Early diagnosis, effective therapy vital for treatment of deadly invasive mold
New guidelines focus on new treatments, early diagnosis of fungal infection
The updated guidelines focus on the diagnosis and treatment of the major forms of aspergillosis: allergic, chronic and invasive, the latter which kills 40 percent to 80 percent of those with widespread infection. An airborne invasive mold, aspergillus often is found in air conditioning units, compost piles and damp or flood-damaged homes or buildings. While generally harmless, it can cause an allergic reaction or chronic lung problems in some people and serious, invasive disease in vulnerable patients. Those at highest risk are people whose immune systems are suppressed, such as those undergoing stem cell and lung and other organ transplants. The infection also can affect those with severe influenza or who are on long-term steroids, or patients in the intensive care unit. “Invasive mold (aspergillosis) often is overlooked, but early diagnosis and treatment are key,” said Thomas Patterson, MD, lead author of the guidelines and chief of the Division of Infectious Disease and professor of medicine at The University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio. “These are complicated infections with a number of treatment options. Patients really benefit from a multidisciplinary approach, including the expertise of an infectious disease specialist.” Updating the 2008 guidelines, the new guidelines for the diagnosis and treatment of aspergillosis highlight the increased evidence for antifungal therapy recommendations as well as diagnostic tests. The improved use of diagnostic tools has enhanced the ability to identify the infection early, the guidelines note. These include blood tests, cultures and computed tomography (CT) imaging. Because some of the methods are invasive — such as taking a culture directly from the lungs — physicians often are reluctant to proceed. Because the infection is so deadly, physicians should be aggressive in diagnosing patients suspected of having the infection, Dr. Patterson notes. Additionally, new more-effective and better-tolerated antifungal medications, or versions of existing medications (e.g. extended release) have improved care, including isavuconazole and posaconazole. In some cases, combination therapy with voriconazole and an echinocandin is recommended for certain patients at highest risk. Because invasive molds like aspergillis are s so deadly, the guidelines recommend some patients at highest risk be treated with antifungals to prevent infection, including those with neutropenia and graft versus host disease (GVHD). Another prevention strategy is the use of special filtration systems for hospitalized immunosuppressed patients. Invasive aspergillosis affects about 200,000 people worldwide, Dr. Patterson said. The allergic form is most common and affects more than 4 million people worldwide, according to the Centers for Disease Control and Prevention (CDC). Those with asthma and cystic fibrosis are at highest risk of developing allergic aspergillosis. The other major form is chronic pulmonary aspergillosis, which can affect healthy people, and occurs in about 400,000 people worldwide, the CDC notes. While requiring treatment, the allergic and chronic forms of aspergillosis typically aren’t deadly. AT A GLANCE
A deadly fungal infection, invasive aspergillosis should be diagnosed early to improve care, according to new guidelines from IDSA. New and improved therapies are expanding treatment options.
Immunocompromised patients are at highest risk for invasive aspergillosis. The mortality rate in those patients is 40 percent or higher.
Aspergillus is a mold that is in the air we breathe, particularly in air conditioning units and flood-damaged areas.
In addition to the invasive form, aspergillus can cause chronic and allergic forms of disease.
Puerto Rico may be on the brink of a massive outbreak of Zika, a mosquito-borne virus which has been linked to birth defects, and cash is urgently needed, warned US health authorities on Thursday.
Tom Frieden, the chief of the US Centers for Disease Control, told reporters on a conference call that he had just returned from a visit to the US island territory, and was worried by what he had seen.
“Puerto Rico is on the front lines of the battle against Zika and it is an uphill battle,” said Frieden.
“I am very concerned that before the year is out there could be hundreds of thousands of Zika infections in Puerto Rico and thousands of infected pregnant women,” he added.
“The rainy season is around the corner and funding from Congress is urgently needed,” said Frieden.
The virus has already swept through Brazil, where thousands of babies have been born with microcephaly, a defect in which the head is unusually small.
Some microcephaly cases have been directly linked to infection with Zika virus while the mother was pregnant.
While researchers caution that Zika has not yet been proven to cause birth defects, evidence so far strongly suggests the possibility.
Frieden also said a link between Zika and Guillan Barre syndrome — in which the immune system attacks the nervous system — “is likely to be proven in the near future.”
Efforts to control mosquitoes have been further complicated by the discovery that some common repellants are not working.
“We are finding widespread resistance to some insecticides,” said Frieden.
– ‘Unmet’ needs –
Other top concerns listed by Frieden include the lack of access to contraception in Puerto Rico, a Caribbean island with some 3.5 million inhabitants.
Last month, the island territory declared a health emergency due to the Zika virus, which can be transmitted by sexual contact as well as by mosquitoes.
Health experts have urged women who want to become pregnant or who are pregnant to avoid travel to the more than 30 areas of the world where Zika is present — or if they live there, to postpone plans to get pregnant if possible.
Men are urged to use condoms, or refrain from sex with pregnant partners.
“Never before have we had a mosquito-borne infection that could cause birth defects on a large scale,” said Frieden.
“Most of the pregnancies in Puerto Rico are unplanned, unintended and there is an unmet need for contraception.”
The latest figures, released in February, showed that Puerto Rico has documented 22 cases of Zika. Updated figures are expected on Friday, Frieden said.
Health authorities anticipate “the number of cases in Puerto Rico at some point beginning to increase not steadily but dramatically,” he said.
– Rainy season –
There is no vaccine to prevent Zika, and in four out of five cases, the infection shows no symptoms. Otherwise, it may cause fever, rash and red eyes.
Speaking to reporters on the same call, Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said early vaccine trials may get under way by late summer or early fall, but reiterated that it will likely be years before an effective vaccine is widely available.
Some 100 CDC staff are working in Puerto Rico, as part of 750 CDC workers assigned to work on the Zika virus, Frieden said.
“There is nothing about Zika control that is quick or easy,” he added.
“The only thing quick is the mosquito bite that can give it to you. And the only thing easy are wrong answers.”
Since the well began leaking Oct. 23, thousands of people in the Porter Ranch area say they have suffered headaches, nosebleeds, nausea and other symptoms from the escaping gas. The smell comes from an additive called mercaptan that is used to warn people of leaking natural gas, which is ordinarily odorless.
Southern California Gas Co. is paying to relocate those who say they are being sickened.
On Oct. 23, gas company employees noticed a leak out of the ground near a well called SS-25. It was late afternoon, so they decided to come back in the morning to fix it.
The next day, however, their efforts were unsuccessful. Gas was now billowing downhill into Porter Ranch, an upscale community on the northern edge of the San Fernando Valley. Customers were beginning to complain about the smell.
Gas leaks are not uncommon, and it took a couple weeks for this one to become news. When Anderle heard about it, in early November, she pulled up the well record on a state website. The file dates back to when the well was drilled in 1953. As she looked it over, she zeroed in on a piece of equipment 8,451 feet underground called a sub-surface safety valve.
If it were working properly, the gas company would be able to shut down the well. The fact that SoCalGas hadn’t meant, to her, that it must be broken. The records indicated that it had not been inspected since 1976.
SS-25 was cemented only from the bottom up to a depth of 6,600 feet. The rest — more than a mile of steel pipe — was left exposed to the rock formation. At the top, the 7-inch casing is surrounded by an 11¾-inch surface casing, which is cemented to the rock. But a new well also would have a layer of cement between those casings to provide greater strength and protection from corrosion.
Gas is now leaking through a hole in the 7-inch casing at 470 feet down to the bottom of the outer casing at 990 feet, and out through the rock to the surface.
The corporate culture of SoCalGas is nothing if not deliberate. And so, in 2014, the company proposed a methodical effort to check each well for corrosion. It would take about seven years and cost tens of millions of dollars. The plan was part of a request to the Public Utilities Commission to increase customers’ monthly gas bills by 5.5 percent. The alternative was to fix leaks only as they occurred, which one executive warned could be dangerous and lead to “major situational or media incidents.”
The SoCalGas plan went well beyond the requirements imposed by the state Division of Oil, Gas and Geothermic Resources, or DOGGR. Steve Bohlen, the outgoing head of DOGGR, has said several times that it does not appear that Southern California Gas violated any regulations.
Gas has now been spewing out of the ground at Aliso Canyon for two months. The gas company expects it to continue for up to another three months. Methane is a potent contributor to climate change. By one estimate, the leak is producing greenhouse gas emissions equivalent to the tailpipes of 2.3 million cars.
The Aliso Canyon leak has increased the state’s methane emissions by 21 percent. As of now, 2.3 percent of the state’s entire carbon footprint is coming from one hole in the ground above Porter Ranch.
“This is an environmental disaster,” said Mayor Eric Garcetti, who stopped by Porter Ranch Community School in November, just before flying to Paris for the United Nations climate change conference. “It’s devastating. It makes you question the long-term sustainability of a carbon-based power system.”
The local impact also has been severe. About 30,000 people live in Porter Ranch, a bedroom community of gated developments with 4,000-square-foot homes that sell for $1 million or more. The neighborhood offers good schools, clean air and a sense of security. All of that has been disrupted. Many residents have experienced headaches, nosebleeds, nausea or other symptoms. Some 2,000 families have been moved to hotels or short-term rentals to escape the gas.
is also known as methanethiol and is a harmless but pungent-smelling gas which has been described as having the stench of rotting cabbages or smelly socks.
It is often added to natural gas, which is colourless and odourless, to make it easier to detect.
The gas is an organic substance, made of carbon, hydrogen and sulphur, and is found naturally in living organisms, including the human body where it is a waste product of normal metabolism. It is one of the chemicals responsible for the foul smell of bad breath and flatulence.
People who have eaten asparagus can experience the distinctive smell of mercaptan in their urine within 30 minutes of consuming the vegetable, which contains substances that are quickly broken down to methanethiol. However, not everyone is able to smell mercaptan in their urine as a genetic mutation in some people means they are immune to the odour.
The great advantage of mercaptan for industrial purposes is that it can be detected by most people in extremely small quantities, less than one part per million. This makes it an ideal additive to odourless gases, and, like natural gas, it is flammable.
What benzene is
Benzene is a chemical that is a colorless or light yellow liquid at room temperature. It has a sweet odor and is highly flammable.
Benzene evaporates into the air very quickly. Its vapor is heavier than air and may sink into low-lying areas.
Benzene dissolves only slightly in water and will float on top of water.
Where benzene is found and how it is used
Benzene is formed from both natural processes and human activities.
Natural sources of benzene include volcanoes and forest fires. Benzene is also a natural part of crude oil, gasoline, and cigarette smoke.
Benzene is widely used in the United States. It ranks in the top 20 chemicals for production volume.
Some industries use benzene to make other chemicals that are used to make plastics, resins, and nylon and synthetic fibers. Benzene is also used to make some types of lubricants, rubbers, dyes, detergents, drugs, and pesticides.
How you could be exposed to benzene
Outdoor air contains low levels of benzene from tobacco smoke, gas stations, motor vehicle exhaust, and industrial emissions.
Indoor air generally contains levels of benzene higher than those in outdoor air. The benzene in indoor air comes from products that contain benzene such as glues, paints, furniture wax, and detergents.
The air around hazardous waste sites or gas stations can contain higher levels of benzene than in other areas.
Benzene leaks from underground storage tanks or from hazardous waste sites containing benzene can contaminate well water.
People working in industries that make or use benzene may be exposed to the highest levels of it.
A major source of benzene exposure is tobacco smoke.
Norovirus (bacteria) has sickened 80 Boston College students who ate at a nearby Chipotle restaurant, state health officials said Tuesday.
“Initial testing conducted by the State Public Health has shown the presence of norovirus,” the health department said in a statement.
Although many of the students said they feared they’d been struck with the same E. coli bacteria that made 52 people in nine states sick this fall after eating at Chipotle restaurants, experts said the pattern of illness didn’t look like E. coli.
“Health officials in Boston believe this is likely a norovirus, which seems consistent with the pattern, in our estimation,” Chipotle spokesman Chris Arnold told NBC News.
Norovirus, sometimes known as the winter vomiting bug in the UK, is the most common cause of viral gastroenteritis in humans. It affects people of all ages. The virus is transmitted by fecally contaminated food or water, by person-to-person contact, and via aerosolization of the virus and subsequent contamination of surfaces. The virus affects around 267 million people and causes over 200,000 deaths each year; these deaths are usually in less developed countries and in the very young, elderly and immunosuppressed.
You can get dehydrated if you are not able to drink enough liquids. You may urinate less, have a dry mouth and throat, and feel dizzy.
30 Boston College students sick after eating at Chipotle.
City health officials ordered the outlet closed after an inspection showed the cooked chicken used to make burritos, tacos and other dishes was being kept at too low a temperature, an employee worked while showing signs of illness and because of the reports of possible foodborne illness.
Chipotle said it had voluntarily closed the restaurant in the Brighton section of the city.
“All 80 students have confirmed that they ate at the Chipotle Restaurant in Cleveland Circle during the weekend,” Boston College said in a statement.
Norovirus is notorious for causing large outbreaks of sickness and it can be spread by a single sick restaurant worker or one sick patron. Simple handwashing is often not enough to prevent its spread.
The Centers for Disease Control and Prevention says it’s still not sure what particular food caused the E. coli outbreak at Chipotle. A separate E. coli outbreak that’s made 19 people sick in seven states was linked to celery sold at Costco, 7-11, King Sooper and other stores.
Symptoms of both illnesses are similar — diarrhea, stomach cramps and fever. But norovirus is far more likely than E. coli to cause vomiting.
The most common symptoms are:
Other symptoms include:
Practice proper hand hygiene
Wash your hands carefully with soap and water—
especially after using the toilet and changing diapers, and
always before eating, preparing, or handling food.
Noroviruses can be found in your vomit or stool even before you start feeling sick. The virus can stay in your stool for 2 weeks or more after you feel better. So, it is important to continue washing your hands often during this time.
Alcohol-based hand sanitizers can be used in addition to hand washing. But, they should not be used as a substitute for washing with soap and water. See “Handwashing: Clean Hands Save Lives.”
Wash fruits and vegetables and cook seafood thoroughly
Carefully wash fruits and vegetables before preparing and eating them. Cook oysters and other shellfish thoroughly before eating them.
Be aware that noroviruses are relatively resistant. They can survive temperatures as high as 140°F and quick steaming processes that are often used for cooking shellfish.
Food that might be contaminated with norovirus should be thrown out.
Keep sick infants and children out of areas where food is being handled and prepared.
When you are sick, do not prepare food or care for others who are sick
You should not prepare food for others or provide healthcare while you are sick and for at least 2 days after symptoms stop. This also applies to sick workers in settings such as schools and daycares where they may expose people to norovirus.
Many local and state health departments require that food workers and preparers with norovirus illness not work until at least 48 hours after symptoms stop. If you were recently sick, you can be given different duties in the restaurant, such as working at a cash register or hosting.
Note: Evidence for efficacy of a cleaning agent against norovirus is usually based on studies using feline calicivirus (FCV)—a virus related to norovirus—as a surrogate. However, FCV and norovirus exhibit different physiochemical properties; thus, it is unclear whether inactivation of FCV by a specific cleaning agent reflects efficacy of such solutions against norovirus.
Wash laundry thoroughly
Immediately remove and wash clothes or linens that may be contaminated with vomit or stool (feces).
handle soiled items carefully without agitating them,
wear rubber or disposable gloves while handling soiled items and wash your hands after, and
wash the items with detergent at the maximum available cycle length then machine dry them.
The reality is there is no such thing as “toxic molds.” There are some mold species that are “toxigenic,” that is they produce “mycotoxins.” Mycotoxins are metabolites produced by molds that are capable of harming other living organisms. Molds evolved these metabolites as part of their strategy to battle bacteria (and each other). One of the most famous of these mycotoxins. . . . . . Read more > > > http://www.huffingtonpost.ca/blair-king/toxic-mold-truth_b_8469358.html
Picture – Black mold behind the surface of a wall – Santa Monica, CA
Because the natural reservoir host of Ebola viruses has not yet been identified scientist speculate on several vectors of virus’s transmission. The way in which the virus first appears in a human at the start of an outbreak is unknown. However, scientists believe that the first patient becomes infected through contact with an infected animal, such as a fruit bat or primate (apes and monkeys), which is called a spillover event. Person-to-person transmission follows and can lead to large numbers of affected people. In some past Ebola outbreaks, primates were also affected by Ebola, and multiple spillover events occurred when people touched or ate infected primates.
When an infection does occur in humans, the virus can be spread in several ways to others. Ebola is spread through direct contact (through broken skin or mucous membranes in, for example, the eyes, nose, or mouth) with
blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with Ebola
objects (like needles and syringes) that have been contaminated with the virus
infected fruit bats or primates (apes and monkeys)
Ebola is not spread through the air or by water, or in general, by food. However, in Africa, Ebola may be spread as a result of handling bushmeat (wild animals hunted for food) and contact with infected bats. There is no evidence that mosquitos or other insects can transmit Ebola virus. Only a few species of mammals (for example, humans, bats, monkeys, and apes) have shown the ability to become infected with and spread Ebola virus. (more…)