Fungi and Immunity: Dr. Peter Rice



Fungi

 

I recently found myself at the Hotel Galvez in Galveston, Texas at the Gordon Research Conference on the Immunology of Fungal Infections. The international conference brought together research and clinical scientists studying fungal infection.  I was a co-author on two research posters with collaborators from East Tennessee State University.  Of course, I’m also a “fun guy”.

This was my first visit to Galveston Island. I was impressed by the Gulf of Mexico, which seemed angry at my arrival but calmer as the week progressed.  The Hotel Galvez was a wonderful location right on the Gulf and given that this is the off-season, I’d love to see everything during the summer season.

Fungi and Immunity


Fungi have always impressed me as underappreciated in human disease.

The microbes which we associate with disease and infection are generally recognized because they can be cultured and identified. Fungi can be harder to culture, so it is easier for them to go unrecognized; they can still kill patients. There are also fungi, such as Candida albicans – responsible for oral thrush and vaginal yeast infections – that are always present but kept in check by other “good” microorganisms. We often see Candida infections following a course of antibiotics that compromises the normal “good” bacteria of the body.

There are many fewer antifungal drugs than antibacterial drugs. Fluconazole is a popular and easy drug for some fungal infections – like oral thrush or vaginal Candidiasis. Other antifungals can have adverse effects or drug interactions that limit their use, and most serious antifungal drugs are injectable and poorly tolerated. The “gold standard” for serious fungal infections is the injectable drug amphotericin B, called “amphoterrible” because of its common adverse effects.

The meeting concentrated on several fungi. Candida albicans is a common cause of mucosal infections, including oral thrush and vaginal candidiasis. There is also a strain of Candida that is resistant to most drugs.  That strain has not clinically entered the US at the present time.

Fungi are more serious for immunocompromised patients and those with current disease. Cryptococcus neoformans is a fungal infection with 500,000 cases per year in patients with HIV/AIDS and 1-5% of transplant patients.

One of the most interesting facts I learned at the meeting was the relationship of Influenza to fungal infection.  One of the research groups examined the incidence of Aspergillosis – an often deadly fungal infection – in patients in the ICU with serious influenza infections.  About 1 in 5 patients in the ICU with influenza also have an Aspergillus infection. This is another great reason to have your influenza vaccination. And BTW, it is not too late for you to get this year’s flu vaccine.

I’ve always believed that there is some microbe out there with my name on it.

One group presented data on susceptibility to Blastomycosis, from a fungus found in decaying wood and soil, particularly in the Mississippi and Ohio River valleys.  It turns out that Blastomyces dermatitidis really does have someone’s name on it, insofar as individuals of the Southeast Asian Hmong ethnicity have about a 10-fold increase in susceptibility to this fungal infection. I still don’t know what microbe has my name on it, but the information supports the view that there are certain microbial organisms which can pose a particular danger to each of us.  

My enthusiasm for vaccinations was increased. My friend Dave was reminding me that there are so many fungi and ineffective drug treatments, that one of the treatment strategies that is most likely to be effective is vaccination, which will allow the body to more quickly recognize and response to fungal infection.  

There’s a lot going on in advancing therapy for fungal infection. Your prescriber or pharmacist can help answer any questions you might have, and offer advice on keeping you healthy.  

https://www.cdc.gov/fungal/

Dr. Peter J. Rice

About Dr. Peter J. Rice

Dr. Peter J. Rice is a professor of Pharmacology emeritus at the East Tennessee State University Quillen College of Medicine and Professor of Clinical Pharmacy at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. --------------------------------------------------------------------------He received his BS in pharmacy from Northeastern University, PhD in pharmacology from the Ohio State University and PharmD from the University of Kentucky. He is a Board Certified Pharmacotherapy Specialist and practices in the ambulatory care and community pharmacy settings. Professor Rice is the author of Understanding Drug Action: An introduction to pharmacology (APhA, 2014) and is a fellow of the American Pharmacists Association. --------------------------He welcomes interesting medication questions and suggestions for future columns.
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