March 2012 and shows no sign of slowing down. Aptly named the 'Grandfather of Allergy' he played a big part in the acceptance of allergy as a medical condition in the middle parts of last century, at a time when it was relatively ignored by the medical profession.

 Bill was responsible for the acceptance of some of the precautions that allergy sufferers now take for granted, for example it was he who first gained acceptance for the regular publishing of the pollen count as a means for sufferers to help predict hay fever.

It was also Frankland who predicted problems with allergy to penicillin while working alongside Fleming at St. Mary's Hospital, London in the 1940's which Fleming (the discoverer of penicillin) apparently disagreed with.

He was one of the first to support the principle of desensitisation as a means to reduce an allergic response and is a keen advocate of the 'Hygiene theory' that contends that our children become allergic & asthmatic because they live in an environment that is too clean in their early years.

There are many more tributes to Dr Frankland in the media that tell several more stories about him (1, 2), and tributes from the Anaphylaxis Campaign that he helped set up (3), but suffice it to say that his attitude to life, his longevity and his work make him an inspiration to all all. We hope there will be many more years of enjoying your work sir!

A life in Allergy - the extraordinary story of Bill Frankland

Wednesday, 16 May 2012

Aspergillosis Research at the National Aspergillosis Centre

A talk given to a non-specialist medical audience at the National Aspergillosis Centre by Principle Scientist Dr Paul Bowyer.

Research in aspergillosis is advancing at the National Aspergillosis Centre thanks in large part to the many patients who attend the clinic and selflessly help us with our research.

Watch & listen to Dr Paul Bowyers talk given to the Aspergillosis Study Day on May 1st 2012.

LIFE Project Successful

The new fungal infection educational organisation LIFE (Leading International Fungal Education), initiated by the Fungal Research Trust  ran an art competition for age groups 13-18 in the UK (Project LIFE competition) starting in March 2012 entitled 'Funky Fungi'..

Funky Fungi
Project LIFE aimed to improve awareness of fungal infections in the North West of England and North Wales and has been very successful with hundreds of entries from all eligible ages, many of which went to great pains to investigate their subject both from the point of view of a patients suffering with an infection (some ran a survey amongst the 'man in the street' to assess what the general level of knowledge about fungi was and what impressions people had about fungi) and from closely observing pictures of fungal structures.
Infected eye

The resulting pictures and sculptures reflect the high degree of creativity and thought that this competition has stimulated in schoolchildren, their parents and their teachers. All must be congratulated and hopefully will now have a much improved awareness of how serious many of these fungal diseases are, and despite their ability to cause infection and their yukky reputation just how beautiful fungi can be.

Judging will now take place over the summer, results will be announced in this blog as soon as they are known.

A forest of conidiaphores
Gallery of entries

Amazing images! Many thanks to all who entered.

Tuesday, 15 May 2012

Podcast: Do fungal infections kill as many people each year as tuberculosis or malaria?

Do fungal infections kill as many people each year as tuberculosis or malaria? Meghna Sachdev chats with Gordon Brown, one of the authors of the editorial 'Tackling Human Fungal Infections,' to find out just how serious these infections are - and why we don't know more about them.
Listen to the debate here:podcast

Monday, 14 May 2012

El Niño Strongly Influences Aflatoxin Contamination

El Niño is a fairly predictable periodic deviation of seawater temperature and atmospheric pressure (higher than normal in both cases) in the southern hemisphere. Research has pointed to this phenomenon along with its complementary periodic cooling (termed La Niña) coinciding with extremes in weather causing flooding & drought in many parts of the world with disastrous consequences.

 Not surprisingly there has been a lot of attention paid to El Niño in the southern hemisphere as extremes in weather have a fundamentally negative impact on farming and fishing in (mainly developing) countries in that part of the world where the population is often highly reliant on those industries for food.

More recently researchers at Universities of Auburn, Georgia & Washington State in the US have found a further health problem associated with El Niño - that of aflatoxin contamination of food. Published in a poster
presented to the SouthEast Climate Consortium they have detected a distinct correlation with the higher temperatures and lower rainfall associated with El Niño and increased levels of aflatoxin contamination of crops in the southern states of North America.

This information could be a valuable addition to that given to farmers in effected area's, enabling them to plan ahead and put in place management procedures well in advance.

Wednesday, 9 May 2012

Why Did the Dinosaurs Die Out? Fungi May Hold the Key

A recent TV programme on the BBC 'After Life - the strange science of decay' covered the highly important role that fungi play in removing much of the dead plant & animal material that is generated every day in our world and converting it into new food for new organisms.
This was not really something new to many of us though it was fascinating to follow the sequence of organisms as dead meat & plants were efficiently reduced to nothing in a matter of 50 days. However there was something new (to me) that came up during the programme - the role of fungi in defining what life currently lives on earth.

The Cretaceous period was a time of great plant growth and the world was covered in woody plants. This had an unfortunate side-effect in that large amounts of carbon dioxide became trapped in the woody stems of these plants with no way for it to be released again - the earth was running out of CO2!

Evidence shows that in some parts of the world  a large cataclysmical extinction event (thought to be an asteroid hitting the earth) marked the end of this geological period. A research team in New Zealand  found an 8cm seam of coal marking this event in which there are a proliferation of forest-type plants as you might expect if the forest was flattened by an explosion or died following loss of light due to dust thrown up by the explosion blocking out sunlight.
At the top of that seam of coal is a remarkable feature - a layer almost completely consisting of fungal spores and other fungal material. The implication is that fungi proliferated at this time and may well have destroyed what was left of the tree life after the extinction event.

Dinosaur eggs contaminated by fungi
The authors speculate that there would have been a world dominated by fungi for a few years. This period would have been a time of intense fungal growth and adaption, probably even including the development of the ability to break down and digest wood. Once able to use wood as a food source fungi would have been able to feed on much of the fallen plantlife, releasing vast quantities of carbon dioxide - with much the same effect as we are experiencing now i.e. Global warming.
The chances are that the period of intense fungal growth would have denied large predators food and along with the reduction in plant life could account for the disappearance of the large dinosaurs - and also account for the lack of fossil fuels laid down after this time as plant matter would have been eaten by fungi rather than left to become buried over time.

It is also speculated that this was the time that fungal plant pathogens would have arisen, driving the evolution of many of our modern plants.

Remember also that mammals maintain a high body temperature inhospitable to fungal growth - to this day relatively few fungi can infect mammals. It is likely that those early mammals were highly resistant to fungal attack, unlike their cold blooded reptile neighbours. A very recent paper has detected fungal contamination of dinosaur eggs. Perhaps this is one more reason why dinosaurs died out and much smaller mammals inherited the earth - some even suggest it is the main reason.

Tuesday, 8 May 2012

Patients Support Meeting - ISSE & damp homes

The monthly support meeting for people living with aspergillus and aspergillosis held at the National Aspergillosis Centre was given a talk by William Kidd last month. William is the CEO of the Institiute for Specialist Surveyers and Engineers (ISSE) who are currently working on plans to introduce a certificated scheme for renovators of mouldy properties and builders of new homes. It is hoped that better education of renovators, landlords & tenants will improve the standard of mould renovation advice in the UK and a certification scheme should help provide peace of mind for people needing advice from the industry.

Listen to the talk and see slides here :

Friday, 4 May 2012

Pink Sculpture to Highlight Fungal Disease

A 300 year old oak tree in Devon, UK has been painted pink to highlight the devastating effect that the fungal disease Phytophthora is having on larch trees, killing many thousands in the South West of England since 2009.
This is the first time that this disease has been noted killing large numbers of coniferous trees, though it has been known as a pathogen of shrubs & bushes for some time.
The disease has now been detected as far north as Scotland so seems to be spreading rapidly (outbreak map).

This artwork serves also to reiterate the subject of one of our recent blogs on the devastating rise in reported fungal disease outbreaks. We highlighted an important report in April that has detected increases in fungal disease throughout the world and in many different host species. Possible causes listed were increases in the rate at which new fungal species and strains can be introduced into many parts of the world via modern international trade and travel, climate changes affecting the ability of host species to resist fungal infection and the ability of the fungus to rapidly evolve into new ecological niches.

Here we see fungi threatening our supply of wood in the UK, but across the world fungal disease is threatening food supply, human & animal illness and much more. Increasing awareness of these problems is rapidly becoming more important and a new initiative 'Leading International Fungal Awareness' (LIFE) aims to do just that,

Wednesday, 2 May 2012

Newsbite: Aspergillosis Study Day

The National Aspergillosis Centre in Manchester, UK has just completed the first study day for nurses, physiotherapists and other medical professions to provide awareness and education on aspergillosis and the many services offered by the Centre. It was very successful and was attended by over 70 professionals from all over the UK who watched a series of talks given by several senior members of staff on prevention, diagnosis, treatment, research and patient support. More meetings are planned...

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