image by: Scott Darbey
Without fungi, rain forests could not exist - David Attenborough
Maybe it’s a matter of climate change or global warming. Perhaps we are being revisited by continental drift. Whatever its cause, we here in the temperate latitudes of North America are being menaced by a threat that not too long ago could only be found in the tropical regions of the globe.
No, we’re not talking about great white sharks, predatory man-eating barracudas, or killer bees that have migrated north in a deadly attack to destroy our civilization. Ironically, the threat we are facing comes in the form of a tiny yeast organism called Cryptococcus and can cause the deadly fungal infection, cryptococcosis (“crypto” for short).
The fungus has been around for ages and biologists have been aware of its danger since it is responsible for the deaths of about a half million people a year globally. Most of the casualties are attributed to C. neoformans, one of the two varieties of the fungus, and they occur in many of the countries comprising sub-Saharan Africa where a significant percentage of the population have immune systems which have been compromised by poverty and disease. The infection usually begins in the lungs and spreads from there to spinal cord and the brain (Neuromeningeal cryptococcosis).
Generally, we here in the western world turn away and shake our heads in disbelief at these types of exotic diseases which befall humans who live “over there” in the tropical areas of the Third World globe. However, a recent development has made us sit up and take note.
A second, more potent variety of Cryptococcus (C. gattii) has found its way out of the tropics and is rearing its head right here in our more northern climes. Once considered primarily a tropical fungus native to Brazil, New Guinea, and Australia, the yeast which lives on trees and in the soil has made an appearance, as of 1999, on Vancouver Island in British Columbia, Canada. What makes it more frightening is that C. gattii is causing the potentially deadly infection to occur not only in HIV and other immune deficient victims, but in otherwise young and healthy adults.
If that’s not scary enough, the infection is now being labelled as an “outbreak” by several governments and is presently spreading across western North America. Because it affects both humans and animals, a spike in the number of diagnosed cases was noticed in the year 2000 in veterinary hospitals. By 2007, British Columbia’s Centre for Disease Control had documented more than two hundred cases.
Even more frightening is the observation three years later that the deadly outbreak had spread across the U.S. border, now infecting both animals and humans in Washington, Oregon, California, Idaho, and even Hawaii. What is particularly puzzling is the statistic that, although the fatality rate in persons diagnosed with the fungal infection in Canada is one in ten, the rate is more than three times higher in the United States.
We have long been vigilant with bacterial and viral infections and have invested billions in researching new drugs and other treatments to combat these microbes which invade our bodies and cause damage to our organs and biological systems. Yeasts, on the other hand, do not exactly strike terror in our hearts. Sure, they may bring about discomfort and itching within the folds of our skin or may cause our toenails to yellow and curl at obscene angles, but we rarely consider them as life-threatening.
It is perhaps because we have underestimated fungal infections that we have allowed them to go misdiagnosed in recent years.
How do these yeast spores get through our bodily defense systems to inflict the damage they do? For starters, the infection is not contagious and isn’t passed from person to person. It starts innocently enough when we inhale some of the white powder that has contaminated some wood, soil, or even bird droppings we may have come in contact with. Some victims catch the infection while chain-sawing lumber or running exotic hardwood boards through a planer. The fungal spores in the powder work their way into the lungs and from there spread to other parts of the body, especially into the meninges (the protective layer covering the brain and spinal cord). Once there, they can prevent the brain from reabsorbing cerebrospinal fluid, thereby causing a buildup of the fluid within the skull. This pressure triggers the excruciating headaches commonly associated with the infection. At this point, the only possible action that can still save the victim is a lumbar puncture or spinal tap (which runs its own fatal risks).
Before the symptoms get this severe, there are some telltale signs that a fungal infection is at work. The main problem is that many of these symptoms are similar to flu-like indicators often associated with bacterial and viral infections. Coughing, shortness of breath, chest pain, fever, nausea, as well as sensitivity to light, confusion, and behavior changes are some of the signs pointing perhaps to cryptococcosis.
Nevertheless, this particular fungal infection seems to have passed beneath the watchful eye of the World Health Organization (WHO) and there has been practically zero funds spent on combatting the disease up to now. Even the Bill Gates Foundation which commits millions of dollars to research on neglected tropical diseases, has not been able to hear the “squeak” in this wheel.
Changes are coming, however, mainly because what used to be considered a problem in the tropics “over there”, has now moved considerably closer “over here”. These fungal infections are being diagnosed more successfully with increased awareness by the medical powers that be. Early detection is saving lives and genetic analysis of the fungus is helping to develop newer treatments, antifungal drugs, and vaccines.
A leader in this research development, Immuno Mycologics (IMMY), founded in Norman, Oklahoma, is one of the fastest growing private companies in America and has been working on simpler tools to diagnose fungal infections. IMMY has been developing Cryptococcal Antigen Lateral Flow Assay, or CrAg LFA, which experts believe will be a major diagnostic to help detect and stop cryptococcal meningitis.
With this new awareness, we may find the will to fight off these fungal infection threats before they become established in our part of the globe. The new information and treatments will hopefully be available to help save the lives of those who contract the disease in the tropical and subtropical regions of the globe. Like Superman, we may be on our way to finding the antidote for this health “cryptonite”.
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