Recognizing and Treating Fungal Related Illness

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