Continued.
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8, 9, 10, 11, 12
FUNGUS
IN DISEASES OTHER THAN FIBROMYALGIA
Fungus in Cancer
Of 20 cancer patients who were given Amphotericin B therapy, 40% died of fungal
infection and 20% from underlying disease with fungal infection. Even though
the diagnosis was made and antifungal therapy begun before death in 75% of
the cases, invasive fungal infection had a 60% overall mortality in these
patients.
A new treatment for fibromyalgia, proven
highly successful in the Ingles Integrative Hospital Mexico, is the
use of an Alkanylated Sulfur
Compound administered intravenously. All patients treated have responded
dramatically after one or more treatment protocols.59 See
Chart 11.
Candida lusitaniae fungemia was detected in 12 cancer patients at
the M.D. Anderson Cancer Center (Houston, Texas) from 1988 to 1999.
Four of these patients had a solid tumor, while the remaining eight
were diagnosed with leukemia. The mortality rate associated with C.
lusitaniae infection was 25%.87
In a surveillance study of candidiasis in cancer patients, conducted
by the Invasive Fungal Infection Group of the European Organization
for Research and Treatment of Cancer, 249 cases were studied. Candida
albicans was isolated in 70% of the 90 cases involving patients with
solid tumors and in 36% of those diagnosed with leukemia. Candida glabrata
was associated with the highest mortality rate (odds ratio, 2.66:1).88
In another study of patients having solid tumors of the respiratory
tract, colonization by fungi and/or yeasts was frequently found.89
Scedosporium prolificans infection was analyzed in 18 patients from
whom the fungus was isolated during the period 1990 to 1999. Six of
these patients had confirmed disseminated infection; four patients
had leukemia; and one patient had breast cancer.90
At the Sloan-Kettering Cancer Center, New York, 22 isolates of Candida
dubliniensis were recovered from 16 patients with solid-organ or hematologic
(leukemic) malignancies, including those having AIDS. Two patients
with cancer had invasive infections.91
The clinical charts of cancer patients
with documented fungal infections in a children's hospital
in Italy from 1980 to 1990 were reviewed. Of 37 patients, ranging
in age from three months to 18 years, 21 patients
were treated for leukemia while 17 had solid tumors. In 40% of the
cases, the fungal infection developed as primary infection, not preceded
by any other infectious episode. Fungemias without evident organ localization
accounted for 40% of the cases with a mortality rate of 20%. The other
22 cases (60%), nine of whom (41%) died, were classified as invasive
mycoses. Mortality was highest among patients with fungal infection
(72%), compared to those with only Candida yeast infections (28%) Note:
Yeast is fungus.92
Aspergillus terreus developed in a patient with acute lymphoblastic
leukemia following chemotherapy. A. terreus is one of the invasive
Aspergillus species.93
Systemic infections related to fluconazole-resistant fungus (yeast)
are increasingly observed in immunocompromised patients receiving fluconazole
as an antifungal treatment. A single case of invasive candidiasis was
caused by Candida ciferrii in a patient with acute myeloid leukemia.
Until now, C. ciferrii has not been known to cause invasive fungal
infections in humans.94
Fusarium species are fungi that attack most grains, including corn,
wheat, rice, barley, and others in the field before harvest. A single
case of disseminated fungal infection caused by Fusarium was reported
in an immunosuppressed patient suffering from acute lymphobastic leukemia.
This report and a review of recent literature suggests that Fusarium
species are emerging fungal pathogens in immunosuppressed patients.95
In a second report, Fusarium moniliforme was isolated from blood culture
of a six-month-old infant who had infantile leukemia and whose family
raised livestock.96
Fungus in Arthritis
The following are case reports of patients suffering from some form
of arthritis and fungal infection. The first case is concerned with
arthritis due to Candida glabrata in two different joints at different
times in the same patient. The first episode of arthritis was in
the right ankle and lasted more than a year before the patient agreed
to the proposed treatment. The intravenous therapy with antibiotics
failed, but was followed by weekly intra-articular administration
of amphotericin B for more than 20 weeks, combined with oral itraconazole.
Several weeks later, the patient developed arthritis in the left
knee while still being treated by itraconazole. Intravenous amphotericin
B therapy begun immediately was successful.97
Cryptococcus neoformans infection generally is rare, particularly
in the hand. Another report describes the case of a 50-year-old patient
with C. neoformans infection in his hand. 98
A case of arthritis from coccidioidomycosis in a 62-year-old man
is described. The diagnosis was made by fine-needle aspiration and
confirmed by positive cultures and antigen testing. Coccidioidomycosis
can infect bones and joints, especially the knee which was the site
of infection in this case. 99
In another case, a patient developed osteoarthritis of an ankle, due
to infection by Neocosmospora vasinfecta (Ascomycete group of fungi)
caused by accidental multiple trauma to his legs while in Africa. Parenteral
antifungal therapy failed, and amputation was required.100
A case of arthritis of the right wrist caused by Aspergillus fumigatus
without evidence of a generalized infection is described, following
chemotherapy for acute lymphoblastic leukemia. The diagnosis was made
by surgical biopsy. Oral itraconazole was given, and the arthritis
improved.101 Another report describes a patient with polyarthritis
(four separate sites) occurring over a period of several years caused
by Candida lambica, probably acquired from a contaminated wound. C.
lambica has not been previously reported to cause infectious arthritis.
Chronic alcoholism was the only apparent risk factor for dissemination.102
Prostaglandin Production by Pathogenic Fungi
The pathogenic fungi Cryptococcus neoformans and Candida albicans produce
prostaglandins that have been demonstrated. Prostaglandins isolated
from both these fungi and synthetic PGE2 display the same biological
activities towards fungal and mammalian cells, implying that the
fungi are producing PGE2. One of these activities is the conversion
of the yeast (bud) form of the fungus to the hypha (thread) form.
This prostaglandin, applied to mammalian cells, down-modulates tumor
necrosis factor (TNF) production while also up-regulating interleukin-10
(IL-10) production. PGE2 is shown to be critical for fungal growth
and can modulate host immune functions. This discovery reveals a
virulence mechanism that has potentially great implications for understanding
the mechanisms of chronic fungal infections in humans.103 IL-10 has
been found to be associated with the down-regulation of T-cell helper
cells.119
Pulmonary Aspergillosis in AIDS Patients
Symptomatic pulmonary aspergillosis rarely has been reported in AIDS
patients. This report describes 13 patients with pulmonary aspergillosis
detected an average of 25 months after the diagnosis of AIDS, usually
following corticosteroid use or the use of broad-spectrum antibiotics.
Two major patterns of disease were observed: invasive aspergillosis
(ten patients) and obstructing bronchial aspergillosis (three patients).
Dissemination to other organs occurred in at least two patients, and
direct invasion of extrapulmonary sites was seen in two others. It
was concluded that pulmonary aspergillosis is a possible late complication
of AIDS.104
Mucor Cerebral Aneurysm Rupture
A 63-year-old female was admitted to the hospital with disturbed consciousness
and high fever. Her past history was that of diabetes mellitus, liver
cirrhosis, and nasal sinusitis. Intravenous cefotaxime and ampicillin
therapy was immediately begun. The patient began to improve, but
on the sixth hospital day, she went into a coma and died on the ninth
day. An autopsy revealed Mucor at the site of the aneurysm rupture.105
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