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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.

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Recognizing and Treating Fungal Related Illness

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  1. Recognizing and Treating Fungal Related Illness David Buscher, M.D. Northwest Center for Environmental Medicine

  2. 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.

  3. 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

  4. Fungal Organisms • 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

  5. Adverse Effects of Fungi • Infection • Allergy • Fungal metabolites- • Mycotoxins • Volatile Organic Compounds (VOCs) • Biological warfare

  6. 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?

  7. Normal Human Fungi • Found on skin and mucous membranes • Dermatophytes • Candida albicans, Rhodotorula? • Trychophytin • Epidermophyton • Cause rashes, asthma, itching, Id reactions

  8. Fungus As Friend • 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

  9. 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

  10. 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

  11. 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

  12. Sick Buildings / Sick People • 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.

  13. Indoor Health Hazards • 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.

  14. Microbial Ecology of the Gut • 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

  15. Major Symptoms of Candida Related Complex in Female • 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

  16. Nystatin Antifungal Medication • 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

  17. Nystatin Dosage - Adult • 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

  18. 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

  19. 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

  20. 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.

  21. 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.

  22. Mold Control • Identify and eliminate the sources • Clean or destroy contaminated belongings • Do not use bleach! • HEPA vacuum, Borax • Lower humidity 50 - 60 %

  23. 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”.

  24. 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

  25. 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

  26. 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

  27. 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

  28. American Academy of Environmental Medicine 7701 East Kellogg, Suite 625 Wichita, KS 67207 316-684-5500 www.aaem.com

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