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, , 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 %

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 )
Oral Itraconazole 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