Transcript Recognizing and Treating Fungal Related Illness

Recognizing and Treating
Fungal Related Illness
David Buscher, M.D.
Northwest Center for
Environmental Medicine
What is Environmental
Medicine?
• The diagnosis, treatment and prevention
of environmentally triggered illnesses.
• The study of how adverse reactions to
environmental substances in air, food,
water affect human health.
Global Increases in Allergic
Respiratory Disease
• Significant increases in allergic rhinitis and
asthma in past two centuries.
• Numerous studies show positive
correlation with increased air pollution.
• Fossil fuel combustion products contain a
variety of polyaromatic hydrocarbons.
• Diesel exhaust -enhances IgE response,
increased production of cytokines.
Ann Allergy Asthma Immunology, 1997
Fungal Organisms
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Over 200,000 different molds and fungi
Transported globally as spores
Extremely resilient
Stachybotrys- survives temperatures up to
500°F, acid, caustics, bleach
• Spores from 2 million-year-old
sedimentary rock-grow on appropriate
media
Adverse Effects of Fungi
• Infection
• Allergy
• Fungal metabolites– Mycotoxins
– Volatile Organic Compounds (VOCs)
• Biological warfare
Fungus As Enemy
• Valley fever-Coccidioides, arid soils in
Southwest
• Histoplasmosis-bird droppings, bat guano,
Ohio River Valley/Mississippi
• Cryptococcus-pigeon droppings
• Aspergillosis- hypersensitivity pneumonitis
• Onychomycosis- fungal nail infections
• Sarcoidosis?
Normal Human Fungi
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Found on skin and mucous membranes
Dermatophytes
Candida albicans, Rhodotorula?
Trychophytin
Epidermophyton
Cause rashes, asthma, itching, Id
reactions
Fungus As Friend
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Most molds are harmless
Recycle organic material
Antibiotics-penicillin
Immune stimulation-mushrooms
Food production- bread, cheese, soy
sauce, chocolate
• Beer, wine, tequila
• “Religious experience”-psilicybin
mushroom
Mold Allergy
• Complex antigenic proteins- up to 40
• Similar to foods antigenically
• Very small (<0.3microns), not filtered by
nose, go to alveoli
• Woods, grass, basements
• Condensation areas under sinks, carpets,
wallpaper.
• Increase in cool evening air as it rises
Symptoms of Mold Allergy
• Rhinitis, sinusitus, asthma, rashes
• Symptoms worse
– damp places
– after rainfall
– when mowing or sitting on gra
– outside in evening 5-9 p.m.
• Worse September to first heavy frost
• Improved with freezing temp or snow
Mycotoxins
• Aflatoxins, trichothecenes, satratoxins.
ochratoxins
• Immunosuppresive
• Highly antigenic/immunoreactive
• “Leaky lungs/nose”- loss of barrier function
• “Adduct formers”- DNA & RNA- impairs
protein synthesis, coagulation defects,
bleeding.
• Neurotoxic- cognitve defects, depression
Sick Buildings / Sick People
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93% of time spent indoors, 5% in transit
Energy efficient buildings are tighter
Synthetic building materials & furniture
Air pollutants indoor 2-5 times outdoor
EPA study > 800 volatile compounds in 4
buildings.
Environmental Research 43, 290-307, 1987.
Indoor Health Hazards
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Adhesives, glues, solvents.
Paints, strippers, sealers.
Particle board, fiberboard
Urea foam insulation, cellulose?
Combustion products - tobacco, oil, gas.
Automobile fumes from attached garage.
Pesticides, fungicides.
Synthetic carpet and pad.
Microbial Ecology of the Gut
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Over 400 species of microorganisms
100,000,000,000,000 bacteria in gut
10,000,000,000,000 cells in adult human
90% anaerobes
Major role in metabolizing nutrients, drugs,
hormones, and carcinogens.
Scand J Infect Dis Suppl 49: 17-30, 1986
Major Symptoms of Candida
Related Complex in Female
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Intestinal gas and bloating
Alternating diarrhea and constipation
Fatigue, depression, feeling “drained”
Sugar and carbohydrate cravings
Premenstrual syndrome
May or may not have vaginal symptoms
Nystatin Antifungal
Medication
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Polyene antibiotic from Strep. noursei
Negligible absorption from GI tract
Very safe, non-toxic
Fungicidal & fungistatic
Selectively binds to ergosterol in yeast cell
membrane
• Herksheimer reaction “ die off” common
Nystatin Dosage - Adult
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500,000 units (1/8 tsp) 3-4xd 1st week
1,000,000 units (1/4 tsp) 3-4xd 2nd week
1,500,000 units (3/8 tsp) 3-4xd 3rd week
2,000,000 units (1/2 tsp) 3-4xd 1-6 months
1 tab = 500,000 units - contains lactose,
corn starch and red, yellow, blue dyes
• Oral suspension - 50% sucrose, alcohol,
saccharin, glycerin, & flavors
Fluconazole (Diflucan)
• Very well absorbed, including CNS
• Cleared primarily by renal excretion (80%
unchanged in urine)
• Usual dose 200 mg/day
• Can cause Herksheimer - start 1/4 tab
Probiotic Therapy
• Lactobacillus Acidoplillus – multi-species
to stimulate more broad-spectrum
response.
• Following “loading dose” 50 billion/day x 1
month or more.
• Maintenance - 25 billion/day at least
Fungal Control Diet
• Recommend - fish, vegetables, poultry,
eggs, nuts, red meats
• Avoid - refined sugars, fruit juices
• Small amount - honey, maple syrup, fruit,
dairy
• Moderate - high carbohydrate vegetables,
cereal grains
• Avoid yeast only if yeast allergy.
When To Suspect the
Environment
• Did the symptoms start with a move into a
new building or home? Remodeling?
• Feel better when not in the building?
• Seasonal variation - worse in fall&winter?
• Do coworkers have similar complaints?
• Sick and tired a lot for no medically
apparent reason.
Mold Control
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Identify and eliminate the sources
Clean or destroy contaminated belongings
Do not use bleach!
HEPA vacuum, Borax
Lower humidity 50 - 60 %
Leviticus 14: 33-48
• “If the mark on the walls has greenish or reddish
depressions”.
• Priest quarantines house 7 days.
• If mark has spread – “scrape all around inside”,
tear out stones and replace.
• If the mark breaks out again – “it is a malignant
mark…it is unclean”.
• “He shall therefore tear down the house”.
• “Whoever goes into the house becomes
unclean….shall wash his clothes”.
Mold Exposed Patient
• 44 yo woman, married, 4 children
• Headaches, sinusitis, rashes, fatigue,
“brain fog”, dizziness
• Major fungal damage – house condemned
• Stage 3 Trichocethene Mycotoxicosis
• Husband- kidney cancer; children
chronically ill
• Cleaned up mold with bleach, no mask
Antifungal Treatment
• Nebulized Itraconazole - 30 mg bid for 6
weeks (Sinus Pharmacy 1-888-884-8470)
• Oral Itraconazole - 100 mg bid 3 months
• Cholestyramine – 1-2 scoops bid
• Environmental control – bathroom gutted
• Allergy desensitization- sublingual
antigens
Effect of Treatment
• After three months
• Sinusitus - 90% improvement
• Daily headaches decreased to 1-2
days/week and 80% less painful.
• Energy 70% better
• Still very sensitive to mold
Keep in Mind
• Allergy is frequently an unrecognized
source of many common health problems.
• Allergies can produce symptoms involving
many different organ systems.
• Repetitive allergic/inflammatory reactions
can lead to chronic disease.
• Mold can cause major allergic health
problems and go unrecognized
American Academy of
Environmental Medicine
7701 East Kellogg, Suite 625
Wichita, KS 67207
316-684-5500
www.aaem.com