4 Key Issues to Know About Lung Infections Attributable to Fungi

Some fungi that can cause serious lung infections have spread to many parts of the United States.A sort of science news story on expand the range Histoplasma, Coccidioides and Blastomyces fungus Touched the nerves of many readers (Serial Number: 1/4/22).

They asked about the symptoms, treatment and testing of these fungal diseases.Some, like Judy Knudsen, whose husband Jack died in a Histoplasma Infected 2020, also wrote to share my fungal infection experience. Others wanted to learn more about the fungus itself.

I went back to Andrej Spec, a mycologist and infectious disease physician at Washington University School of Medicine in St. Louis, whose team released a new range map, for answers.

Spec and his colleagues are studying what causes the fungus to spread and what might make people sick. These include climate change, weather patterns, extreme weather events such as wildfires and floods, and even animal migration patterns.

How do you get these fungal infections?

People usually get infected by inhaling fungal spores released during the normal life cycle of the fungus. Human activities that disturb the soil in which these fungi normally live — such as agriculture, horticulture, construction, roadworks or archaeology — can also stir up dust and spores.

In addition to soil, guano and bat droppings can also be used as Histoplasma. The fungus can infect bats and grow in the animals’ guts. Birds don’t usually carry the fungus because their body temperature is usually between 39°C and 42°C (102°F and 107°F). “They’re so hot Histologybut their droppings are perfect for growing” the fungus, Speck said.

Humans are at greatest risk when bird and bat droppings dry up. “People will try to sweep [the droppings], and then you kick up all the dust and inhale it. Instead of sweeping, Spec recommends “hose and scoop it up.” ”

Wearing a mask can also help limit exposure. “Especially if you have a suppressed immune system, wear a mask.”

It is possible, but very rare, for the fungus to get into a cut or abrasion and start infecting the skin, Spec said. People generally do not pass the infection on to other people, except in rare cases where an infected person donates an organ or other body tissue, he said.

What’s going on inside the body?

These three types of fungi are called dimorphic fungi because they have two forms. In the soil where they usually grow, they are molds. But at 37°C (body temperature), they deform into yeast, which can grow quickly and spread more easily in the body.

When a person inhales fungal spores, the fungus infects the lungs, under conditions suitable for its transformation. People with healthy immune systems may experience no symptoms or mild flu-like symptoms including fever, cough, fatigue, chills and body aches.some people Coccidioidomycosis — diseases caused by Coccidioides — A rash may also appear on the legs or upper body.

Symptoms may take a while to appear.some people Histoplasmosis — diseases caused by Histoplasma — Symptoms can appear 3 to 17 days after exposure.Symptoms of coccidioidomycosis – also known as valley fever — Appears within one to three weeks of inhaling the spores.but it may take three weeks to three months Blastomycosis – Depend on Blastomyces – Symptoms start.

Mild cases usually resolve on their own within a few weeks to months. But some people may have lingering symptoms, especially if the infection becomes severe.

In the United States in 2019, more than 20,000 people were diagnosed with coccidioidomycosis, 1,124 with confirmed or suspected histoplasmosis, and 240 with confirmed or suspected blastomycosis, based on cases reported to the US Centers for Disease Control and Prevention. This may be an underestimate, the researchers said, given that mild cases may not have been reported and the infection could easily be misdiagnosed as a more common lung disease. But of the reported cases, more than half of those diagnosed with histoplasmosis and blastomycosis were hospitalized.about 5% of patients with histoplasmosis dieThe same is true for 9% of people with blastomycosis.

Some people may develop severe or chronic pneumonia. In a small number of people, the infection may spread to other parts of the body. Histoplasma “Loves to attack our liver and spleen, our bone marrow … adrenal glands … and our gut,” Speck said.

Blastomyces Often spreads to bones and joints. It may also spread to the brain, where it may cause an abscess.

Coccidioides similar to Blastomyces, for bones, joints, skin and brain. Instead of a brain abscess, however, the fungus can cause meningitis, an inflammation of the membranes surrounding the brain and spinal cord.

“If it travels to your brain, it’s with you forever,” Speck said. “You can’t escape cocci“Doctors can control the brain infection with antifungal drugs and give other medicines to help relieve symptoms.

Antifungal medicines clear up most other infections. “If caught early, most people do extremely well,” he said.

Who is most affected by these fungal infections?

People with weakened immune systems are more likely to develop symptoms and severe illness.

Fungal infections and serious illnesses occur more frequently in men than in women.about seventy percent Blastomyces infection, 52% Coccidioides case and 56% Histoplasma A 2019 CDC investigation found that those infected were men.

Why men are more susceptible is not entirely clear. Some have speculated that men tend to have more outdoor jobs and hobbies, which expose them to dirt and thus more fungi.

It is unclear how Jack Knudsen became infected. “We don’t know why this happened,” said Judy, 82, of Oklahoma City. Jack’s immune system, already battling chronic lymphocytic leukemia, heart disease and diabetes, couldn’t handle the fungus. “He was struggling,” she said.

He spent two weeks in the hospital on intravenous antifungal medication. He also took four daily doses of a liquid antifungal drug called itraconazole for the rest of his life. He passed away on January 23, 2020 at the age of 79. “We’ve had 61 wonderful years together,” Judy said.

There may be biological reasons for the imbalance between men and women.A recent study on coccidioidomycosis found that sex differences also exist in Nonhuman Primates and DogsThere was little difference between the occupational exposures and hobbies of “male and female” animals, said Spec, who was not involved in the study.

The researchers found no difference in infection rates among those under the age of 19. Afterwards, infection rates among men remained stable.But infection rates have declined in women, microbiologist and immunologist Ian McHardy of Scripps Health in San Diego and colleagues reported in a March 2022 report. Open Forum Contagion. This could mean that higher levels of estrogen and other hormones, which are normally found in women, protect against fungal infections. But that link is still speculation.

Strangely, Filipinos or Africans may be more likely to get more severe Valley Fever. unknown reason. Others, including pregnant women, people with HIV/AIDS, or those with otherwise weakened immune systems, are also more likely to develop more severe illness from the three fungi. The same goes for diabetics and older adults.

How can I tell if my infection is caused by fungus?

Because the symptoms of fungal infections are so similar to those of other diseases, it can be difficult to diagnose fungal diseases, Speck said.

Jack Knudsen started having seizures in 2018, Judy said. At first, doctors thought he had epilepsy, but drugs to treat the condition were ineffective.When one side of his face began to sag, an MRI and other tests revealed that Jack had Histoplasma in his brain. “I’ve never heard of it in my life,” said Judy, who said she wanted to share her husband’s story so people could learn more about the disease.

Blood or urine tests can be used to diagnose fungal infections. A chest x-ray or CT scan may also be used. In some cases, doctors may need to take a small amount of body tissue or fluid to test for fungus.

“Many people think they have [a fungal infection] Probably won’t have it. Norm said. “The disease is definitely more common than people think, but it’s still relatively rare.” The new map compiled by Spec and colleagues may make doctors and others more aware that fungal diseases may exist where they live.

People who are worried that they may have a fungal infection can visit mycoses.org Spec and his colleagues created an interactive map showing where the fungus was found. “You will be able to see [based on] Where do you live and what are your risks. When you have this data, your best goal is to talk to a doctor for a test. “

Any doctor can order a test, but an infectious disease specialist may have more expertise in fungal diseases, he said.