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Mold Toxins and Human Illness: Patients Need Mold-Free Buildings and Mold-Free Food. Homes, Schools, Government Structures and Businesses Cannot Cause Mold Sickness and Remain Sick Buildings
2 Practical Up to Date and Clear Mold Books with Solutions by Dr. Schaller
- 1: J Appl Microbiol. 2007 Nov 15 [Epub ahead of print]
Fungi and selected mycotoxins from pre- and postfermented corn silage.
González Pereyra ML, Alonso VA, Sager R, Morlaco MB, Magnoli CE, Astoreca AL, Rosa CA, Chiacchiera SM, Dalcero AM, Cavaglieri LR.
Departamento de Microbiología e Inmunología, Universidad Nacional de Río Cuarto, Río Cuarto, Córdoba, Argentina.
Aim: To determine fungal genera, Aspergillus and Fusarium species and aflatoxin B(1) (AFB(1)), zearalenone (ZEA), deoxynivalenol (DON), fumonisin B(1) (FB(1)) contamination from pre- and postfermented corn silage produced in the most important region of Argentina where silage practice is developed. Methods and Results: Sampling of corn silos was performed manually through silos in transects at three levels: upper, middle and low sections. AFB(1) and FB(1) were quantified by high-performance liquid chromatography, zearalenone by enzyme-linked immunosorbent assay and DON by gas chromatography. Over 90% of the samples showed counts higher than 1 x 10(4) CFU g(-1). Aspergillus flavus and Fusarium verticillioides were the prevalent species. Some tested samples were contaminated with AFB(1), ZEA, DON and FB(1). Conclusions: This study demonstrates the presence of fungi and AFB(1), ZEA, DON and FB(1) contamination in corn silage in Argentina. Significance and Impact of the Study: This manuscript makes a contribution to the knowledge of mycotoxins in Argentinean silage in particular because the environmental conditions in this country differ from those of most reports. The comparison of pre- and postfermentation silage is also outstanding. Therefore, information on fungi and mycotoxins present in silage - an increasingly popular commodity - is useful to estimate potential risk for animal and human health.
PMID: 18005347 [PubMed - as supplied by publisher]
- 2: Sci Total Environ. 2007 Dec 15;388(1-3):16-23.
Ochratoxin A production in relation to ecophysiological factors by Aspergillus section Nigri strains isolated from different substrates in Argentina.
Astoreca A, Magnoli C, Barberis C, Chiacchiera SM, Combina M, Dalcero A.
Departamento de Microbiología e Inmunología, Facultad de Ciencias Exactas, Físico-Químicas y Naturales, Universidad Nacional de Río Cuarto, Río Cuarto, Córdoba, Argentina. aastoreca@exa.unrc.edu.ar
Contamination of foodstuff with mycotoxins such as ochratoxins is a major matter of concern for human and animal health. In Aspergillus species, ochratoxin synthesis depends on several environmental factors. The aims of this work were to evaluate the effect of water activity (0.995-0.85), temperature (15, 25 and 30 degrees C), incubation time (7, 14 and 21 days) and their interactions on OTA production on peanut, maize kernels, dried grapes and coffee beans meal extract agar medium by eight strains of Aspergillus section Nigri isolated from human food in Argentina. The optimum temperature for OTA production was 25 or 30 degrees C depending on the strains assayed, in most cases the highest OTA levels were achieved after 7 days of incubation, whereas this situation occurred at 15 degrees C after 14 days of incubation for only one strain. The maximum OTA level was obtained at earlier growth states when incubation temperature increased. In general, OTA concentration increased as water activity (a(W)) increased with no significant production at 0.85-0.91 a(W) under all temperature levels tested. Production occurred over a range of temperatures (15-30 degrees C) with optimum production at 30 degrees C depending on a(W) assayed. The knowledge of Aspergillus section Nigri ecophysiology is critical in the development and prediction of the risk models of raw material and final product contamination by these species under fluctuating and interacting environmental parameters.
Publication Types:
PMID: 17920659 [PubMed - in process]
- 3: Allergy Asthma Proc. 2007 Jul-Aug;28(4):489-96.
Using rare diseases as models for biobehavioral research: allergic bronchopulmonary aspergillosis.
Greenberger PA, Yucha CB, Janson S, Huss K.
Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA. p-greenberger@northwestern.edu
Biobehavioral science explores links between biological, psychosocial, and behavioral factors and health. Maintaining positive health outcomes over time and across a variety of populations and settings requires understanding interactions among biological, behavioral, and social risk factors as well as other variables that influence behavior. Some barriers to biobehavioral research are related to performing biobehavioral research along the natural history of an illness, limitations in existing methodologies to assess the biological impact of behavior, the unknowns relating to impact of behavior on biology, and lack of valid and reliable biobehavioral methods to assess outcomes. A rare disease, such as allergic bronchopulmonary aspergillosis (ABPA) can be used as a model of biobehavioral research. ABPA complicates asthma and cystic fibrosis. It is a hypersensitivity reaction to Aspergillus fumigatus in most cases. ABPA can be classified into five stages: acute, remission, exacerbation, steroid-dependent asthma, and fibrotic or end stage. Because of its rarity, there can be delays in diagnosis. Treatment has used oral corticosteroids and antifungal agents in addition to management of asthma or cystic fibrosis. The National Institute of Nursing Research held an invitational 2-day working group meeting on July 15-16, 2004 with biobehavioral, biological, and immunologic science experts to examine current knowledge of biobehavioral research and to provide recommendations for additional research. The focus was on biobehavioral methods of measurement and analysis with interdisciplinary/biobehavioral approaches. This article is an outcome of this meeting.
Publication Types:
PMID: 17883921 [PubMed - indexed for MEDLINE]
- 4: Int J Food Microbiol. 2007 Oct 20;119(1-2):11-6. Epub 2007 Jul 31.
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Biodiversity of complexes of mycotoxigenic fungal species associated with Fusarium ear rot of maize and Aspergillus rot of grape.
Logrieco A, Moretti A, Perrone G, Mulè G.
Institute of Sciences of Food Production, National Research Council, ISPA, Via G. Amendola 122/O, 70126 Bari, Italy.
Fusarium ear rot of maize and Aspergillus rot of grape are two examples of important plant diseases caused by complexes of species of mycotoxigenic fungi. These complexes of species tend to be closely related, produce different classes of mycotoxins, and can induce disease under different environmental conditions. The infection of maize and grape with multiple fungal species and the resulting production of large classes of mycotoxins is an example of mutual aggressiveness of microorganisms toward host species as well as to humans and animals that eat feed or food derived from the infected and contaminated plants. Infection of crop plant with a complex of microbial species certainly represents a greater threat to a crop plant and to human and animal health than infection of the plant with a single fungal species.
PMID: 17765992 [PubMed - in process]
- 5: Mol Ecol. 2007 Oct;16(20):4401-17.
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Recombination, balancing selection and adaptive evolution in the aflatoxin gene cluster of Aspergillus parasiticus.
Carbone I, Jakobek JL, Ramirez-Prado JH, Horn BW.
Center for Integrated Fungal Research, Department of Plant Pathology, North Carolina State University, Raleigh, NC 27695, USA. ignazio_carbone@ncsu.edu
Aflatoxins are toxic and carcinogenic polyketides produced by several Aspergillus species that are known to contaminate agricultural commodities, posing a serious threat to animal and human health. Aflatoxin (AF) biosynthesis is almost fully characterized and involves the coordinated expression of approximately 25 genes clustered in a 70-kb DNA region. Aspergillus parasiticus is an economically important and common agent of AF contamination. Naturally occurring nonaflatoxigenic strains of A. parasiticus are rarely found and generally produce O-methylsterigmatocystin (OMST), the immediate precursor of AF. To elucidate the evolutionary forces acting to retain AF and OMST pathway extrolites (chemotypes), we sequenced 21 intergenic regions spanning the entire cluster in 24 A. parasiticus isolates chosen to represent the genetic diversity within a single Georgia field population. Linkage disequilibrium analyses revealed five distinct recombination blocks in the A. parasiticus cluster. Phylogenetic network analyses showed a history of recombination between chemotype-specific haplotypes, as well as evidence of contemporary recombination. We performed coalescent simulations of variation in recombination blocks and found an approximately twofold deeper coalescence for cluster genealogies compared to noncluster genealogies, our internal standard of neutral evolution. Significantly deeper cluster genealogies are indicative of balancing selection in the AF cluster of A. parasiticus and are further corroborated by the existence of trans-species polymorphisms and common haplotypes in the cluster for several closely related species. Estimates of Ka/Ks for representative cluster genes provide evidence of selection for OMST and AF chemotypes, and indicate a possible role of chemotypes in ecological adaptation and speciation.
Publication Types:
PMID: 17725568 [PubMed - in process]
- 6: Ann Agric Environ Med. 2007;14(1):173-86.
Factors determining accumulation of mycotoxin producers in cereal grain during harvesting.
Lugauskas A, Raila A, Zvicevicius E, Railiene M, Novosinskas H.
Laboratory of Biodeterioration Research, Institute of Botany, Vilnius, Lithuania. lugauskas@botanika.lt
During the meteorologically contrasting period of 2003-2005, the contamination of winter wheat, malt barley and fodder barley grain with micromycetes during grain harvesting and preparation for storage was investigated. Micromycetes of over 70 species ascribed to 16 genera were isolated and identified, the density of their populations in grain was determined. Micromycetes with a population density of >50% were attributed to dominant species. Short biological characteristic, ecological peculiarities of the dominating micromycetes are provided; factors determining intensity of their development and abilities to synthesise and excrete toxic metabolites are indicated. The importance of grain drying for stabilisation of its contamination with micromycete propagules is highlighted. It is noted that in grain dried in shaft dryer using air at 90 degrees C the number of cfu (colony forming units) was reduced from 2.2 to 8.2 times. When active ventilation is applied, conditions favourable for the development of micromycetes remain longest in the upper layers of the mound. The airflow passing through the layer of damp grain inhibits the development of micromycetes, but an increase of comparative air flow for more than 500 m3x(txh)(-1) did not reduce the abundance of micromycete cfu. After drying Alternaria alternata, Fusarium avenaceum, F. culmorum, Penicillum verrucosum dominated in wheat grain; Aspergillus flavus, Bipolaris sorokiniana, Fusarium chlamydosporum, F. culmorum, F. tricinctum in malts barley grain; Fusarium avenaceum, F. culmorum, F. tricinctum, Alternaria alternata in fodder barley grain. It has been determined that all micromycetes recorded on grain after drying are potential producers of toxic metabolites, i.e. are hazardous to human health.
PMID: 17655196 [PubMed - indexed for MEDLINE]
- 7: J Med Microbiol. 2007 Aug;56(Pt 8):1101-6.
AIDS-related opportunistic mycoses seen in a tertiary care hospital in North India.
Wadhwa A, Kaur R, Agarwal SK, Jain S, Bhalla P.
Department of Microbiology, Maulana Azad Medical College, New Delhi, India. dranupriyawadhwa@gmail.com
Sixty symptomatic confirmed human immunodeficiency virus (HIV)-positive adult patients, of both sexes, suspected of having a fungal infection were taken as a study population, and the clinicomycological profile was correlated with the immunological status of the patients with particular reference to CD4 counts. Relevant samples were collected and subjected to direct microscopy, fungal culture and serology. CD4 counts were determined by flow cytometry. Patients belonged to the age group of 17-65 years, with a male : female ratio of 4.8 : 1. Heterosexuality was the commonest mode of transmission. Candidiasis was the most common diagnosis (41.7 %), followed by cryptococcosis (10.0 %), and pneumocystinosis and aspergillosis (8.3 % each). Two cases of histoplasmosis were also diagnosed. A low mean CD4 count of <200 cells microl(-1) was seen with most fungal infections. A total of 73 % of patients belonged to World Health Organization (WHO) stage 4, while 23.33 % belonged to stage 3. Thirty one patients (51.67 %) belonged to Centers for Disease Control and Prevention (CDC) stage C3. Various fungal infections correlated well with the mean CD4 counts. It was difficult to correlate statistically WHO and CDC staging because of the small sample size. However, it was possible to assess to a limited extent the possibility of using clinical diagnosis to predict the status of progression of HIV infection in a resource-poor outpatient setting.
Publication Types:
PMID: 17644719 [PubMed - indexed for MEDLINE]
- 8: Rev Iberoam Micol. 2007 Mar;24(1):24-8.
[Nematophagous fungi of Toxocara canis eggs in a public park of La Plata, Argentina]
[Article in Spanish]
Gortari C, Cazau C, Hours R.
CIC-PBA and CINDEFI (CONICET-UNLP) Facultad de Ciencias Exactas, UNLP, La Plata, Argentina.
Fungi have showed a great potential for the biological control of nematodes. However, they have not been evaluated for the control of animal and/or human parasites transmitted by egg contaminated soils. Environmental contamination with Toxocara spp. eggs is a public health problem. Accidental swallowing of Toxocara canis eggs (a nematode of dogs) usually results on a zoonotic infection (toxocarosis). The objectives of this research were: 1) To test the presence of antagonistic fungi against T. canis in the soil in public places of La Plata city, Argentina, infected with eggs of this parasite, 2) To determine the possible association between biotic and abiotic factors of the soil with the presence of fungal parasites of egg nematodes. Soil samples were tested for: textural type, organic matter (%), pH, presence of egg-parasite fungi, of larvae and of nematode eggs, in particular of Toxocara spp. The studied area showed the following characteristics: pH: 6.6-8.0, organic matter: 1.2-70%, with a predominantly loam texture. The following antagonistic fungal genera were identified: Acremonium, Aspergillus, Chrysosporium, Fusarium, Humicola, Mortierella, Paecilomyces and Penicillium. A prevalence of 70% was detected for nematode eggs, of 33% for Toxocara spp. eggs and of 90% for larvae. No association between the presence of egg-parasite fungi and the considered factors was found. More studies are necessary to know the natural antagonism factors to T. canis eggs for its in situ biological control.
Publication Types:
PMID: 17592887 [PubMed - indexed for MEDLINE]
- 9: Rev Iberoam Micol. 2007 Mar;24(1):3-13.
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Harmful fungi in both agriculture and medicine.
De Lucca AJ.
Southern Regional Research Center, USDA, ARS, New Orleans, LA 70124, USA. adelucca@srrc.ars.usda.gov
Most fungi are saprophytic and not pathogenic to plants, animals and humans. However, a relative few fungal species are phytopathogenic, cause disease (e.g., infections, allergies) in man, and produce toxins that affect plants, animals and humans. Among such fungi are members of the Aspergillus and Fusarium genera as well as other genera (e.g., Alternaria, Mucor) comprising the emerging pathogen group in humans. These fungi present a common threat to both agricultural production and the health of healthy and immunocompromised individuals. Taken together, these relative few fungi can cause huge economic losses to agriculture, loss of food for consumption, and serious, often fatal diseases in humans and animals. Plants may be a source of antifungal compounds since they have had to develop compounds to resist infections by fungi present in their environment.
Publication Types:
PMID: 17592884 [PubMed - indexed for MEDLINE]
- 10: Salud Publica Mex. 2007 May-Jun;49(3):227-35.
[Exposure to aflatoxin B1 in experimental animals and its public health significance]
[Article in Spanish]
Guzmán de Peña D.
Laboratorio de Micotoxinas, Departamento de Biotecnología y Bioquímica, Campus Guanajuato, Centro de Investigación y de Estudios Avanzados del IPN, Irapuato, Guanajuato, México. dguzman@ira.cinvestav.mx
The presence of AFB1 in human beings was detected in Mexico in 1996 both as a mutation of the gene p53 in hepatocellular carcinomas in Monterrey, Mexico, and as the adduct AFB1-lysine in serum from patients in Matamoros, Mexico in 2003. Aflatoxin B1 has been classified as a carcinogenic agent to humans by the International Agency for Research on Cancer. The compound is a natural contaminant produced by Aspergillus flavus and/or A. parasiticus when these fungi grow on different food products. At the molecular level, this review covers the carcinogenic, mutagenic and toxic properties of these mycotoxins and their risk to humans. It also gives insight into the causal relationship between aflatoxins and hepatocellular carcinoma. Information is provided about AFB1-formamidopyrimidine, which is a determinant of the carcinogenic and mutagenic capabilities. The results suggest that the Mexican population ingests food containing low amounts of AFB1. Analyses is presented of AFB1 toxicity, which is a consequence of the carcinogenic activity in liver cells.
Publication Types:
PMID: 17589777 [PubMed - indexed for MEDLINE]
- 11: Rev Chilena Infectol. 2007 Jun;24(3):199-203. Epub 2007 May 30.
[Detection of some zoonotic agents in the domestic pigeon (Columba livia) in the city of Chillán, Chile]
[Article in Spanish]
González-Acuña D, Silva G F, Moreno S L, Cerda L F, Donoso E S, Cabello C J, López M J.
Facultad de Medicina Veterinaria, Universidad de Concepción, Chillán, Chile. danigonz@udec.cl
INTRODUCTION: There is an increase in the population of doves (Columba livia) as well as their contact with healthy and immunocompromised hosts. OBJECTIVES: detection of some zoonotic agents of the domestic pigeon (Columba livia) in Chillán city, Chile. MATERIALS AND METHODS: From October 2002 to September 2003, 100 domestic pigeons were captured. Blood, organs and intestine contents were sampled from each pigeon. The samples were cultivated in different kinds of agar according to the searched microorganism. Fungi were typified by morphological studies after staining with 2% methylene blue. For the detection of Chlamydophila psittaci a commercial Elisa kit (IDEXX) was used. RESULTS: Pigeons were registered positive for: chlamydiosis (11%), staphylococcus (8%), salmonellosis (4%) and aspergillosis (1%). No pigeon had evidence of cryptococcosis and listeriosis. CONCLUSIONS: these results confirm that domestic pigeon could act as vector of zoonotic agents of public health importance.
Publication Types:
PMID: 17554438 [PubMed - indexed for MEDLINE]
- 12: Rinsho Ketsueki. 2007 Apr;48(4):291-6.
[Evidence-based infection control]
[Article in Japanese]
Yano K.
Publication Types:
PMID: 17515119 [PubMed - indexed for MEDLINE]
- 13: Med Mycol. 2007 Jun;45(4):321-46.
Nosocomial fungal infections: epidemiology, diagnosis, and treatment.
Perlroth J, Choi B, Spellberg B.
Division of Infectious Diseases, Harbor-University of California Los Angeles (UCLA) Medical Center, California 90502, USA.
Invasive fungal infections are increasingly common in the nosocomial setting. Furthermore, because risk factors for these infections continue to increase in frequency, it is likely that nosocomial fungal infections will continue to increase in frequency in the coming decades. The predominant nosocomial fungal pathogens include Candida spp., Aspergillus spp., Mucorales, Fusarium spp., and other molds, including Scedosporium spp. These infections are difficult to diagnose and cause high morbidity and mortality despite antifungal therapy. Early initiation of effective antifungal therapy and reversal of underlying host defects remain the cornerstones of treatment for nosocomial fungal infections. In recent years, new antifungal agents have become available, resulting in a change in standard of care for many of these infections. Nevertheless, the mortality of nosocomial fungal infections remains high, and new therapeutic and preventative strategies are needed.
Publication Types:
PMID: 17510856 [PubMed - indexed for MEDLINE]
- 14: Curr Med Chem. 2007;14(11):1263-75.
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Role of micafungin in the antifungal armamentarium.
Ikeda F, Tanaka S, Ohki H, Matsumoto S, Maki K, Katashima M, Barrett D, Aoki Y.
Development Division, Astellas Pharma Inc. 3-17-1 Hasune, Tokyo 174-8612, Japan.
Serious infections caused by opportunistic molds remain a major problem for public health. Immune deficiency following organ transplantation and aggressive cancer treatment has greatly increased the incidence of systemic mycoses, and invasive aspergillosis in patients with AIDS is associated with significant morbidity and mortality. Amphotericin B is the first-line therapy for systemic infection because of its broad-spectrum and fungicidal activity. However, considerable side effects limit its clinical utility. The echinocandins are large lipopeptide molecules that inhibit the synthesis of 1,3-beta-D-glucan, a key component of the fungal cell wall. Three echinocandins have reached the market, and some others are in early clinical development. Caspofungin was the first echinocandin to be licensed for clinical use in most countries. Micafungin is licensed for clinical use in Japan, China, Taiwan, Jordan, Korea, Hong-Kong and the US, and anidulafungin is currently licensed in the US. The novel class of echinocandins represents a milestone in antifungal drug research that has further expanded our therapeutic options. Studies to date have shown that micafungin exhibits extremely potent antifungal activity against clinically important fungi, including Aspergillus and azole-resistant strains of Candida. In animal studies, micafungin is as efficacious as amphotericin B with respect to improvement of survival rate. Micafungin is also characterized by a linear pharmacokinetic profile and substantially fewer toxic effects. Micafungin is a poor substrate for the cytochrome P450 enzymes, and compared to azoles, fewer drug interactions are described. No dose adjustments of the drug are required in the presence of mycophenolate mofetil, cyclosporin, tacrolimus, prednisolone, or sirolimus. Strategies using this new echinocandin agent will benefit a large number of patients with severe immune dysfunction.
Publication Types:
PMID: 17504145 [PubMed - indexed for MEDLINE]
- 15: Mycologia. 2006 Nov-Dec;98(6):1053-64.
Eurotiomycetes: Eurotiomycetidae and Chaetothyriomycetidae.
Geiser DM, Gueidan C, Miadlikowska J, Lutzoni F, Kauff F, Hofstetter V, Fraker E, Schoch CL, Tibell L, Untereiner WA, Aptroot A.
Department of Plant Pathology, Pennsylvania State University, University Park 16802, USA. dgeiser@psu.edu
The class Eurotiomycetes (Ascomycota, Pezizomycotina) is a monophyletic group comprising two major clades of very different ascomycetous fungi: (i) the subclass Eurotiomycetidae, a clade that contains most of the fungi previously recognized as Plectomycetes because of their mostly enclosed ascomata and prototunicate asci; and (ii) the subclass Chaetothyriomycetidae, a group of fungi that produce ascomata with an opening reminiscent of those produced by Dothideomycetes or Sordariomycetes. In this paper we use phylogenetic analyses based on data available from the Assembling the Fungal Tree of Life project (AFTOL), in addition to sequences in GenBank, to outline this important group of fungi. The Eurotiomycetidae include producers of toxic and useful secondary metabolites, fermentation agents used to make food products and enzymes, xerophiles and psychrophiles, and the important genetics model Aspergillus nidulans. The Chaetothyriomycetidae include the common black yeast fungi, some of which are pathogens of humans and animals, as well as some primarily lichenized groups newly found to be phylogenetically associated with this group. The recently proposed order Mycocaliciales shows a sister relationship with Eurotiomycetes. The great majority of human pathogenic Pezizomycotina are Eurotiomycetes, particularly in Eurotiales, Onygenales and Chaetothyriales. Due to their broad importance in basic research, industry and public health, several genome projects have focused on species in Onygenales and Eurotiales.
Publication Types:
PMID: 17486980 [PubMed - indexed for MEDLINE]
- 16: Appl Environ Microbiol. 2007 Jul;73(13):4211-7. Epub 2007 May 4.
Mass spectrometry-based strategy for direct detection and quantification of some mycotoxins produced by Stachybotrys and Aspergillus spp. in indoor environments.
Bloom E, Bal K, Nyman E, Must A, Larsson L.
Dept of Laboratory Medicine, Division of Medical Microbiology, Lund University, Sölvegatan 23, Lund, Sweden.
Dampness in buildings has been linked to adverse health effects, but the specific causative agents are unknown. Mycotoxins are secondary metabolites produced by molds and toxic to higher vertebrates. In this study, mass spectrometry was used to demonstrate the presence of mycotoxins predominantly produced by Aspergillus spp. and Stachybotrys spp. in buildings with either ongoing dampness or a history of water damage. Verrucarol and trichodermol, hydrolysis products of macrocyclic trichothecenes (including satratoxins), and trichodermin, predominately produced by Stachybotrys chartarum, were analyzed by gas chromatography-tandem mass spectrometry, whereas sterigmatocystin (mainly produced by Aspergillus versicolor), satratoxin G, and satratoxin H were analyzed by high-performance liquid chromatography-tandem mass spectrometry. These mycotoxin analytes were demonstrated in 45 of 62 building material samples studied, in three of eight settled dust samples, and in five of eight cultures of airborne dust samples. This is the first report on the use of tandem mass spectrometry for demonstrating mycotoxins in dust settled on surfaces above floor level in damp buildings. The direct detection of the highly toxic sterigmatocystin and macrocyclic trichothecene mycotoxins in indoor environments is important due to their potential health impacts.
Publication Types:
PMID: 17483261 [PubMed - indexed for MEDLINE]
- 17: Ceylon Med J. 2006 Dec;51(4):137-42.
An outbreak of Aspergillus meningitis following spinal anaesthesia for caesarean section in Sri Lanka: a post-tsunami effect?
Gunaratne PS, Wijeyaratne CN, Chandrasiri P, Sivakumaran S, Sellahewa K, Perera P, Fernando R, Wanigasinghe J, Jayasinghe S, Ranawala R, Riffsy MT, Seneviratne HR.
National Hospital of Sri Lanka. pagunara@hotmail.com
An outbreak of Aspergillus fumigatus meningitis occurred in 5 women following spinal anaesthesia, performed between 21 June and 17 July 2005 for caesarean section, in Colombo, Sri Lanka. The patients' median age was 27 years. Different teams in 2 maternity hospitals gave spinal anaesthesia. Mean incubation period was 11.2 days. Fever, headache and nuchal rigidity were common presentations. Remittent fever continued despite broad-spectrum intravenous antibiotics. Papilloedema, lateral rectus palsy, cerebral infarction and haemorrhage developed later. Three patients died. Cerebrospinal fluid pleocytosis with low glucose yielded negative PCR for fungi. Fungal cultures subsequently grew Aspergillus fumigatus. A post-mortem of the first patient confirmed Aspergillus meningitis, followed by treatment with amphotericin B and voriconazole, that saved the lives of others. Visual and hearing impairment in one and complete recovery in the other were observed a year after treatment. Examination of unused plastic syringes, needles, cannulae, and ampoules of anaesthetic agents confirmed that 43 syringes from three different manufactures were contaminated with Aspergillus fumigatus. The stores for drugs and devices of the Ministry of Health were examined and found to be full of tsunami donations, while regular procurements of the Ministry were kept in a poorly maintained humid warehouse. Inadequate space for tsunami donations was identified as the most plausible explanation for sub-optimal storage. Withdrawal and incineration of all unused syringes controlled the outbreak. The survival of those aggressively treated for Aspergillus meningitis suggests in hindsight that the availability of diagnostic tests and specific treatment, and early recognition of the outbreak could have saved the lives of victims who died. Early life-threatening side-effects and permanent long term sequelae of antifungal medication stress the need to be cautious with empirical treatment in immuno-competent low-risk individuals.
PMID: 17461323 [PubMed - indexed for MEDLINE]
- 18: Scand J Infect Dis. 2007;39(4):337-43.
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Diagnostics of fungal infections in the Nordic countries: we still need to improve!
Arendrup MC, Chryssanthou E, Gaustad P, Koskela M, Sandven P, Fernandez V.
Unit of Mycology and Parasitology, Statens Serum Institute, Copenhagen, Denmark. mad@ssi.dk
A Nordic External Quality Assessment programme in medical mycology was established in 2005. In order to monitor not 'best practice' but the level of routine diagnostics, specimens were designed to resemble clinical samples and laboratories were asked to handle the samples like routine samples. Five simulated clinical samples were distributed to 59 participating Nordic laboratories of clinical microbiology. The specimens contained the following microorganisms: 1) Candida glabrata and C. albicans in a ratio of 1:20; 2) Cryptococcus neoformans; 3) Aspergillus fumigatus, C. albicans and Enterobacter cloacae; 4) C. tropicalis, Klebsiella pneumonia and Enterococcus faecium; 5) None. 66% of the laboratories failed to detect the C. glabrata isolate in sample no. 1. 34% of the laboratories reporting susceptibility results incorrectly reported the Cryptococcus neoformans isolate as fluconazole susceptible. 24% of the laboratories failed to detect Aspergillus fumigatus in specimen no. 3 despite the accompanying clinical information notifying that it was a BAL sample from a neutropenic patient in an ICU. In conclusion, this distribution of simulated clinical samples illustrates that the traditional quality assessment programmes may give a false sense of satisfactory performance, that mycological diagnosis is difficult, and that there is a need of further improvement and attention.
Publication Types:
PMID: 17454898 [PubMed - indexed for MEDLINE]
- 19: Clin Infect Dis. 2007 May 15;44(10):1329-36. Epub 2007 Apr 4.
Optimization of the cutoff value for the Aspergillus double-sandwich enzyme immunoassay.
Maertens JA, Klont R, Masson C, Theunissen K, Meersseman W, Lagrou K, Heinen C, Crépin B, Van Eldere J, Tabouret M, Donnelly JP, Verweij PE.
Department of Hematology, Universitaire Ziekenhuizen, Catholic University Leuven, Leuven, Belgium. johan.maertens@uz.kuleuven.ac.be
BACKGROUND: Many health care centers worldwide use the Platelia Aspergillus enzyme immunoassay (PA-EIA; Bio-Rad Laboratories) for diagnosis of invasive aspergillosis (IA). A cutoff optical density (OD) index of 1.5 was originally recommended by the manufacturer, but in practice, most institutions use lower cutoff values. Moreover, a cutoff OD index of 0.5 was recently approved in the United States. In the present study, we set out to optimize the cutoff level by performing a retrospective analysis of PA-EIA values for samples that had been obtained prospectively from adult patients at risk for IA at 2 European health care centers. METHODS: In total, 239 treatment episodes were included of which there were 19 episodes of proven IA and 19 episodes of probable IA. Per-episode and per-test analyses and receiver operating characteristic curves were used to determine the optimal cutoff value. RESULTS: In the per-episode analysis, lowering the cutoff OD index for positivity from 1.5 to 0.5 increased the overall sensitivity by 21% (from 76.3% to 97.4%) but decreased the overall specificity by 7% (from 97.5% to 90.5%). Requiring 2 consecutive samples with an OD index > or = 0.5 resulted in the highest test accuracy, with an improved positive predictive value. At a cutoff OD index of 0.5, the antigen test result was positive during the week before conventional diagnosis in 65% of cases and during the week of diagnosis in 79.5% of cases. CONCLUSIONS: A cutoff OD index of 0.5--identical to the approved cutoff in the United States--improves the overall performance of the PA-EIA for adult hematology patients.
Publication Types:
PMID: 17443470 [PubMed - indexed for MEDLINE]
- 20: Food Microbiol. 2007 Sep;24(6):658-63. Epub 2007 Jan 12.
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Ethylene inhibits aflatoxin biosynthesis in Aspergillus parasiticus grown on peanuts.
Gunterus A, Roze LV, Beaudry R, Linz JE.
Department of Food Science and Human Nutrition, Michigan State University, E. Lansing, MI 48824, USA.
The filamentous fungi Aspergillus parasiticus and Aspergillus flavus synthesize aflatoxins when they grow on a variety of susceptible food and feed crops. These mycotoxins are among the most carcinogenic naturally occurring compounds known and they pose significant health risks to humans and animals. We previously demonstrated that ethylene and CO2 act alone and together to reduce aflatoxin synthesis by A. parasiticus grown on laboratory media. To demonstrate the potential efficacy of treatment of stored seeds and grains with these gases, we tested ethylene and CO2 for ability to inhibit aflatoxin accumulation on Georgia Green peanuts stored for up to 5 days. We demonstrated an inverse relationship between A. parasiticus spore inoculum size and the level of toxin accumulation. We showed that ethylene inhibits aflatoxin synthesis in a dose-dependent manner on peanuts; CO2 also inhibits aflatoxin synthesis over a narrow dose range. Treatments had no discernable effect on mold growth. These observations support further exploration of this technology to reduce aflatoxin contamination of susceptible crops in the field and during storage.
Publication Types:
PMID: 17418318 [PubMed - indexed for MEDLINE]
- 21: Kokuritsu Iyakuhin Shokuhin Eisei Kenkyusho Hokoku. 2006;(124):21-9.
[Hazardous food-borne fungi and present and future approaches to the mycotoxin regulations in Japan]
[Article in Japanese]
Takatori K, Aihara M, Sugita-Konishi Y.
takatori@nihs.go.jp
In recent years, various food-related accidents and health scares have dissipated trust in the food industry. Health hazards resulting from food contaminated with fungi is increasing. Food contamination by fungi causes many problems, especially in Japan, which relies on foreign countries for about 60% of its food: the contamination of imported food by fungi and mycotoxins constitutes a serious problem. As the quantity of imported food increases and changes in food distribution have occurred, so too has the number and type of fungi causing food-related damages; osmophilic and thermotolerant fungi, in addition to the mainstream fungi of genera Cladosporium, Pecinillium, and Aspergillus, have become a problem. Although European countries and the U.S. have recently conducted risk assessments for mycotoxins, Japan has not attained an international level in the determination of baseline values. However, in addition to risk management for Aflatoxin M1, Ochratoxin, T-2 toxin/HT-2 toxin, and Fumonisin, determination of baseline values for mycotoxins is beginning in Japan. In this review, we summarize hazardous food-borne fungi, and present and future approaches to the mycotoxin regulations in Japan.
Publication Types:
PMID: 17405518 [PubMed - indexed for MEDLINE]
- 22: Nepal Med Coll J. 2006 Dec;8(4):215-9.
Onychomycosis in eastern Nepal.
Agarwalla A, Agrawal S, Khanal B.
Department of Dermatology, Marwari Maternity Hospital, Adhgaon, Guwahati, Assam, India.
Onychomycosis, a fungal infection of the nail is responsible for up to 50.0% of all nail diseases. Though, dermatophytes are most frequently implicated as the causative agents in onychomycosis, yeast and molds are increasingly recognized as causative pathogens. This study was aimed to know the clinical and mycological pattern of onychomycosis in eastern Nepal. Eighty-two clinically diagnosed patients of onychomycosis attending the Dermatology Outpatient department of a tertiary hospital over a period of one year were enrolled in this study. Clipping from the severely affected nail and skin scrapping from active border of the skin lesions if associated were collected from each patient and subjected to microscopy and culture for identification of fungi. The commonest affected age group was 21-40 years. The male: female ratio was 2.7:1. Fifty-one patients had isolated fingernail involvement, while involvement of toenails was seen in 15 patients. Distolateral subungual onychomycosis (67%) was the commonest clinical type followed in decreasing order by superficial white onychomycosis (14.6%), proximal subungual onychomycosis (9.8%), candidal onychomycosis (7.4%) and total dystrophic onychomycosis (1.2%). Trichophyton mentagrophytes (28.8%) was the most common pathogen isolated followed by Trichophyton rubrum (21.2%), Trichophyton tonsurans (11.5%), Candida albicans (11.5%), Trichospron beigelii, (9.6%), Epidermophyton floccosum (7.7%), Trichophyton violaceum (5.8%), and Aspergillus flavus (3.9%). Distolateral subungual onychomycosis was the most common clinical presentation and T. mentagrophytes and T. rubruni were the most frequently isolated fungi for onychomycosis in eastern Nepal.
Publication Types:
PMID: 17357634 [PubMed - indexed for MEDLINE]
- 23: Rev Soc Bras Med Trop. 2006 Nov-Dec;39(6):556-9.
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[Fungus microbiota in air conditioners in intensive care units in Teresina, Piauí]
[Article in Portuguese]
Mobin M, do Amparo Salmito M.
Laboratória de Microbiologia e Imunologia, Faculdade de Saúde, Ciências Humanas e Tecnológicas do Piauí, Teresina, PI, Brazil. mitramobin@novafapi.com.br
With the aim of identifying the fungus microbiota in air conditioners in intensive care units (ICUs) within public and private hospitals in Teresina, Piauí, solid material was collected from ten different ICUs. Thirty-three species of Moniliaceae and Dematiaceae were isolated, which was the first report of these in Piauí. High frequencies of Aspergillus niger Van Tieghem (60%), Aspergillus fumigatus Fres (50%), Trichoderma koningii Oudem (50%) and Aspergillus flavus Link: Fr. (40%) were recorded. The air conditioner cleanliness validity had expired in all the ICUs, and the quantity of colony-forming units exceeded the levels permitted by Law 176/00 from the Ministry of Health. It is important to provide individual protection equipment for professionals, adopt hospital infection control measures, raise the awareness of the presence of fungus infection, improve air circulation around the environment, periodically clean the air conditioners, and make health professionals alert to the importance of these fungi in the hospital environment.
Publication Types:
PMID: 17308702 [PubMed - indexed for MEDLINE]
- 24: Nippon Ishinkin Gakkai Zasshi. 2007;48(1):1-12.
Trends in the epidemiology of invasive fungal infections.
Warnock DW.
Division of Foodborne, Bacterial and Mycotic Diseases, National Center for Zoonotic, Vector-Borne and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Invasive fungal infections have increased in importance, largely because of the increasing size of the population at risk. Candida species remain the fourth most important cause of hospital-acquired bloodstream infections. Infections with Candida species other than C. albicans appear to have become more common, but significant geographic variation has been reported. Invasive aspergillosis and other mould infections are a leading cause of infection-related death in hematopoietic stem cell transplant recipients. Although Aspergillus fumigatus remains the most frequent cause of infection, A. terreus has emerged as an important pathogen, at least among certain populations. Despite marked reductions in the rates of AIDS-associated fungal infections, such as cryptococcosis, in the United States and other developed countries, the burden of these diseases in developing countries is large and increasing. Enhanced surveillance and reporting will be critical to improve our understanding of the importance of invasive fungal infections, to enable prioritization of research and prevention efforts, and to evaluate prevention strategies.
Publication Types:
PMID: 17287717 [PubMed - indexed for MEDLINE]
- 25: PLoS Pathog. 2007 Feb;3(2):e13.
Environmental dimensionality controls the interaction of phagocytes with the pathogenic fungi Aspergillus fumigatus and Candida albicans.
Behnsen J, Narang P, Hasenberg M, Gunzer F, Bilitewski U, Klippel N, Rohde M, Brock M, Brakhage AA, Gunzer M.
Department of Molecular and Applied Microbiology, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany.
The fungal pathogens Aspergillus fumigatus and Candida albicans are major health threats for immune-compromised patients. Normally, macrophages and neutrophil granulocytes phagocytose inhaled Aspergillus conidia in the two-dimensional (2-D) environment of the alveolar lumen or Candida growing in tissue microabscesses, which are composed of a three-dimensional (3-D) extracellular matrix. However, neither the cellular dynamics, the per-cell efficiency, the outcome of this interaction, nor the environmental impact on this process are known. Live imaging shows that the interaction of phagocytes with Aspergillus or Candida in 2-D liquid cultures or 3-D collagen environments is a dynamic process that includes phagocytosis, dragging, or the mere touching of fungal elements. Neutrophils and alveolar macrophages efficiently phagocytosed or dragged Aspergillus conidia in 2-D, while in 3-D their function was severely impaired. The reverse was found for phagocytosis of Candida. The phagocytosis rate was very low in 2-D, while in 3-D most neutrophils internalized multiple yeasts. In competitive assays, neutrophils primarily incorporated Aspergillus conidia in 2-D and Candida yeasts in 3-D despite frequent touching of the other pathogen. Thus, phagocytes show activity best in the environment where a pathogen is naturally encountered. This could explain why "delocalized" Aspergillus infections such as hematogeneous spread are almost uncontrollable diseases, even in immunocompetent individuals.
Publication Types:
PMID: 17274685 [PubMed - indexed for MEDLINE]
- 26: Anal Chem. 2007 Jan 15;79(2):751-7.
A new competitive fluorescence assay for the detection of patulin toxin.
de Champdoré M, Bazzicalupo P, De Napoli L, Montesarchio D, Di Fabio G, Cocozza I, Parracino A, Rossi M, D'Auria S.
Institutes of Protein Biochemistry and of Genetics & Biophysics, CNR, and Department of Organic Chemistry, University of Naples, Naples, Italy.
Patulin is a toxic secondary metabolite of a number of fungal species belonging to the genera Penicillum and Aspergillus. It has been mainly isolated from apples and apple products contaminated with the common storage-rot fungus of apples, Penicillum expansum, but it has also been extracted from rotten fruits, moldy feeds, and stored cheese. Human exposure to patulin can lead to serious health problems, and according to a long-term investigation in rats, the World Health Organization has set a tolerable weekly intake of 7 ppb body weight. The content of patulin in foods has been restricted to 50 ppb in many countries. Conventional analytical detection methods involve chromatographic analyses, such as HPLC, GC, and, more recently, techniques such as LC/MS and GC/MS. However, extensive protocols of sample cleanup are required prior to the analysis, and to accomplish it, expensive analytical instrumentation is necessary. An immunochemical analytical method, based on highly specific antigen-antibody interactions, would be desirable, offering several advantages compared to conventional techniques, i.e., low cost per sample, high selectivity, high sensitivity, and high throughput. In this paper, the synthesis of two new derivatives of patulin is described, along with their conjugation to the bovine serum albumin for the production of polyclonal antibodies. Finally, a fluorescence competitive immunoassay was developed for the on-line detection of patulin.
Publication Types:
PMID: 17222046 [PubMed - indexed for MEDLINE]
- 27: J Crit Care. 2006 Dec;21(4):322-7.
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Isolation of Aspergillus in critically ill patients: a potential marker of poor outcome.
Khasawneh F, Mohamad T, Moughrabieh MK, Lai Z, Ager J, Soubani AO.
Wayne State University/Detroit Medical Center, Detroit, MI 48201, USA.
OBJECTIVE: Recent reports have suggested a rising incidence of pulmonary aspergillosis in intensive care unit (ICU) patients. The aim of this study was to determine the clinical significance of isolating Aspergillus from respiratory samples of critically ill patients. DESIGN: Retrospective review of medical records. SETTING: Tertiary medical center that has a large cancer center. PATIENTS: All patients admitted to the ICU between January 1998 and August 2004, in whom Aspergillus was isolated from respiratory samples or lung tissue. INTERVENTION: None. RESULTS: The charts of 104 patients were reviewed. Aspergillus was isolated for a mean of 6.6 days after ICU admission. Thirty-three percent of patients had hematological malignancy, 10% had absolute neutro