Gregor Campbell, an art teacher from Paisley in Scotland, is joining UK doctors this autumn to warn gardeners who have asthma or a weak immune system to be on alert for a deadly fungus that lurks in compost heaps and in piles of rotting leaves.
Experts advise wearing masks to protect against the microscopic dust that is given off when rotting leaf, plant and tree mulch is moved, particularly when people tidy up their gardens in preparation for winter.
Father of three Gregor (47) knows first hand the devastating affect the fungus can have. Two year’s ago he developed a chronic fungal infection after cutting up wet and rotting logs to store and dry out for the winter.
He recalls: “ That summer I was being treated by the doctor for a lung condition, but I had been cycling to work every day and was I feeling well. One weekend I started getting night sweats and on the Monday I was in hospital. I was told I had pneumonia and was treated with antibiotics. I wasn’t getting better. I lost a lot of weight. I only started to recover when the consultant correctly diagnosed chronic pulmonary aspergillosis and prescribed me special drugs to fight the fungal infection.”
Gregor now only has two thirds of his breathing capacity after a fungal mass the size of a tennis ball was discovered in his lungs, and he has had to reduce his teaching time to three days a week. However, he considers himself one of the lucky ones. “I was diagnosed pretty quickly and I am being looked after by the experts. I always thought that outside dirt was safe dirt. The suddenness of the whole thing shocked me the most. I would caution anyone contemplating clearing up their garden for the winter to wear a mask – and keep well away from mouldy logs and rotting leaves.”
Professor David Denning and his team at the National Aspergillosis Centre*, in Manchester, have issued the warning after treating a growing number of patients who have developed the condition from inhaling the Aspergillus fungal spores. He explains: “ Keen gardeners bed down their gardens for the winter. For most of us there is no problem. But for others it can cause long term breathing difficulties and damage that can be treated but never cured.
“Most of us are either immune to the fungus or have a sufficiently healthy system to fight the infection. But, in asthma sufferers it can produce coughing and wheeziness, and in people with weak or damaged immune systems, such as cancer patients undergoing chemotherapy, Aids patients and people who have an auto immune disease like Gregor, the fungus can cause pulmonary aspergillosis – a condition which can cause irreparable, and sometime fatal, damage to the lungs and sinuses.
“Aspergillus is a fungus that occurs everywhere in the world and normally lives on dead animal or plant material, in this role it is vitally important to the environment and for the recycling of organic material necessary for life.
It produces microscopically small spores that are extremely light and float easily in the air and by this mechanism it is spread.
“Normally, when aspergillus spores are inhaled by people, their immune system recognises the spores as foreign and they are destroyed and no infection arises. Occasionally, in an individual with a weakened immune system or who has a pre-existing medical condition the aspergillus spores can grow inside a lung or a wound. My advice would be when in doubt wear a protective mask to be safe rather than sorry,” he adds.
*This is the first centre in the world dedicated to aspergillosis. It is based at Wythenshawe Hospital, UHSM, in Manchester for the diagnosis and treatment of chronic pulmonary aspergillosis, and houses specialist diagnostics and research into all forms of aspergillosis. Phone: 0161 291 5811.
To speak with Professor Denning call 0161 291 5811 or mobile 07802 48193, or Gregor Campbell call 01505 615537, or for more information please contact Susan Osborne, Director of Communications at The Goodwork Organisation on 07836 229208
What is Aspergillosis?
Diseases caused by the fungus Aspergillus are called aspergillosis. The severity of aspergillosis is determined by various factors, but one of the most important is a weakened immune system. Infections can affect any area of the body, but by far the most common are the lungs and sinuses. There are several distinct types of aspergillosis as described briefly below.
Aspergilloma and chronic pulmonary aspergillosis
In this disease the fungus – usually Aspergillus fumigatus – grows within a cavity of the lung, which was previously damaged during another lung illness such as tuberculosis or sarcoidosis. The spores penetrate the cavity and germinate; if a fungal ball forms within the cavity it is called an aspergilloma.
Any lung disease that causes cavities in a lung can leave a person open to developing an aspergilloma see underlying diseases. In some people, cavities in the lung are formed by Aspergillus, and no fungal ball is present. The fungus secretes toxic and allergic products, which may make the person feel ill. The person affected may have no symptoms (especially early on). Weight loss, chronic cough, and feeling rundown and tired are common symptoms. Coughing of blood (haemoptysis) can occur in up to 50-90% of affected people and can be severe.
Allergic bronchopulmonary aspergillosis (ABPA)
This is a condition, where a person develops an allergy to the spores of the Aspergillus moulds. Asthmatic patients can be allergic to Aspergillus spores – up to 5% of asthmatics might get this at some time during their lives.
ABPA is also common in cystic fibrosis patients, as they reach adulthood. The symptoms are similar to those of asthma: intermittent episodes of feeling unwell, coughing and wheezing.
People with invasive aspergillosis usually have a fever and some lung symptoms (may be a cough, chest pain, discomfort or breathlessness) that do not respond to standard antibiotics. This condition is usually only diagnosed in a person with low defenses such as a bone marrow transplant patient, following cancer treatment, or AIDS patients or major burns cases. There is also a rare inherited condition that gives people low immunity (chronic granulomatous disease) that puts affected people at moderate risk.
Chest X-rays and CT scans show abnormalities and help to locate the disease. Bronchoscopy (inspection of the inside of the lung with a small tube inserted via the nose) is often used to help to confirm the diagnosis along with cultures and blood tests.
In people with particularly poor immune systems, the fungus can transfer from the lung through the blood stream to the brain or to other organs, including the eye, the heart, the kidneys and the skin. Usually this is a bad sign as the condition is more severe and the person is very ill. This condition can be fatal and the best chance of survival is with an early diagnosis and early treatment with antifungals.
Aspergillus disease can happen in the sinuses leading to Aspergillus sinusitis. Just as in the lungs, Aspergillus can cause the three diseases in the sinus – allergic sinusitis, a fungal ball or invasive sinus aspergillosis. The fungal ball caused by Aspergillus happens in a similar way to an aspergilloma. In those with normal immune systems, stuffiness of the nose, chronic headache or discomfort in the face is common.
When patients have damaged immune systems – if, for example they have had cancer or have had a bone marrow transplant – Aspergillus sinusitis is more serious. In these cases the sinusitis is a form of invasive aspergillosis. The symptoms include fever, facial pain, nasal discharge and headaches. The diagnosis is made by finding the fungus in fluid or tissue from the sinuses and with scans.
There are a number of antifungal drugs that are used to treat aspergillus infections – each type of aspergillosis may require different medication, this is described in more detail here, with patient information leaflets also available. The principle antifungal drugs used for the treatment of aspergillosis are Amphotericin B, Itraconazole, Voriconazole, Posaconazole, Caspofungin and Flucytosine. Some resistant strains of Aspergillus species have been identified so antifungal drug resistance is monitored alongside blood levels of a drug to check optimal dosing.
Professor David Denning FRCP FRCPath FMedSci
Professor of Infectious Disease and Global Health, The University of Manchester
Director, National Aspergillosis Centre, University Hospital of South Manchester (Wythenshawe), Manchester, UK
David Denning is an infectious diseases clinician with expertise in fungal diseases. He is Director of the National Aspergillosis Centre, Manchester, UK that sees over 300 new patients annually with aspergillosis. He leads a multi-disciplinary research and clinical group, spanning fundamental genomics to randomised and phase 4 clinical trials in fungal diseases (infection and allergy). Major past contributions include describing azole resistance and mechanisms in Aspergillus, leading the effort to sequence the A. fumigatus genome (3 papers published in Nature), leading the phase 2 study and then RCT demonstrating the superiority of voriconazole over amphotericin B for invasive aspergillosis and describing and demonstrating antifungal efficacy in severe asthma with fungal sensitisation (SAFS). His current interests are chronic and allergic pulmonary fungal disease, the global burden of fungal infection and azole resistance in Aspergillus.
He has published more than 450 papers, books and book chapters, including an undergraduate textbook of Medicine. He is heavily involved in postgraduate teaching, both clinical scientists and physicians. He was instrumental in the establishment of the Mycology Reference Centre in Manchester (2009), which grew out of the Fungal Testing Laboratory he founded in 1991. His work has been cited over 37,500 times (Google scholar H-index 93).