Presentation on theme: "Recognizing and Treating Fungal Related Illness"— Presentation transcript:
1Recognizing and Treating Fungal Related Illness David Buscher, M.D.Northwest Center for Environmental Medicine
2What 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.
3Global 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
4Fungal Organisms Over 200,000 different molds and fungi Transported globally as sporesExtremely resilientStachybotrys- survives temperatures up to 500°F, acid, caustics, bleachSpores from 2 million-year-old sedimentary rock-grow on appropriate media
5Adverse Effects of Fungi InfectionAllergyFungal metabolites-MycotoxinsVolatile Organic Compounds (VOCs)Biological warfare
6Fungus As Enemy Valley fever-Coccidioides, arid soils in Southwest Histoplasmosis-bird droppings, bat guano, Ohio River Valley/MississippiCryptococcus-pigeon droppingsAspergillosis- hypersensitivity pneumonitisOnychomycosis- fungal nail infectionsSarcoidosis?
7Normal Human Fungi Found on skin and mucous membranes Dermatophytes Candida albicans, Rhodotorula?TrychophytinEpidermophytonCause rashes, asthma, itching, Id reactions
8Fungus As Friend Most molds are harmless Recycle organic material Antibiotics-penicillinImmune stimulation-mushroomsFood production- bread, cheese, soy sauce, chocolateBeer, wine, tequila“Religious experience”-psilicybin mushroom
9Mold Allergy Complex antigenic proteins- up to 40 Similar to foods antigenicallyVery small (<0.3microns), not filtered by nose, go to alveoliWoods, grass, basementsCondensation areas under sinks, carpets, wallpaper.Increase in cool evening air as it rises
10Symptoms of Mold Allergy Rhinitis, sinusitus, asthma, rashesSymptoms worsedamp placesafter rainfallwhen mowing or sitting on graoutside in evening 5-9 p.m.Worse September to first heavy frostImproved with freezing temp or snow
11Mycotoxins Aflatoxins, trichothecenes, satratoxins. ochratoxins ImmunosuppresiveHighly antigenic/immunoreactive“Leaky lungs/nose”- loss of barrier function“Adduct formers”- DNA & RNA- impairs protein synthesis, coagulation defects, bleeding.Neurotoxic- cognitve defects, depression
12Sick Buildings / Sick People 93% of time spent indoors, 5% in transitEnergy efficient buildings are tighterSynthetic building materials & furnitureAir pollutants indoor 2-5 times outdoorEPA study > 800 volatile compounds in 4 buildings.Environmental Research 43, , 1987.
13Indoor Health Hazards Adhesives, glues, solvents. Paints, strippers, sealers.Particle board, fiberboardUrea foam insulation, cellulose?Combustion products - tobacco, oil, gas.Automobile fumes from attached garage.Pesticides, fungicides.Synthetic carpet and pad.
14Microbial Ecology of the Gut Over 400 species of microorganisms100,000,000,000,000 bacteria in gut10,000,000,000,000 cells in adult human90% anaerobesMajor role in metabolizing nutrients, drugs, hormones, and carcinogens.Scand J Infect Dis Suppl 49: 17-30, 1986
15Major Symptoms of Candida Related Complex in Female Intestinal gas and bloatingAlternating diarrhea and constipationFatigue, depression, feeling “drained”Sugar and carbohydrate cravingsPremenstrual syndromeMay or may not have vaginal symptoms
16Nystatin Antifungal Medication Polyene antibiotic from Strep. nourseiNegligible absorption from GI tractVery safe, non-toxicFungicidal & fungistaticSelectively binds to ergosterol in yeast cell membraneHerksheimer reaction “ die off” common
17Nystatin Dosage - Adult 500,000 units (1/8 tsp) 3-4xd 1st week1,000,000 units (1/4 tsp) 3-4xd 2nd week1,500,000 units (3/8 tsp) 3-4xd 3rd week2,000,000 units (1/2 tsp) 3-4xd 1-6 months1 tab = 500,000 units - contains lactose, corn starch and red, yellow, blue dyesOral suspension - 50% sucrose, alcohol, saccharin, glycerin, & flavors
18Fluconazole (Diflucan) Very well absorbed, including CNSCleared primarily by renal excretion (80% unchanged in urine)Usual dose 200 mg/dayCan cause Herksheimer - start 1/4 tab
19Probiotic TherapyLactobacillus 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
20Fungal Control DietRecommend - fish, vegetables, poultry, eggs, nuts, red meatsAvoid - refined sugars, fruit juicesSmall amount - honey, maple syrup, fruit, dairyModerate - high carbohydrate vegetables, cereal grainsAvoid yeast only if yeast allergy.
21When 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.
22Mold Control Identify and eliminate the sources Clean or destroy contaminated belongingsDo not use bleach!HEPA vacuum, BoraxLower humidity %
23Leviticus 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”.
24Mold Exposed Patient 44 yo woman, married, 4 children Headaches, sinusitis, rashes, fatigue, “brain fog”, dizzinessMajor fungal damage – house condemnedStage 3 Trichocethene MycotoxicosisHusband- kidney cancer; children chronically illCleaned up mold with bleach, no mask
26Effect of Treatment After three months Sinusitus - 90% improvement Daily headaches decreased to 1-2 days/week and 80% less painful.Energy 70% betterStill very sensitive to mold
27Keep in MindAllergy 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
28American Academy of Environmental Medicine 7701 East Kellogg, Suite 625Wichita, KS 67207