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Fungal Illness: Dr. Marinkovich - Diagnosis

IV. Diagnosis

The diagnosis of fungal hypersensitivity syndrome rests on four criteria: Exposure to an identified heavily contaminated source, appropriate symptoms temporally related to exposure, high serum specific IgG levels to molds, and finally a positive response to therapy. IgE antibodies are usually not involved in hypersensitivity phenomena secondary to exposure to high dose antigen such as fungi, foods and occupational exposures to organic matter (Fink, 1984). Skin tests are, therefore of little, if any, value. The fourth criterion for diagnosis is an essential feature of all medical therapy, namely, the clinical improvement resulting from a fungal avoidance regimen. When this condition is not met, the diagnosis must be revisited. Either avoidance is inadequate, therapy is insufficient or the diagnosis is wrong.

A. Antibodies or lack thereof

Everyone is exposed to fungi in daily living and, therefore, antibodies to fungi are found in nearly everyone. They have been shown to be protective, except for patients whose immune systems are inadequate in response. These patients are extremely susceptible to fungal infection. In such cases, e.g., AIDS patients, cancer patients (especially if on chemotherapy), transplant recipients on immunosuppressive drugs, and patients with acquired or congenital immune deficiency, especially involving cellular immunity, fungal colonization can be life threatening. In most healthy individuals, the constant exposure to ambient fungal spore levels is handled easily by normal mucosal cleansing mechanisms and the ever-vigilant immune system. Ill effects do not generally occur in the normal population. However, this statement is not true for all otherwise “healthy” individuals. The extreme example of this is seen in certain occupational fungal diseases, e.g., farmer’s lung (Emanuel et al., 1964), malt workers pneumonitis (Riddle et al., 1968), etc. where enormous exposures occur on a daily basis and virtually everyone can be symptomatic. In such cases the inflammatory changes produced in the lungs can cause severe destruction of lung tissue, extensive colonization of lungs with fungi and bacteria, and slow progression to respiratory deficiency and death (Pepys, 1969). Such patients must be treated aggressively with complete cessation of further exposure, high doses of systemic and inhaled antifungals (Stevens et al. 2000) (Nark et al., 2003) and the judicious use of systemic steroids to reduce inflammation and arrest the progressive damage or remodeling of the lungs (Kaltreider, H.B., 1993). Steroids actually encourage fungal growth by suppressing the inflammatory reaction and their use must be carefully monitored to walk the tightrope between too much steroid encouraging fungal growth and too little allowing progressive destruction of lung tissue.

B. Individual Variations in Response

The levels of fungi in contaminated homes and office buildings may be quite high but are generally not nearly as high as encountered in the special occupational situations previously mentioned above. Still they are high enough to cause serious illness in non-immuno-compromised individuals (Burr, 2001). A considerable variation in response to moldy homes among members of the family is common. In some cases all members of the family are affected with some small variations in severity and in the organs infected, e.g., skin, lungs, sinuses, gastrointestinal tract, headaches, etc. In other instances the variation in severity of illness can be considerable among family members, one person at one extreme may be quite ill, even disabled, while another at the other extreme has little to show for the exposure. This is understandable in that not all rooms in the house may be equally contaminated and those sleeping in the rooms with highest levels of contamination are likely to have more severe symptoms. Variations may be seen in the amount of time each individual spends at home. And then there is genetic polymorphism where each individual is endowed with his own unique immune responsiveness and two individuals in the same family or bloodline may respond quite differently to the same exposure. In studies done with serum sickness where normal, healthy individuals were given different volumes of horse serum intravenously, some individuals developed symptoms (Von Pirquet, 1951) with relatively low volumes of serum while others required ten times more serum to show the same symptoms. The conclusion of these studies was that everyone was susceptible, but there is a dose dependent susceptibility among different individuals.

Sustained exposure to airborne fungal spores at levels far below the occupational disease levels in otherwise normal healthy individuals will produce symptoms in some percentage of patients. The exact percentage of susceptible individuals is likely to be low, perhaps under 1% of the population. But with the widespread contamination of home and workplaces in this country, with perhaps 30% of the schools, homes and offices involved, the actual number of affected individuals can easily reach one million. One percent of the population is about three million individuals and a third of these would be one million. This is an epidemic. Unfortunately, many of these cases are not recognized by the medical community and go undiagnosed and untreated. Thanks to the Internet and the media publicizing the results of litigation involving mold cases, the public’s awareness of the problem has grown. Hopefully, this will induce more health caregivers to learn about fungal illness.

C. Hypersensitivity

The human immune response, part of the body’s system of adaptive immunity can be amazingly sensitive. A person allergic to cats can sense the presence of cat dander in a room months after the cat has departed. And rarely, one reads of a sudden death from anaphylaxis provoked by exposure to a tiny amount of antigen such as vespid venom from a single bee sting or the steam rising from a fish stew, or tiny particles of peanut contaminating a package of almonds processed on machinery previously used to process peanuts (Samson, 1992). The extreme sensitivity potential of the immune system is rarely seen but frightening when it occurs. When the number of individuals exposed to such spore levels is very high, as seems to be the case today in homes, schools and workplaces, a significant number of cases will occur. To deny this is akin to denying the existence of significant pollen or cat allergies because the great majority of people do not show such symptoms on exposure. Genetic polymorphism is the basis for a considerable number of differences within the human population and the immune response, based on the same mechanisms, shows the same wide variations in response among individuals.

Quotes

"My symptoms persisted and eventually turned into lethargy and depression. At the age of 26, I required a nap every evening after work."

– Jennifer

"We all suffered from headaches, hormonal body temperature fluctuations, brain fog, fatigue, difficulty breathing, thrush, rashes, and yeast infections... we vacated our home two weeks ago."

– Anonymous

"...at age 35 or 36 I started to become allergic to everything, and I got asthma at age 36... I went to doctor after doctor after doctor and was desperate for help, but nobody could help me."

– Mia

"I knew it was mold, but doctors kept telling me I had anxiety. I was sitting in my office and could not remember who I was talking to, or what we were talking about."

– Brenda

"I have been sick for almost 6 months now and doctors were not able to figure out why. I finally put it all together after going away for vacation for a week and suddenly my symptoms were going away."

– Anonymous

"I started finding myself sitting on the floor in rooms of my house and not remembering how I got there, what I was doing before, or how long I had been there."

– Brenda

"I'm new at this, but today I cleaned my bathroom with baking soda and vinegar. It's much better not having those strong chemical smells afterwards."

– Anonymous

"We were having a lot of health problems and had been to the doctor countless times... we had large circles of slimy greenish-black mold on the bathroom ceiling, where it had caved in a few months before."

– C.

"We had some water leaks in our home... we never thought we needed to clean out and remove the floor, the ceiling, or the drywall... my two small children and I have remained constantly sick for years in this home."

– Mia

"The entire time we lived in our (mold-infested) house the kitchen sponge would get musty smelling within 3-4 days. It was so strange. I had to buy a pack of sponges nearly every week."

– Anonymous

"I was skeptical at first that these (natural cleaning) products would work, but they work better than the stuff I buy at the store! We will soon be moving to the personal care products as well!"

– Jennifer

"Both of my sons went downhill quickly and coughed for months... They both lost their ability to read, had profound vision disturbances, and had phenomenal gastric issues."

– Lee

"I've been living in a mold-infested home for 13 months... I was going CRAZY! Finally figured it out... Just a few days of recovering in a mold-free home and I feel AMAZING!!!"

– Lauren

"My daughter started having digestive problems... heart palpitations... coughing episodes... muscle/joint pain... asthma/allergies... Her doctor finally advised me to check for mold in our home."

– Anonymous

"The ERMI mold test as well as your helpful articles and Toxic Talk Tuesday programs have helped us avoid a terrible mistake in purchasing a new home."

– Angela

"In my moldy home if I left the wet clothes in the washer they would get musty very quickly and I'd have to re-wash... Sometimes I'd run a load, go to work, and they'd be musty when I returned that evening."

– Anonymous

"I had been struggling with headaches, head fog, breathing difficulties (unable to get a full breath), constant scalp tingling, migraines, nausea, feeling spacey/detached, and severe itchy skin."

– Anonymous

"Our family has been out of our home for 9 months due to mold... I am so scared and weak from all of this. We have lost friends; family members don't understand."

– Anonymous

"My daughter has had many blood samples taken to test for everything imaginable and her doctor just seems puzzled. Everything comes back normal."

– Anonymous

Dedication