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 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 Found on skin and mucous membranes Dermatophytes Candida albicans, Rhodotorula? Trychophytin Epidermophyton Cause rashes, asthma, itching, Id reactions

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

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 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 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 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 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 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 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 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