|Fungi and Disease|
Hospital Infections with Fungi
Fungi are found everywhere. Hospitals are not the clean, germ free places we would like them to be. Instead, hospitals concentrate pathogenic organisms including fungi. Hospital also concentrate patients whose immune defenses are compromised, even shut down so that infections of all kinds are very common.
The two most prevalent fungal infections in hospitals are caused by Candida and Aspergillus species. The prevention of fungal infections in hospitals should be a priority but in practice few preventive measures are deployed. Diagnosis and treatment remain difficult at best.
Pappas stated: "Invasive fungal infections are an increasingly important consideration in the medical care of critically ill patients and in patients with immunosuppression. New methods may increase the rate and accuracy of the diagnosis of invasive fungal infections, and the use of scoring systems that consider the risk factors for the development of invasive fungal infections may allow earlier therapy, a critical component of the successful treatment of these serious infections.
Husain et al studied fungal infections in 53 liver and heart transplant recipients: Invasive mycelial infections were due to Aspergillus species in 69.8% of patients, to non-Aspergillus hyalohyphomycetes in 9.4%, to phaeohyphomycetes in 9.4%, to zygomycetes in 5.7%, and to other causes in 5.7%. Overall mortality at 90 days was 54.7%. The associated mortality rate was 100% for zygomycosis, 80% for non-Aspergillus hyalohyphomycosis, 54% for aspergillosis, and 20% for phaeohyphomycosis. Thus, non-Aspergillus molds have emerged as significant pathogens in organ transplant recipients. These molds are more likely to be associated with disseminated infections and to be associated with poorer outcomes than is aspergillosis. Clin Infect Dis. 2003; 37(2):221-9 (ISSN: 1537-6591)
A concern is the emergence of more resistant fungi; better selection of at risk patients for antifungal prophylaxis will reduce indiscriminate drug use and reduce the rate of fungal evolution.
Candida albicans is the most common fungal pathogen among immune-compromised, hospitalized patients, accounting for roughly 50-60% of all bloodstream fungal isolates. Candida species are an important cause of infection in intensive care units increased by 207% from 1979 to 2000. Risk factors include chemotherapy, organ transplants, abdominal surgery, central vascular lines, often used in ICU patients; the use of multiple or broad-spectrum antibiotics; total parenteral nutrition (TPN). The incidence of candida infection increases the longer a patient stays in hospital with peak incidence of infection around day 10.
Waknine reported that makers of tumor necrosis factor (TNF)-blocking agents were ordered to strengthen warnings regarding the risk for histoplasmosis and other invasive fungal infections by the US Food and Drug Administration. Since the initial approval of the 4 TNF blockers, the prescribing information for these drugs has included information about the risk of serious infections, including fungal infections; however physician are not recognizing cases of histoplasmosis and other invasive fungal infections, leading to delays in treatment.
The US FDA has received 240 reports of histoplasmosis in patients receiving infliximab (Remicade); 207 cases from etanercept (Enbrel);and adalimumab (Humira) 16 cases. 1 case occurred during treatment with certolizumab pegol (Cimziac), approved in 2008. Missed diagnoses in 21 patients led to treatment delays and 12 deaths. Fatal cases of coccidioidomycosis and blastomycosis have also been reported. Healthcare professionals are advised to closely monitor patients for signs and symptoms of fungal infection during and after treatment with anti-TNF drugs. Patients who develop fever, malaise, weight loss, sweats, cough, dyspnea, pulmonary infiltrates on X-ray, or serious systemic illness should undergo a "complete diagnostic workup."
The FDA advised that a high index of suspicion should be maintained for invasive fungal infections in symptomatic patients. If possible, the decision to initiate empiric antifungal therapy should be made in conjunction with an infectious diseases specialist. An infectious disease consultation is also recommended when determining the duration of antifungal therapy and whether anti-TNF therapy should be resumed on recovery, particularly for patients who reside in regions of endemic mycoses. TNF blockers are immunosuppressive agents approved to treat immune system diseases, including juvenile idiopathic arthritis, rheumatoid arthritis, psoriatic arthritis, plaque psoriasis, Crohn's disease, and ankylosing spondylitis.
Yael Waknine. Patient Deaths Spark Stronger Warnings for TNF Blockers. Medscape Medical News 2008. Accessed online September 4, 2008. In the US, adverse events related to use of anti-TNF agents should be reported to the FDA's MedWatch reporting program by telephone at 1-800-FDA-1088, by fax at 1-800-FDA-0178, online at http://www.fda.gov/medwatch, or by mail to 5600 Fishers Lane, Rockville, MD 20852-9787.
Pappas PG, Rex JH, Sobel JD, et al. Guidelines for treatment of candidiasis. Clin Infect Dis. 2004;38:161-189.
Segal BH, Walsh TJ. Current approaches to diagnosis and treatment of invasive aspergillosis. Am J Respir Crit Care Med. 2006;173:707-717
Cornely OA, Maertens J, Winston DJ, et al. Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med. 2007;356:348-359
A profusion of fungi exists in the environment. Some fungi are able to cause an invasive infection in otherwise healthy individuals. Other fungi are opportunistic fungi that become invasive when immune defenses are compromised. Diagnosis of fungal infection is difficult. There are many problems when you try to connect a test result to a disease. Fungi are so abundant and there are so many varieties in every environment that it is seldom easy to pick just one cause among many. Fungi are inhaled and ingested. Foods always contain fungal spores and actively growing molds. Attempts to culture fungi often fail; only a small number grow in the culture media commonly used. Some new methods of detecting fungal DNA may be useful but development of reliable tests is slow and expensive.
'You are at Alpha Online, a service of Environmed Research Inc. Sechelt, British Columbia Canada. Orders for printed books, eBooks for download and nutrient formulas are placed at Alpha Online.
Secure Order Site
Order Alpha Education Books
Alpha Education Books: There are 20 books in this series that address important health issues and their solution. Everyone, who is interested in Nutritional Therapy, will need a copy of the Alpha Nutrition Program. All books can be downloaded as PDF files.
Click the add to cart buttons to begin your order for printed books for mail delivery to the USA and Canada. Click the Download buttons to order eBooks for download.
We ship through the Post Office to all destinations in Canada and the USA. All correspondence about your order is done by email- send to Alpha Support. All orders are completed with encrypted security. Payments are made through Pay Pal by account or credit cards.
Nutrient Formulas for Meal Replacement Alpha ENF
the complete nutrient set for meal replacement, nutrient supplementation and
food holidays. Alpha PMX performance mix,
the complete nutrient set except for fat with increased amino acids.
Alpha DMX the complete nutrient set except
for lipids ( fat) and carbohydrate... all vitamins, amino acids and minerals
Persona Digital publishes a series of books on current topics in psychology, sociology, neuroscience and philosophy. eBooks and can be downloaded to any destination on the planet. Printed books and eBooks are ordered from Alpha Online. Printed books are shipped only to Canada and the USA by postal services.
Nutritional Rescue Starter Packs Starter packs bundle books and formulas to help you get started solving your health problems. The starter packs are sold at discounts to make is easier and more affordable for you to learn more and try out a formula. A copy of the Alpha Nutrition Program is included in every starter pack. Starter Pack Details
Alpha Nutrition is a trademark and a division of Environmed Research Inc., founded in 1984 at Vancouver, BC, Canada. Online Since 1995. Experts in Self-Managed Care. Experts in Elemental Nutrient Formulas. We are located on the Sunshine Coast in Sechelt, a ferry ride from West Vancouver. Alpha Online can be reached using one of 2 URLS - www.nutramed.com or www.alphanutrition.com
PayPal is a secure payment gateway that authorizes credit card payment, usually within seconds of submitting your information. PayPal acts as a secure payment gateway for Visa, MasterCard, Discovery or AMEX credit cards. When your payment information is complete, you will receive an order confirmation email from PayPal and from Alpha Nutrition Online. We ship your order on the same or next business day.