Monday, 28 January 2013

Oral Sex and Aspergillosis?

(a) Image of laryngoscopy when the patient first came to our hospital in September 21, 2009 (b) Image of laryngoscopy after 30 days of antifungal treatment in October 21, 2009, (c) SEM observation of the focus tissue, (d) Histopathological examination (HE, ×400), (e) The slide culture of the isolate (methylene blue, ×400).

There have been a few descriptions of Aspergillus infecting people who apparently have a completely healthy immune system. These mostly describe instances when someone has inhaled a cloud of fungal spores when opening a bag of gardening compost and then subsequently become very ill. Post mortem reveals extensive invasive aspergillosis.

Other examples of vulnerable people include those with immunocompromising conditions such as AIDS or genetic disorders such as Chronic Granulomatous Disorder and people with pre-existing lung damage from infections like Tuberculosis.

All of these are explainable and remain very rare as our healthy immune systems are able to defeat all but the most serious infections. When infections occur they are very slow growing as the fungus 'battles' with our immune system and usually emanate from an area in the infected host that has a weakened immune system - lung scar tissue for example, or occasionally a fold in part of our sinus'.

This report suggests that there might be other small hidden populations that could be vulnerable to infection. Far from convincing but intriguingly a single patient who has a completely normal immune system contracted a rare form of aspergillosis at the back of their throat. Treatment with itraconazole quickly cleared up the infection but there were few clues as to why this person became infected. The researchers have alluded to a comment that she made that she was accustomed to regular oral sex with her male partner(s). They claim that there might be a link between this practice and the Aspergillus infection but that is not substantiated.

A further observation is made by the research group that reported cases of laryngeal aspergillosis (only 50 cases recorded since 1969)  have occurred mainly in younger (sexually active) women over the last 10 years. Previously the victims have been mainly older men.

This is one to monitor over the next few years rather than take too seriously just yet!

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