Monday, February 24, 2014

CDC Article on Fungal Infections After Natural Disasters

Dear loyal readers,

Things have been crazy busy here at Spore Consulting, LLC - we moved the main portion of our office (and lives, since we're a home-based business) from Prescott to Tempe, Arizona over the last two weeks. More on that later.

We're never too busy to catch up on our reading, though. The CDC just released their latest issue of the online journal Emerging Infectious Diseases. In the March 2014 issue, there's an article on "Invasive Fungal Infections After Natural Disasters" that is eligible for continuing education credit.

This article was interesting to me for two reasons: 1) it described some of the risks associated with Coccidioides species fungi during disaster situations, and 2) it discussed indoor mold exposures after disasters.

My interest in Coccidioides species fungi stems from my undergraduate studies at the University of Arizona in Tucson, Arizona. The University of Arizona is home to the Valley Fever Center for Excellence, and I learned about their studies and attempts to get funding for their research into "Valley Fever" - the common name for Coccidioides infection. They developed an excellent online *free* continuing education course on Valley Fever that should be taken by any medical provider in the Southwest. 

The information the authors provided on indoor mold exposures after disasters was fascinating; however, this may lead to an increase in "toxic mold" and "black mold" tort lawsuits among homeowners and business owners who have experienced any sort of flooding or water intrusion event. I can't wait to see what the media makes of the article (hopefully they don't pick it up). 

The EID article referenced a 2004 Institute of Medicine book "Damp Indoor Spaces and Health" that, according to the authors of the article, "found sufficient evidence of association between indoor mold exposure and upper respiratory tract symptoms, cough, and wheezing, and evidence of an association between indoor mold exposure and some noninfectious health conditions that included asthma symptoms in persons with asthma and hypersensitivity pneumonitis in some groups of people. Although the report found no association between indoor mold exposure and invasive infection in healthy persons, there was evidence to support a link between exposure to Aspergillus and aspergillosis in severely immunocompromised persons.

The EID article also discussed that most people who survived Hurricanes Katrina and Rita (and their aftermath) did not report invasive fungal infections, even in severely immunocompromised people.

The part I found most interesting in the EID article was this: "Global warming has also been hypothesized to select for fungi with tolerance to warmer temperatures. The relative scarcity of fungal diseases among mammals has been hypothesized to be associated with the inability of many fungal species to survive at temperatures >37°C; however, warmer ambient temperatures may enable nonpathogenic fungi to acquire the ability to infect warm-blooded hosts." 

When we do viable sampling for fungi (in sterile environments like operating rooms, bone marrow transplant patient areas, and sterile processing), we have the culture plates put in an incubator for 48- to 72-hours at 37 degrees Celsius to see if the fungi will grow at approximate human body temperature. If anything grows, we evaluate if the fungi have been reported as human pathogens or not. It would be interesting to see if the environmental laboratories have noticed an increase in pathogenic and non-pathogenic fungi able to grow and reproduce at human body temperature.