INDEX
• About: Aspergillosis, healthatoz.
• About: Aspergillosis, respiratory-lung.
• About: Aspergillosis, Wikipedia.

• Article: Aspergillosis, Merck.
• Article: Aspergillosis, doctorfungus.
• Article: Aspergillosis. (CHART) Forms of.

• Finding: Diagnosing Aspergillosis presence.
• Remedy: selective Serotonin reuptake inhibitors (SSRIs).
• Remedy: CDC Treatment Guidelines; Drugs.
• Remedy: What has worked for Recovering persons.
• Remedy: Treatment by drugs or surgery.
  1. CDC, USA Center for Disease Control
  2. American Thoracic Society
  3. HealthAtoz
  4. Doctor Fungus

• Practice Guidelines, Infectious Diseases Society.
• Danger: Aspergillus fumigatus isolate surveillance.
• Article: Walking Pneumonia.
• Basics: Lung microbiome.

  Article: Fungal Infection (Aspergillosis) in Dogs.

  Article: Canine Aspergillosis in Dogs.

  Article: Nutrition for Dogs - Eagle, Now.

  Review: Holistic Select Dog Food ingredients.

• References.
• Related Sites and Therapy Information.
• COMMENT: A Quiet epidemic that sickens and kills.

About: Aspergillosis, healthatoz. INDEX
http://www.healthatoz.com/healthatoz/Atoz/common/standard/
transform.jsp?requestURI=/healthatoz/Atoz/ency/aspergillosis.jsp

Aspergillosis refers to several forms of disease caused by a fungus in the genus Aspergillus.
Aspergillosis fungal infections can occur in the ear canal, eyes, nose, sinus cavities, and lungs.
In some individuals, the infection can even invade bone and the membranes that enclose the brain and spinal cord (meningitis).

Aspergillosis is primarily an infection of the lungs caused by the inhalation of airborne spores of the fungus Aspergillus.
Spores are the small particles that most fungi use to reproduce. Although virtually everyone is exposed to this fungus in their daily environment, it rarely causes disease. When Aspergillus does cause disease, however, it usually occurs in those individuals with weakened immune systems (immunocompromised) or who have a history of respiratory ailments.

Because it does not present distinctive symptoms, aspergillosis is generally thought to be underdiagnosed and underreported. Furthermore, many patients with the more severe forms of aspergillosis tend to have multiple, complex health problems, such as AIDS or a blood disorder like leukemia, which can further complicate diagnosis and treatment.

Once considered particularly rare, the incidence of reported aspergillosis has risen somewhat with the development of more sophisticated methods of diagnosis and advances made in other areas of medicine, such as with the increased use of certain chemotherapeutic and corticosteroid drugs that are extremely useful in treating various types of cancer but that decrease the individual's immune response, making them more susceptible to other diseases like aspergillosis. ...

* Allergic bronchopulmonary aspergillosis (ABPA) is seen in patients with long-standing asthma, particularly in patients taking oral corticosteroids for a long period of time. This is usually the least serious and most treatable form.

* Aspergilloma refers to the mass formed when fungal spores settle into or colonize areas of the lung that have been pitted and scarred as a result of tuberculosis or prior pneumonia. There are several available treatments, although the success rate varies with each treatment.

* Invasive fungal infection refers to rare cases in which the fungus spreads throughout the body via the blood stream and invades other organ systems. Once established, invasive fungal infections are extremely difficult to cure and, as a result, the associated death rate is extremely high.

Prevention
Fungal infection by Aspergillus presents a major challenge, particularly in the patient with a suppressed immune system (immunocompromised). Hospitals and government health agencies continually seek ways to minimize exposure for hospitalized patients.

Practical suggestions are minimal but include moving leaf piles away from the house. Unfortunately, overall avoidance of this fungus is all but impossible because it is present in the environment virtually everywhere.

Research efforts are being directed at enhancing patients' resistance to Aspergillus rather than trying to eliminate exposure to the fungus. Given the growing number of people with immune disorders or whose immune systems have been suppressed in the course of treating another disease, research and clinical trials for new antifungal agents will be increasingly important in the future.

About: Aspergillosis, respiratory-lung. INDEX
http://respiratory-lung.health-cares.net/aspergillosis-symptoms.php

The most common symptoms of aspergillosis are

pain in the sinuses, 
pain in the nose, or 
pain in the ear canal; 
facial swelling; 
cough and 
difficulty breathing; 
chest pain; and 
fever, and 
night sweats. 

Aspergillosis affecting the deeper tissues makes a person very ill. ...
fever, 
chills, 
shock, 
delirium, and 
blood clots. ...
kidney failure, 
liver failure (causing jaundice), and 
breathing difficulties ...
Death ... 

Aspergillus infection of the ear (called otomycosis), can produce itching and a discharge, sometimes noticed as a spot on the pillow.

Fungal infection of the cornea of the eye in a susceptible person can result in blindness, if not diagnosed and treated promptly.

About: Aspergillosis, Wiki. INDEX
https://en.wikipedia.org/wiki/Aspergillus
LINK 2: http://www.cdc.gov/fungal/diseases/aspergillosis/definition.html
LINK 3: http://www.cdc.gov/fungal/diseases/aspergillosis/symptoms.html

Aspergillosis is the group of diseases caused by Aspergillus.
The most common subtype among paranasal sinus infections associated with aspergillosis is A. fumigatus.
The symptoms include fever, cough, chest pain, or breathlessness, which also occur in many other illnesses, so diagnosis can be difficult. ...

In humans, the major forms of disease are:

Allergic bronchopulmonary aspergillosis (ABPA),
which affects patients with respiratory diseases such as asthma, cystic fibrosis, and sinusitis;
... causes inflammation in the lungs and allergy symptoms such as coughing, wheezing, shortness of breath, and, fever (in rare cases) ... but doesn't cause an infection.

Allergic Aspergillus sinusitis:
Aspergillus causes inflammation in the sinuses and symptoms of a sinus infection (runny nose, stuffiness, headache, reduced ability to smell) ... but doesn’t cause an infection.

Aspergilloma, a "fungus ball" that can form within cavities such as the lung or sinuses, but usually does not spread to other parts of the body. Symptoms include Cough, Coughing up blood, Shortness of breath.

Chronic pulmonary aspergillosis:
a long-term (3 months or more) condition in which Aspergillus can cause cavities in the lungs.
One or more fungal balls (aspergillomas) may also be present in the lungs.
Symptoms include: Weight loss, Cough, Coughing up blood, Fatigue, Shortness of breath.

Invasive aspergillosis:
a serious infection that usually affects people who have weakened immune systems, such as people who have had an organ transplant or a stem cell transplant. Invasive aspergillosis most commonly affects the lungs, but it can also spread to other parts of the body. Usually occurs in people who are already sick from other medical conditions. Symptoms can include:

    Fever
    Chest pain
    Cough
    Coughing up blood
    Shortness of breath
    Other symptoms can develop if the infection spreads from the lungs to other parts of the body.

Acute invasive aspergillosis,
a form that grows into surrounding tissue, more common in those with weakened immune systems such as AIDS or chemotherapy patients

Cutaneous (skin) aspergillosis:
Aspergillus enters the body through a break in the skin (for example, after surgery or a burn wound) and causes infection, usually in people who have weakened immune systems. Cutaneous aspergillosis can also occur if invasive aspergillosis spreads to the skin from somewhere else in the body, such as the lungs.

Disseminated invasive aspergillosis, an infection spread widely through the body

Aspergillosis of the air passages is also frequently reported in birds, and certain species of Aspergillus have been known to infect insects.

Some Aspergillus species cause serious disease in humans and animals.
The most common pathogenic species are A. fumigatus and A. flavus, which produces aflatoxin which is both a toxin and a carcinogen, and which can contaminate foods such as nuts. The most common species causing allergic disease are A. fumigatus and A. clavatus. Other species are important as agricultural pathogens. Aspergillus spp. cause disease on many grain crops, especially maize, and some variants synthesize mycotoxins, including aflatoxin. Aspergillus can cause neonatal infections.

A. fumigatus (the most common species) infections are primary pulmonary infections and can potentially become a rapidly necrotizing pneumonia with a potential to disseminate. The organism can be differentiated from other common mold infections based on the fact that it takes on a mold form both in the environment and in the host (unlike Candida Albicans which is a dimorphic mold in the environment and a yeast in the body).

Aspergillus was first catalogued in 1729 by the Italian priest and biologist Pier Antonio Micheli.
Viewing the fungi under a microscope, Micheli was reminded of the shape of an aspergillum (holy water sprinkler), from Latin spargere (to sprinkle), and named the genus accordingly. Aspergillum is an asexual spore-forming structure common to all Aspergillus species; around one-third of species are also known to have a sexual stage.

Species of Aspergillus are important medically and commercially.
Some species can cause infection in humans and other animals.
Some infections found in animals have been studied for years, while other species found in animals have been described as new and specific to the investigated disease, and others have been known as names already in use for organisms such as saprophytes. More than 60 Aspergillus species are medically relevant pathogens. For humans, a range of diseases such as infection to the external ear, skin lesions, and ulcers classed as mycetomas are found.

Other species are important in commercial microbial fermentations.
For example, alcoholic beverages such as Japanese sake are often made from rice or other starchy ingredients (like manioc), rather than from grapes or malted barley. Typical microorganisms used to make alcohol, such as yeasts of the genus Saccharomyces, cannot ferment these starches. Therefore, koji mold such as Aspergillus oryzae is used to first break down the starches into simpler sugars.

Members of the genus are also sources of natural products that can be used in the development of medications to treat human disease.

Perhaps the largest application of A. niger is as the major source of citric acid; this organism accounts for over 99% of global citric acid production, or more than 1.4 million tonnes per year. A. niger is also commonly used for the production of native and foreign enzymes, including glucose oxidase, lysozyme, and lactase (see section 2 in http://www.fda.gov/downloads/Food/IngredientsPackagingLabeling/GRAS/NoticeInventory/UCM400718). In these instances, the culture is rarely grown on a solid substrate, although this is still common practice in Japan, but is more often grown as a submerged culture in a bioreactor. In this way, the most important parameters can be strictly controlled, and maximal productivity can be achieved. This process also makes it far easier to separate the chemical or enzyme of importance from the medium, and is therefore far more cost-effective.

A. nidulans (Emericella nidulans) has been used as a research organism for many years and was used by Guido Pontecorvo to demonstrate parasexuality in fungi. Recently, A. nidulans was one of the pioneering organisms to have its genome sequenced by researchers at the Broad Institute. As of 2008, a further seven Aspergillus species have had their genomes sequenced:

• the industrially useful A. niger (two strains),
• A. oryzae, and
• A. terreus, and

  the pathogens

  A. clavatus,

  A. fischerianus (Neosartorya fischeri),

  A. flavus, and

  A. fumigatus (two strains).

A. fischerianus is hardly ever pathogenic, but is very closely related to the common pathogen A. fumigatus; it was sequenced in part to better understand A. fumigatus pathogenicity

Of the 250 species of aspergilli, about 64% have no known sexual state.
However, many of these species likely have an as yet unidentified sexual stage.
Sexual reproduction occurs in two fundamentally different ways in fungi.
These are outcrossing (in heterothallic fungi) in which two different individuals contribute nuclei, and self-fertilization or selfing (in homothallic fungi) in which both nuclei are derived from the same individual. In recent years, sexual cycles have been discovered in numerous species previously thought to be asexual. These discoveries reflect recent experimental focus on species of particular relevance to humans.

A. fumigatus is the most common species to cause disease in immunodeficient humans.
In 2009, A. fumigatus was shown to have a heterothallic, fully functional sexual cycle.
Isolates of complementary mating types are required for sex to occur.

A. flavus is the major producer of carcinogenic aflatoxins in crops worldwide.
It is also an opportunistic human and animal pathogen, causing aspergillosis in immunocompromised individuals. In 2009, a sexual state of this heterothallic fungus was found to arise when strains of opposite mating types were cultured together under appropriate conditions.

A. lentulus is an opportunistic human pathogen that causes invasive aspergillosis with high mortality rates.
In 2013, A. lentulus was found to have a heterothallic functional sexual breeding system.

A. terreus is commonly used in industry to produce important organic acids and enzymes, and was the initial source for the cholesterol-lowering drug lovastatin. In 2013, A. terreus was found to be capable of sexual reproduction when strains of opposite mating types were crossed under appropriate culture conditions.

A. nidulans, a homothallic fungus, is capable of self-fertilization.

Selfing involves activation of the same mating pathways characteristic of sex in outcrossing species,
i.e. self-fertilization does not bypass required pathways for outcrossing sex, but instead requires activation of these pathways within a single individual.

Among those Aspergillus species that exhibit a sexual cycle, the overwhelming majority in nature are homothallic (self-fertilizing). .. (enabling some species to proliferate) in areas with widely different climates and environments, also displays little genetic variability either within geographic regions or on a global scale, ...

Article: Aspergillosis, Merck. INDEX
http://www.merck.com/mmhe/sec17/ch197/ch197b.html

Aspergillus is very common and is frequently found in compost heaps, air vents, and airborne dust. Inhalation of Aspergillus spores is the primary cause of aspergillosis.

Aspergillosis usually affects open spaces in the body, such as cavities that have formed in the lungs from preexisting lung diseases. The infection may also occur in the ear canals and sinuses. In the sinuses and lungs, aspergillosis shows up as a ball (aspergilloma) composed of a tangled mass of fungus fibers, blood clots, and white blood cells. The fungus ball gradually enlarges, destroying lung tissue in the process, but usually does not spread to other areas.

Less often, aspergillosis can become very aggressive and rapidly spread throughout the lungs and often through the bloodstream to the brain and kidneys. This rapid spread occurs mainly in people with a weakened immune system.

In addition to causing infection, Aspergillus sometimes produces an allergic reaction when it is present on a person's skin or mucous membranes (see Allergic and Autoimmune Diseases of the Lungs: Allergic Bronchopulmonary Aspergillosis).

Symptoms and Diagnosis
A fungus ball in the lungs may cause no symptoms and may be discovered only with a chest x-ray.
Or it may cause repeated coughing up of blood and -- rarely -- severe, even fatal, bleeding.

A rapidly invasive Aspergillus infection in the lungs often causes cough, fever, chest pain, and difficulty breathing.

Aspergillosis affecting the deeper tissues makes a person very ill.
Symptoms include fever, chills, shock, delirium, and blood clots.
The person may develop kidney failure, liver failure (causing jaundice), and breathing difficulties.
Death can occur quickly.

Aspergillosis of the ear canal causes itching and occasionally pain.
Fluid draining overnight from the ear may leave a stain on the pillow.
Aspergillosis of the sinuses causes a feeling of congestion and sometimes pain or discharge.

In addition to the symptoms, an x-ray or computed tomography (CT) scan of the infected area provides clues for making the diagnosis. Whenever possible, a doctor sends a sample of infected material to a laboratory to confirm identification of the fungus.

Article: Aspergillosis. 2004-05-13, Doctor Fungus. INDEX
http://www.doctorfungus.org/

Definition
Aspergillosis is a large spectrum of diseases caused by members of the genus Aspergillus (see Table below).
The 3 principal entities are:

allergic bronchopulmonary aspergillosis,
pulmonary aspergilloma and
invasive aspergillosis [1986].

Colonization of the respiratory tract is also common.

The clinical manifestation and severity of the disease depends upon the immunologic state of the patient.
Lowered host resistance due to such factors as

underlying debilitating disease,
neutropenia
chemotherapy,
disruption of normal flora, and
an inflammatory response due to the use of antimicrobial agents and steroids can predispose the patient to colonization, invasive disease, or both.

Aspergillus spp. are frequently secondary opportunistic pathogens in patients with bronchiectasis, carcinoma, other mycoses, sarcoid, and tuberculosis.

Histopathology
The tissue reaction in aspergillosis is acute suppurative inflammation with areas of ischemic necrosis.
The fungus proliferates as septate hyphae 2.5-4.5 micro in diameter.
The hyphae can be characterized as branching dichotomously (approximately 45 deg C angle) with the overall appearance of an army on the march. The hyphae may branch irregularly and appear similar to hyphae found in zygomycosis.

Blood vessel invasion, thrombosis, infarction, and dissemination are extremely common.

Natural habitat
Aspergillus spp. are ubiquitous in the environment.
They are especially common in the soil and decaying vegetation.

Susceptibility Testing
Susceptibility testing is not routinely used to guide therapy of aspergillosis.
We offer both a general discussion of susceptibility testing and a searchable database from which you can retrieve specific results from a variety of published articles.

Article: Aspergillosis. (CHART) Forms of the disease. INDEX
http://www.doctorfungus.org/

¹This is the most common site of primary invasive aspergillosis.

Finding: Diagnosing Aspergillosis presence. INDEX
http://www.cdc.gov/fungal/diseases/aspergillosis/diagnosis.html
LINK 2: http://www.cdc.gov/fungal/diseases/aspergillosis/statistics.html
LINK 3: http://www.thoracic.org
Aspergillosis: Fungal Disease Series #4
Author: Hrishikesh S Kulkarni MD
Am J Respir Crit Care Med Vol. 186, P1-P2, 2012 •
Online Version Updated October 2013
The ATS Patient Information Series is a public service of the
American Thoracic Society and its journal, the AJRCCM.

LINK 4: http://www.healthatoz.com/healthatoz/Atoz/.../aspergillosis.jsp
LINK 5: http://www.doctorfungus.org/ ">


CDC-USA, Diagnosis INDEX

• Medical history consideration;
• Laboratory tests -- of biopsy,
• Laboratory tests -- of fluid sample,
• Laboratory tests -- of blood,
• Risk factors evaluation.

Healthcare providers (may/rarely) consider your medical history, risk factors, symptoms, physical examinations, and lab tests when diagnosing aspergillosis.

You may (benefit from) imaging tests such as a chest x-ray or a CT scan of your lungs or other parts of your body depending on the location of the suspected infection (IF you can have it independently and professionally read).

If your healthcare provider suspects that you have an Aspergillus infection in your lungs, he or she might collect a sample of fluid from your respiratory system to send to a laboratory (that can test for it).

Healthcare providers may also perform a tissue biopsy, in which a small sample of affected tissue is analyzed in a laboratory for evidence of Aspergillus under a microscope or in a fungal culture (provided the laboratory is authorized and experienced in doing so).

A blood test can help diagnose invasive aspergillosis early ....

Because aspergillosis is not a reportable infection in North America, the exact number of cases is impossible to determine.

Statistics which are reported are fundamentally inaccurate as projections and guesswork based upon incidentally recognized cases.

American Thoracic Society, Diagnosis INDEX
2013-10: Because the number of people with weakened immune systems has been increasing over the years, aspergillosis, ... is now the leading cause of death due to invasive fungal infections in the United States.

Unfortunately, the only way to diagnose aspergillosis with certainty is by a tissue biopsy (sampling a piece of your lung). Other tests that can be done include examining your sputum (phlegm) or taking cultures from your airways (breathing tubes). Culture specimens can be collected by a bronchoscopy. Unfortunately, these cultures sometimes miss the infection.

There is also a test that identifies parts of the fungus in your blood, called the serum galactomannan test.
However, this test is not 100% accurate. It may even miss a few cases, but a positive test increases the chance you have the infection, especially if you have risk factors for aspergillosis, and have what looks like aspergillosis on a chest X-ray or CT scan.

Health Atoz, Diagnosis INDEX
Aspergillosis can be quite difficult to diagnose because the symptoms, such as coughing and wheezing, if present at all, are common to many respiratory disorders. Furthermore, blood and sputum cultures are not very helpful.

The presence of Aspergillus is so common, even in asthmatics, that a positive culture alone is insufficient for a diagnosis. Other, potentially more useful, screening tools include examining the sample obtained after repeatedly washing the bronchial tubes of the lung with water (bronchial lavage), but examining a tissue sample (biopsy) is the most reliable diagnostic tool. Researchers are currently attempting to develop a practical, specific, and rapid blood test that would confirm Aspergillus infection.

Signs of ABPA include a worsening of bronchial asthma accompanied by a low-grade fever.
Brown flecks or clumps may be seen in the sputum. Pulmonary function tests may show decreased blood flow, suggesting an obstruction within the lungs. Elevated blood levels of an antibody produced in response to Aspergillus and of certain immune system cells may indicate a specific allergic-type immune system response.

A fungal mass (aspergilloma) in the lung usually does not produce clear symptoms and is generally diagnosed when seen on chest x rays. However, 70% or more of patients spit up blood from the lungs (hemoptysis) at least once, and this may become repetitive and serious. Hemoptysis, then, is another indication that the patient may be suffering from an aspergilloma.

In patients with lowered immune systems who are at risk for developing invasive aspergillosis, the physician may use a combination of blood culture with visual diagnostic techniques, such as computed tomography scans (CT) and radiography, to arrive at a likely diagnosis.

Doctor Fungus, Laboratory INDEX

Direct examination

Clinical material, such as fluids, sputa, or tissue, is mounted in 10% KOH. Long, branching, hyaline, septate hyphae approximately 3.0 micro in diameter typify aspergillosis.
The demonstration of hyphae in the clinical specimen and the repeated recovery of the same species of Aspergillus in culture is critical in supporting the diagnosis of aspergillosis.

It must always be remembered that a number of other fungi can be morphologically identical to Aspergillus in tissue. On rare occasions, the hyphae of an Aspergillus sp. may have lateral conidia in tissue.

Isolation

Inoculate the clinical material onto Sabouraud glucose agar, Inhibitory Mould Agar (IMA) or other proper medium with antibiotics (gentamicin or chlorampenicol) and incubate at 30 deg C.

The aspergilli are sensitive to cycloheximide, hence they will not grow on media containing this antimicrobial agent.
Discard negative cultures after 4 weeks.

Mycology (principal fungi)

- Aspergillus flavus
- Aspergillus fumigatus
- Aspergillus glaucus group
- Aspergillus nidulans
- Aspergillus niger
- Aspergillus terreus group

Detection of galactomannan antigen in serum

The mortality rate of invasive aspergillosis is as high as 50-100% and definitive diagnosis by culture may take as long as 4 weeks. Thus, early diagnosis is of remarkable significance for earlier initiation of antifungal therapy and reduction of mortality rates.

Detection of galactomannan antigen, an exoantigen of Aspergillus, has recently been shown to be a useful screening test for early diagnosis of invasive aspergillosis.

Platelia Aspergillus EIA (Bio-Rad Laboratories) is a commercially available kit used to detect galactomannan antigen in body fluids. This method can detect as little as 1 ng/ml of galactomannan in the tested sample. Serum is the most frequently tested specimen and appears to provide highest sensitivity. Use of other samples such as bronchoalveolar lavage and cerebrospinal fluid also appears to provide promising results.

Galactomannan antigen positivity is among the microbiological diagnostic criteria proposed by
European Organization for Research and Treatment of Cancer (EUORTC) and
Invasive Fungal Infections Cooperative Group and the
National Institute of Allergy and Infectious Diseases Mycoses Study Group (MSG) for diagnosis of invasive aspergillosis. This tool continues to gain acceptance: the US Food & Drug Administration approved the marketing of Platelia Aspergillus EIA kit in USA on 16 May 2003.

Galactomannan antigen positivity can be detected 5-8 days (average) before clinical signs develop (in 65.2% of patients), findings on chest X-ray are visible (in 71.5% of patients) and culture results become positive (in 100% of patients).

The test should be used as a screening test for patients at high risk of developing invasive aspergillosis.
Detection of positive results particularly in two consecutive serum samples provides strong support for the diagnosis of invasive aspergillosis. Platelia Aspergillus EIA can also be used for follow-up of clinical response to antifungal therapy. The titer of the antigen tends to decrease in case of clinical response, except for patients who are treated with an echinocandin compound.

The overall sensitivity and specificity of the method were 80.7% and 89.2%, respectively, in the dataset submitted to the US FDA. False positive reactions have been observed in 1-18% of the tested samples and may be due to cross reactivity or false positive antigenemia. Cross reactivity may be due to the existence of other fungi, such as Penicillium chrysogenum, Penicillium digitatum, Rhodotorula rubra, and Paecilomyces variotii in the tested sample.

The mechanism of false positive antigenemia, on the other hand, has not been fully clarified.
It appears to be more frequent in children [940, and may develop after translocation of galactomannan antigen found in various food stuff (bread, pasta, corn flakes, rice, cake, turkey, sausage, etc.) through the damaged intestinal mucosa.

In addition to these, very recent data have shown that the serum samples of patients receiving piperacillin/tazobactam (Zosyn^®), an injectable antibacterial combination product from Wyeth Pharmaceuticals, may also yield false positive galactomannan antigen test results.

Detection of galactomannan antigen in certain batches of Zosyn^® strengthened this finding.
Thus, Bio-Rad, the manufacturer of the Platelia Aspergillus EIA kit, now states that positive galactomannan antigen test results in patients treated with Zosyn^® should be interpreted cautiously. Since the existence of invasive aspergillosis cannot be ruled out in these patients, other methods should be used for confirmation of the diagnosis. You may refer to the practice caution document (released on November 20, 2003) concerning Zosyn^® and the Platelia Aspergillus EIA test kit for more detailed information.
LINK: http://www.fda.gov/cdrh/oivd/laboratory.html#tip8

You may also want to review our subpage for more detailed information on the key data regarding the use of the galactomannan antigen test in the diagnosis of invasive aspergillosis.

Remedy: selective Serotonin reuptake inhibitors (SSRIs). INDEX
http://www.nutritionscan.cc
Serotonin - Can Fight Fungus, 2003
By Stephen Pincock (Reuters Health)
SOURCE: Journal of Medical Microbiology 2003;52:169-171.

Two years ago, the University of Innsbruck team showed that antidepressants called selective serotonin reuptake inhibitors (SSRIs) could also inhibit fungi.

Serotonin seemed to suppress the symptoms of vaginal candidiasis, or yeast infection, in women.
The patients found they had no flare-ups of the yeast infection while taking Zoloft to treat premenstrual dysphoric disorder, but when they stopped taking the drug the infection returned.

Fungi belonging to the Candida family are responsible for yeast infections, and can also cause thrush, an infection of the mouth and throat. Aspergillus fungi can also infect humans.

Because (SSRIs) increase serotonin levels during treatment, the researchers tested serotonin directly against a range of Candida species.

The researchers report in this month's issue of the Journal of Medical Microbiology that serotonin was active against all four species tested.

Remedy: CDC Treatment Guidelines; Drugs. INDEX
http://www.cdc.gov/fungal/diseases/aspergillosis/treatment.html

Allergic forms of aspergillosis
For allergic forms of aspergillosis such as allergic bronchopulmonary aspergillosis (ABPA) or allergic Aspergillus sinusitis, the recommended treatment is itraconazole, a prescription antifungal medication.
Corticosteroids may also be helpful.

Invasive aspergillosis
Invasive aspergillosis needs to be treated with prescription antifungal medication, usually voriconazole.
Other antifungal medications used to treat aspergillosis include

lipid amphotericin formulations, 
posaconazole, 
isavuconazole, 
itraconazole, 
caspofungin, and 
micafungin. 

Whenever possible, immunosuppressive medications should be discontinued or decreased.
People who have severe cases of aspergillosis may need surgery.

If you are a healthcare provider, ... see the Infectious Diseases Society of America’s
Practice Guidelines for the Diagnosis and Management of Aspergillosis
LINK: http://cid.oxfordjournals.org/content/63/4/e1

Remedy: What has worked for Recovering persons. INDEX
https://www.earthclinic.com/cures/aspergillosis.htm
Youtube: https://www.youtube.com/c/earthclinic
Apr 22, 2017

Replied by Debbie A.
California --- 03/31/2016

For all you Dear people with Abpa or chronic Aspergillosis. I have been there. ...
Please know it isn't a death sentence. I had a very very bad case.
Now five years later I am doing great. But I had to pretty much learn from the websites in England.
They are ahead of the game. And on my own trial and error, some BIG errors.

I just want to let you know my IGe was 4300 some go as high as 12,000.
First do not drink orange juice or lemon aid or any citrus.
You can make your own but commercial is full of aspergillus, do not eat nuts, unless you soak them in vitamin C then reroast them.

Do not drink sake it is made with aspergillus, do not take Beano made with aspergillus.
Do not take digestive enzymes, made with aspergillus.
Do not dust or vacuum ever! Have someone else do it.
Do not garden or have house plants. Do not have birds, chickens or pigeons near you.
Stay away from all chemicals. You will also be very sensitive to malls and stores as clothes are all sprayed with pesticides, formaldehyde, sizing, and cotton has a ton of aspergillus. Clothes you buy need to immediately be washed.
Read all labels on food.

Replied by Ben
Bremerton Wa --- 04/09/2016

Years ago I nearly died from aspergillosis in my lungs.
I was living in an old house filled with black mold. I found out how carcinogenic it is after I got cancer in my spleen.

As for your dad supplements are expensive they can easily run 2 or 3 hundred a month so you got to get the most bang for your buck.

Systemic enzymes like serrapeptase are essential for this kind of lung problems. ...
.. lungs are filled with fibrosis only systemic enzymes can dissolve fibrin scar tissue and clear the lungs up.

Basically the destruction of lung tissue is caused by a wide range of microorganisms inhabiting biofilm in the lungs all working against you. Biofilm typically consists of over 500 germ species and fungus all creating havoc.

One of the worst of the beasties is mycoplasma fermentans.
It causes lung destruction like in COPD and pulmonary fibrosis.

One of the super cheap things that helps immensely but is not a total cure --- is hydrogen peroxide mist vaporized then inhaled deeply into the lungs.

Another super cheap one is DMSO plus garlic.
You simply crush a bunch of garlic then add a little DMSO in a small bottle then inhale the vapors.

Often the lung infections are fungal plus viral plus bacteria.
DMSO plus garlic can kill fungus and virus alike

Another very cheap thing is colloidal silver mist inhaled.
You can make this at home for pennies and it is super powerful

Another super powerful germ killer is lyposomal vitamin C.
You can make this at home too. Youtube will teach you how to make it for pennies.

... There are many ways to kill virus, one way is with electricity.
It's called blood electrification, a very effective technique but almost no one knows about it.
This is very cheap and kills a multitude of virus all for the cost of a few flashlight batteries and the unit at about 120 bucks last time I checked. This ends up being way cheaper than supplements

Another dirt cheap yet super powerful thing is MMS and MMS-2 ...

Replied by Bill
San Fernando, Philippines --- 05/06/2016

Well if you're going to take Vfend may I wish you the best of luck because you're going to need it. It certainly wont cure your Aspergillosis problem because Vfend -- aka voricanozole -- contains 3 fluorine atoms per molecule of voracanozole which makes it very similar-acting to that other horrible and debilitating antibiotic drug called Cipro. Flourine is a poison that will, over time and without any doubt, bring down both your thyroid and your immune system. How is that result going to help against your fungl problem? And I'm not surprised your vision is affected by this drug.

Cortizone/steroids will also seriously acidify your body.
Any fungus or mold just loves acid bodies -- helps them to grow, dominate and spread rapidly throughout the body for sure.

If I were you I would seriously start investigating natural and effective fungal cures (without side-effects) like
turpentine, alkalizing, lugol's iodine, undecylenic acid, hydrogen peroxide, borax, Gymnema sylvestre, colloidal silver, gallium nitrate, oregano, lavender oil etc

Replied by Alice
Southern California --- 10/24/2015

Voriconazole is very toxic, when taken orally or intravenously.
However, some doctors in Europe have been giving this drug to Aspergillosis patients via inhalation, at a much lower dose, with no adverse effects. The idea behind this treatment is that when a patient inhales voriconazole, the target tissue (lungs) get much higher saturation with much lower dose than when the patient takes the drug orally or intravenously.

When the drug gets into the bloodstream eventually, it won't cause as much harm, because of the lower dose.
Here is the link to the article which describes the treatment, dosages, etc.
LINK: http://erj.ersjournals.com/content/40/1/271

Replied by Jean Jones
09/21/2016

Take Turmeric.
I use 4000 mg daily taken 2x a day. I use one that is time released.
My IGE dropped almost 3000 points over 1 1/2 years thanks to Turmeric.

I also use a salt pipe.
Salt has been shown to inhibit the growth of aspergillus and you will see immediate results.
I have had ABPA for 8 years. The drugs didn't help. I'm doing fine now.

Remedy: Treatment by drugs or surgery. INDEX
Aspergillosis: Fungal Disease Series #4
Author: Hrishikesh S Kulkarni MD
Am J Respir Crit Care Med Vol. 186, P1-P2, 2012 •
Online Version Updated October 2013
The ATS Patient Information Series is a public service of the
American Thoracic Society and its journal, the AJRCCM.

LINK 2: http://www.healthatoz.com/healthatoz/Atoz/.../aspergillosis.jsp
LINK 3: http://www.merck.com/mmhe/sec17/ch197/ch197b.html
LINK 4: http://www.doctorfungus.org/

Anti-fungal drugs used to treat aspergillosis include:
voriconazole, amphotericin B, caspofungin, itraconazole, and posaconazole.

Because most of these drugs have side effects, they are not usually given unless your health care provider is sure that you have aspergillosis. If you have a history of aspergillosis, you may be asked to take anti-fungal drugs to prevent the infection from coming back, especially when your immune system is weakened. ...

If you have an aspergilloma, you may need surgery to remove the fungus ball because drugs are not very effective in treating it. Surgery may also be recommended if your infection does not improve with drugs.

HealthAtoz Treatment
The treatment method selected depends on the form of aspergillosis.
ABPA can usually be treated with many of the same drugs used to treat asthma, such as systemic steroids. Long-term therapy may be required, however, to prevent recurrence. Antifungal agents are not recommended in the treatment of ABPA. In cases of aspergilloma, it may become necessary to surgically remove or reduce the size of a fungal mass, especially if the patient continues to spit up blood. In aspergillosis cases affecting the nose and nasal sinuses, surgery may also be required.

In non-ABPA cases, the use of antifungal drugs may be indicated.
In such cases, amphotericin B (Fungizone) is the first-line therapy.
The prescribed dose will depend on the patient's condition but usually begins with a small test dose and then escalates. Less than 1/3rd of patients are likely to respond to amphotericin B, and its side effects often limit its use. For patients who do not respond to oral amphotericin B, another option is a different formulation of the same drug called liposomal amphotericin B.

For patients who fail to respond or who cannot tolerate amphotericin B, another drug called itraconazole (Sporanox), given 400-600 mg daily, has also been approved. Treatment generally lasts about 3 months. Giving itraconazole can produce adverse reactions if prescribed in combination with certain other drugs by increasing the concentrations of both drugs in the blood and creating a potentially life-threatening situation. Even antacids can significantly affect itraconazole levels. As a result, drug levels must be continually monitored to ensure that absorption is occurring at acceptable levels.

Two other methods of treatment are being studied:
direct instillation of an antifungal agent into the lungs and administration of antifungals using a nebulizer. Instilling or injecting amphotericin B or itraconazole directly into the lung cavity or into the fungal ball (aspergilloma) itself has been helpful in stopping episodes of hemoptysis, but not in preventing future recurrences. Furthermore, many patients with aspergillomas are poor risks for surgery because their lung function is already compromised. As a result, instillation of a fungal agent should only be considered in those who have significant hempotysis.

A popular method of treating some respiratory disorders is to add a liquid drug to another carrier liquid and aerosolize or produce a fine mist that can be inhaled into the lungs through a device called a nebulizer. However, this has not yet been shown to improve the patient's condition in cases of aspergillosis, possibly because the drug is not reaching the aspergilloma.

At this point, preventative therapy for aspergillosis is not suggested for susceptible individuals, primarily because overuse of the drugs used to fight fungal infections may lead to the development of drug-resistant aspergillosis against which current antifungal drugs are no longer effective.

Prognosis
The likelihood of recovery from aspergillosis depends on any underlying medical conditions, the patient's general health, and the specific type of aspergillosis. If the problem is based on an allergic response, as in ABPA, the patient will likely respond well to systemic steroids.

Patients who require lung surgery, especially those who have problems with coughing up blood, have a mortality rate of about 7-14%, and complications or recurrence may result in a higher overall death rate. However, by treating aspergilloma with other, non-surgical methods, that risk rises to 26%, making surgery a better option in some cases.

Unfortunately, the prognosis for the most serious form, invasive aspergillosis, is quite poor, largely because these patients have little resilience due to their underlying disorders. Death rates have ranged from about 50% in some studies to as high as 95% for bone-marrow recipients and patients with AIDS. The course of the illness can be rapid, resulting in death within a few months of diagnosis.

Merck Prognosis and Treatment
Aspergillosis that is present only in a sinus or a single spot in the lung progresses slowly.
The infection requires treatment but does not pose an immediate danger.
However, if the infection is widespread or the person appears seriously ill, treatment is started immediately.
Aspergillosis is treated with antifungal drugs, such as

amphotericin B .. FUNGIZONE, 
itraconazole .. SPORANOX, or 
voriconazole  .. VFEND

Some forms of Aspergillus are resistant to these drugs, however, and may need to be treated with a caspofungin .. CANCIDAS

Doctors treat aspergillosis in the ear canal by scraping out the fungus and applying drops of antifungal drugs. Fungus collections in the sinuses must usually be removed surgically. If fungus balls in the lungs grow near large blood vessels, they may also need to be removed surgically because they may invade the blood vessel and cause bleeding.

Doctor Fungus Prognosis and therapy

Prognosis depends upon the type and severity of disease as well as the immunological status of the patient.
Allergic aspergillosis is typically a chronic entity, but evolves from episodes of acute corticosteroid-responsive asthma to fibrotic end-stage lung disease. Allergic aspergillosis has been successfully treated with corticosteroids, and intraconazole.
The prolonged use of steroids in cases of chronic aspergillosis should be approached with caution.

Aspergillomas may be treated by surgical resection.
However, this approach may cause significant morbidity and mortality, therefore it should be reserved for patients at high risk to develop severe hemoptysis.

Invasive aspergillosis may be treated with

voriconazole,
amphotericin B, (deoxycholate and lipid preparations), and
itraconazole.

The ability of voriconazole to effectively treat invasive aspergillosis and to reduce associated mortality was recently demonstrated by a large well-conducted randomized trial and is particularly noteworthy. A large number of new investigational drugs

posaconazole,
ravuconazole,
caspofungin,
FK463, and
anidulafungin (LY303366)

Caspofungin was also recently licensed in the United States for treatment of invasive aspergillosis in patients who are refractory to, or intolerant of other therapies (i.e., amphotericin B, lipid formulations of amphotericin B, and/or itraconazole). However, despite these advances in therapy, the invasive forms of aspergillosis are often associated with significant morbidity and mortality.

Selection of therapy also needs to consider the certainty of the diagnosis.
Voriconazole, itraconazole, the investigational azoles with anti-mould activity, and amphotericin B all possess a reasonably broad-spectrum of activity against Aspergillus and the related hyaline moulds. Their activity does, however, vary for the agents of zygomycosis, with posaconazole being the azole with the most reliable activity against this class of fungi. The echinocandin glucan synthesis inhibitors (caspofungin, FK463, and anidulafungin) possess a narrower spectrum of activity and should only be used if the infection is known to be due to Aspergillus spp.

Practice Guidelines, Infectious Diseases Society. INDEX
Practice Guidelines for the Diagnosis and Management of Aspergillosis:
2016 Update by the Infectious Diseases Society of America
Clinical Infectious Diseases® -- 2016;63(4):e1 (15 August) -- 60p
includes 655 references

It is important to realize that guidelines cannot always account for individual variation among patients.
They are not intended to supplant physician judgment with respect to particular patients or special clinical situations.
IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient’s individual circumstances.

... 6. Until molecular tools are more widely used in clinical laboratories, we recommend that tissue and fluid specimens be submitted in adequate quantities for simultaneous histopathologic/cytologic and culture examination. In the case of isolates with atypical growth or concerns for resistance, species identification by molecular methods should be employed (strong recommendation; high-quality evidence).

... 13. We recommend performing a chest computed tomographic (CT) scan whenever there is a clinical suspicion for IPA (Invasive Pulmonary Aspergillosis) regardless of chest radiograph results (strong recommendation; high-quality evidence).

... 14. Routine use of contrast during a chest CT scan for a suspicion of IPA is not recommended (strong recommendation; moderate-quality evidence). Contrast is recommended when a nodule or a mass is close to a large vessel (strong recommendation; moderate-quality evidence).

... 26. Early initiation of antifungal therapy in patients with strongly suspected IPA is warranted while a diagnostic evaluation is conducted (strong recommendation; high-quality evidence).

... 30. We recommend that treatment of IPA be continued for a minimum of 6–12 weeks, largely dependent on the degree and duration of immunosuppression, site of disease, and evidence of disease improvement (strong recommendation; low-quality evidence).

... 36. Surgery for aspergillosis should be considered for localized disease that is easily accessible to debridement ...

... 39. We recommend an individualized approach that takes into consideration the rapidity, severity, and extent of infection, patient comorbidities, and to exclude the emergence of a new pathogen (strong recommendation; low-quality evidence).

... The majority of cases of invasive mold infections are sporadic, although outbreaks are well recognized [20 – 23]. Cases of invasive mold disease with onset of symptoms = 7 days after hospital admission are more likely to be nosocomial [24]. In the absence of an outbreak with an identified environmental source (e.g., a contaminated air vent) or molecular analysis that demonstrates clustering of fungal isolates, it is not possible to reliably distinguish community-acquired from nosocomial aspergillosis.

... clinical signs and symptoms are not specific for the diagnosis of IPA, radiographic imaging is critical.
The role of imaging is to identify the site of infection, to assess the type, number and size of lesions, and local extension. Imaging also helps to direct diagnostic procedures (e.g., BAL or CT-guided biopsy) to the most appropriate area [137]. CT scan is more sensitive than chest radiograph to identify lesions of IPA, especially at their early stage [138], and high-resolution computed tomography (also called thin-section CT scanning with a thin collimation of 0.25 – 1 mm) is the preferred method. CT angiography may be a useful test pending further evaluation [139]. Chest CT scan performed early after onset of fever helps to identify the cause of fever, may be informative before Aspergillus GM is positive, and has been associated with an increased survival in febrile neutropenic patients who have received intensive chemotherapy for a hematologic malignancy [140–142].

Typical features of IPA on CT imaging include nodules, consolidative lesions, and wedge-shaped infarcts.
Particularly in neutropenic patients, a halo sign, defined as a nodule (>1 cm in diameter) surrounded by a perimeter of ground-glass opacity reflecting hemorrhage, may be observed [143–147]. Pleural effusions are occasionally observed. Appearance of an air crescent or a cavity in a mass, nodule, or consolidation is also suggestive of invasive mold disease but is usually a later sign, often associated with recovery from neutropenia [145, 146]. The reverse halo sign is more frequently associated with pulmonary mucormycosis than with IPA.

... Magnetic resonance imaging (MRI) has no additional value compared to CT scanning for early diagnosis of IPA [153], but is the preferred imaging modality to identify and characterize osseous, paranasal sinus lesions, or CNS disease

... The advances of molecular techniques have led to important changes to Aspergillus taxonomy contributed to by the phylogenetic species recognition concept [325]. This method, based on sequencing of several targets for species recognition analysis, has identified new cryptic species, some of which are more resistant to current antifungal drugs [326].

... Surgical resection of Aspergillus-infected tissue may be useful in patients who have lesions that are contiguous with the great vessels or other critical organs, lesions causing recalcitrant hemoptysis from a single focus, and in lesions eroding into bone. This decision should be mindful of the probability of structural adhesion eliciting spillage of organism into the pleural space.

... Surgery:
In general, surgical treatment of aspergillosis should be considered for localized disease that is accessible to debridement. Emergent debridement of sinus aspergillosis can be life-saving and limit extension to the orbit and brain. Localized cutaneous aspergillosis should also be debrided. CNS aspergillosis is a devastating complication; neurosurgical removal combined with antifungal therapy may be life-saving, although the expected postsurgical neurologic outcome should also be considered during the decision process. Surgical resection of pulmonary lesions due to Aspergillus species can provide a definitive diagnosis and can potentially completely eradicate a localized infection.

Surgical therapy may be useful in patients with lesions that are contiguous with the great vessels or the pericardium, uncontrolled bleeding, or invasion of the pleural space and chest wall. Intervention should also be considered for localized pulmonary aspergillosis refractory to antifungal therapy [387].

... many issues confound the interpretation of current published evidence for salvage therapy for IA including publication bias, inadequate statistical power, and heterogeneity of studies. In salvage therapy studies, differentiating Aspergillus-attributable mortality vs the impact of underlying disease or coinfections is not possible [392, 393].

Page 36 ...
aspergillosis of the esophagus and gastrointestinal tract is relatively common in advanced cases of disseminated IA [483].
In fact, in autopsy studies, esophageal and gastrointestinal tract involvement is the third most common site of infection [483]. Disease may occur through hematogenous dissemination or ingestion, and some authors have suggested the gastrointestinal tract as a potential portal of entry for Aspergillus spp [484], although this has not been definitively demonstrated. The few well-documented cases have been associated with high morbidity and mortality and the diagnosis is infrequently made antemortem [485]. Because of the paucity of data for esophageal and gastrointestinal aspergillosis, there is no clear indication of optimal therapy, and a rational approach is to combine both medical and surgical therapy [486].

Hepatic aspergillosis may occur as single or multiple hepatic lesions.
Dissemination to the liver is thought to occur via the portal venous system from the gastrointestinal tract, or as a component of general and widespread systemic dissemination [487].

Page 44 ...
Management Options for an Aspergillus Fungal Ball of the Lung (Aspergilloma)

90. Patients with symptoms, especially significant hemoptysis, with a single aspergilloma, should have it resected, assuming that there are no contraindications (strong recommendation; moderate-quality evidence).

... single aspergilloma, previously often referred to as simple aspergilloma, may occur with CPA (Chronic Pulmonary Aspergillosis) so that the evidence supporting management of a fungal ball due to Aspergillus should be considered in the context of CPA in that situation. These patients may be asymptomatic, present with hemoptysis, shortness of breath, or cough.

“ Single uncomplicated aspergilloma” is defined as a single pulmonary cavity containing a fungal ball in a nonimmunocompromised patient with microbiological or serological evidence of Aspergillus spp with minimal or no symptoms and no radiographic progression over at least 3 months [603].

An aspergilloma is described radiographically as an approximately spherical shadow with surrounding air, also called a fungal ball, in a pulmonary cavity, with evidence that Aspergillus spp is present in the material. Aspergillus fumigatus is the usual cause. Fungal balls of the lung may rarely be caused by other fungi, such as A. flavus, or other molds like Scedosporium spp.

... There are many unanswered and unresolved epidemiological, laboratory, and clinical questions that need to be addressed and understood in the diagnosis, treatment, and prevention of aspergillosis. Better diagnostic tests and improved understanding of the optimal use of current methods are needed both to facilitate more accurate identification of patients with IA and to permit earlier initiation of therapy.

The availability of more active and better tolerated antifungal agents has significantly improved therapy of patients at risk for serious Aspergillus infections, but even with optimal antifungal therapy the mortality rate remains high; therefore, further development of new antifungal agents is greatly needed. Critical gaps in knowledge remain regarding management of these infections including the optimal utility of combination therapy, tools for early detection of these infections, evaluation of response, therapy for patients with breakthrough or refractory infection, and the population of patients for whom prophylaxis would be most beneficial.

Danger: Aspergillus fumigatus isolate surveillance. INDEX
http://www.cdc.gov --- 2017-03-11

Dr. Shawn Lockhart 
Centers for Disease Control and Prevention 
Attn: Aspergillus fumigatus azole study 
DASH Unit 40 
Bldg 17 Rm 2124 
1600 Clifton Rd NE 
Atlanta, GA 30333

Azole resistance in Aspergillus fumigatus is an increasing problem throughout the world. Resistant isolates have been identified in Europe, the Middle East, Asia, Africa, South America, and recently in the US. A recently published manuscript (Wiederhold, 2016 J. Clin. Microbiol. 54:168-171) has identified an isolate in the US with the same resistance mechanism that is being detected all over the world (called TR34 L98H).

Most US hospitals do not perform mold susceptibility testing, so the amount of azole resistance in Aspergillus in the US is not known. In order to determine the extent of azole resistance, the Centers for Disease Control and Prevention is collecting human clinical isolates of A. fumigatus from US hospitals and laboratories.

We are interested in collecting all A. fumigatus isolates from clinical labs regardless of whether or not they are a cause of infection. We will test these isolates for resistance to the medical triazoles such as itraconazole and voriconazole. Isolates found to have high MICs will then be screened for specific mutations linked with resistance.

To determine the US prevalence of A. fumigatus azole resistance, we are requesting submission of any new isolates (collected in 2015 or later) of A. fumigatus. We are not collecting patient information.

Article: Walking Pneumonia. INDEX
http://www.news-medical.net/health/Walking-Pneumonia.aspx
By Cashmere Lashkari
Last Updated: Jun 29, 2017

Pneumonia refers to an inflammation of the air sacs, called alveoli, present in the lung.
The alveoli may begin to fill up with pus or fluids due to an infection or inflammation.
It can be life­threatening.

The condition may be caused by many bacterial or viral infections.
The affected person will display symptoms such as a cough, fever, difficulty in breathing and chills.

It can be dangerous for adults but is often fatal for young children whose immune systems cannot withstand the severe infection. Pneumonia makes patients weak, robs them of energy and stamina, and very often requires hospitalization after the diagnosis is confirmed. Walking pneumonia refers to a less serious infection of the lungs. Here the person affected is not so badly off as to require hospitalization or even bed rest. The symptoms are mild and the person may be able to go about their daily routine easily. It is caused by Mycoplasma pneumoniae bacteria as well as a couple of other organisms that creates symptoms akin to the common cold.

Symptoms of Walking Pneumonia
The person usually does not feel unwell enough to need to rest.
Very often the illness is contracted by people who work in crowded areas such as schools.
Common symptoms in those affected may include any of the following:

• some pain in the chest region,
• chills and shivers running down the body,
• a dry cough,
• headache,
• sore throat and
• high fever.

The affected person may also suffer from excessive sweating.
There may be a loss of appetite and vomiting.
Not all symptoms may be seen in every patient.

The symptoms often take a couple of weeks to manifest properly.
Some additional symptoms include

• ear pain,
• soreness of the eyes,
• muscles aching and
• stiffness in the joints.
• a rash or lesions on the skin,
• a lump may be form in the neck
• breathing more rapidly than usual.

Diagnosing Walking Pneumonia
Since the initial symptoms are very mild, most people don’t realise that it is a serious respiratory illness till the symptoms persist for more than a couple of weeks. Ideally, symptoms of what resembles a common cold should not last longer than ten days. If this occurs, it would be advisable to get a medical assessment. Delay can cause the health to deteriorate faster.

The crackling sound that accompanies the breathing is a clear indicator of walking pneumonia to most health care providers. Medical evaluation of suspected pneumonia will require a chest x­ray. A CT scan of the chest is often ordered to diagnose most types of pneumonia.

In case of more severe symptoms, other tests which may be required include blood tests, bronchoscopy, nose or throat swabs to check for bacteria, sputum tests for mycoplasma bacteria, and measurements of the levels of carbon dioxide and oxygen in the blood. In extremely serious cases an open lung biopsy may also be required.

Treating Walking Pneumonia
Self­care can include keeping the fever down with NSAIDs like ibuprofen or naproxen, or acetaminophen.
The patient should drink plenty of fluids and get adequate rest.
Children should never be given aspirin as it may cause Reye syndrome.
This is the occurrence of acute brain and liver damage in a child following exposure to this drug.
It has been seen in cases where children suffering from chicken pox or flu were given aspirin.

Should a child display prolonged cold symptoms, medical consultation is recommended.
Self­treatment with cough syrups should not be done, as it may make it more difficult to cough up the extra sputum.
Should symptoms become more severe, antibiotics may be prescribed for about two weeks. Usually it is a 7 to 10 days course. The full course should be completed, rather than stopping the antibiotics once the patient feels better. If treatment is prematurely interrupted, the pneumonia may return and may be even more difficult to treat because of the emergence of resistant strains.

Complications that may occur in Walking Pneumonia
While the prognosis for a full recovery is good once treatment is begun for walking pneumonia, there may be additional complications such as skin rashes, ear infections and hemolytic anemia.

Hemolytic anemia is a medical condition wherein the body destroys its own red blood cells.
The cough and weakness associated with walking pneumonia may persist for almost four to six weeks, even with treatment and medication.

Patients should remember that the infection, however mild, is contagious.
Caregivers and patients should ensure that they regularly wash their hands with warm water and soap.
Drinking glasses, plates, flatware, and toothbrushes should never be shared.
While children are more prone to catch the infection, adults with a weak immune system are also at risk.
If the initial symptoms are ignored, the condition can deteriorate into full­blown pneumonia.
The best way to avoid getting it is to take influenza vaccination every year, and to ask the health care provider if a preventive pneumonia vaccine would be useful.

Basics: Lung microbiome. INDEX
http://www.news-medical.net/life-sciences/Lung-microbiome.aspx
By Sally Robertson, BSc --- May 12, 2017
Reviewed by Afsaneh Khetrapal BSc (Hons)

Over the past decade, culture­independent microbial investigation techniques have led to an improved understanding of the complete set of microbes that live on and within the human body. This set of human­associated microbes is collectively known as the microbiome. The human body is host to trillions of microbes and the gene set that makes up the microbiome is 360 times more abundant than that comprising the human genome.

Historically, the lungs have been considered sterile in health, but culture­independent techniques have now shown that the lower respiratory tract is home to a diverse microbial community: the lung microbiome. Increasingly, evidence has emerged that supports the concept that a distinct microbiota is present in the lower respiratory tract in both healthy and disease states. Research into the lung microbiome is rapidly growing and revealing important discoveries about the microbiome’s association with respiratory disease. It is hoped that continued study of this field will provide new insights into the pathogenesis of lung diseases as well as the role the lung microbiota play in respiratory health. Analysis of the lung microbiome is mainly performed using bronchoalveolar lavage (BAL), although spontaneously expectorated sputum is used to analyze cases of cystic fibrosis.

It is generally presumed that the fetal lungs are sterile and that infants acquire their lung microbiota after birth.
Immediately after birth, the mother’s microbes rapidly populate the mucosal surfaces of the infant. At first, the colonization is uniform across the infant’s body sites, but the microbiota soon differentiates into site­specific communities in the days or weeks to come.

Many studies have characterized the microbiome of the adult lung using BAL samples taken from healthy human adults.
These have shown that the most common phyla include
Bacteroides, Firmicutes and Proteobacteria, with the most common genera being

Streptococcus, Pseudomonas, Veillonella and Prevotella.

... YJ Huang et al. published a study in The Journal of Allergy and Clinical Immunology (2011), which investigated the differences in lung microbiota between asthmatics and controls. They reported a greater bacterial diversity and burden among the asthmatic versus control participants, as well as a greater relative abundance of Proteobacteriae.

The presence of multiple species also correlated positively with the degree of bronchial hyper­responsiveness that asthma patients had.

Furthermore, in a study carried out by Hans Bigaard (University of Copenhagen), infants with lungs that contained pathogenic bacteria after they were born, were at an increased risk of developing asthma, compared with infants who were not born with the harmful bacteria in their lungs.

In another study, Homer Boushey (University of California) found that adults with asthma had more bacteria in their lungs than non­asthmatic individuals. The severity of asthma also increased in cases with more diverse bacterial colonization.

Article: Fungal Infection (Aspergillosis) in Dogs. INDEX
http://www.petmd.com/dog/conditions/
infectious-parasitic/c_multi_aspergillosis#.Uc22otf7tu8

Aspergillosis is an opportunistic fungal infection caused by the Aspergillus, a species of common mold found throughout the environment including, dust, straw, grass clippings, and hay. An "opportunistic infection" occurs when an organism, which does not generally cause disease infects a dog. However, in the case of aspergillosis, it does because the pet's immune system and/or body is weakened from some other disease.

There are two types of Aspergillus infection, nasal and disseminated.
Both types can occur in cats and dogs, but they occur more frequently in dogs.
Young adult dogs with a long head and nose (known as dolichocephalic breeds) and dogs with a medium length head and nose (known as mesatcephalic breeds) are also more susceptible to the nasal form of aspergillosis. The disseminated version of the disease seems to be more common in German Shepherds.

The condition or disease described in this medical article can affect both dogs and cats.
If you would like to learn more about how this disease affects cats, please visit this page in the PetMD health library.

Symptoms and Types
There are two types of Aspergillus infections.
The first is the nasal form, where the infection is localized in the nose, nasal passages, and front sinuses.
It is believed that this develops from direct contact with the fungus through the nose and sinuses.
For example, if an animal is outside and around dust and grass clippings, the fungus may enter via the moist lining of the nose.

The second type of Aspergillus infection is disseminated, meaning it is more widespread, and is not only located in the nasal area. It's not certain how this form enters the body.

Symptoms of nasal aspergillosis include

sneezing,
nasal pain,
bleeding from the nose,
reduced appetite,
visibly swollen nose, and
long-term nasal discharge from the nostril(s),
which may contain mucus, pus and/or blood.

In some cases, loss of pigment or tissue on the surface of the skin may also occur.

Symptoms of disseminated aspergillosis in dogs may develop suddenly or slowly over a period of several months, and include
• spinal pain or lameness ...
  due to infection, and cause inflammation of the animal's bone marrow and bones ...
• fever,
• weight loss,
• vomiting, and
• anorexia.

Causes
Aspergillosis is an infection caused by the Aspergillus fungus, which is commonly found in the environment in substances such as dust, hay, and grass. The nasal form of the disease is usually seen in outdoor and farm dogs because there more frequently exposed to the substances in which the fungus Aspergillus is found.

As an opportunistic infection, an animal is only likely to contract Aspergillosis if the immune system is already in a weakened state. Dogs exhibiting immunodeficiency -- an inability to produce a normal immune response -- are at higher risk.

Diagnosis
Diagnostic procedures vary depending on whether the case is nasal or disseminated.
For suspected nasal aspergillosis, analysis of nasal swabs, fungal cultures of nasal discharge, and a rhinoscopy -- inserting a small fiber-optic scope into the nose in order to examine the inside of the nose and its mucus linings -- can be expected. The symptoms for disseminated aspergillosis are mostly nonspecific and therefore more difficult to diagnose. Tests may include a urine analysis and X-rays to examine the spine.

Treatment
Treatment varies depending on whether the disease is nasal or disseminated.
The primary choice of treatment for dogs with nasal aspergillosis is the administration of an antifungal drug directly into the patient's nose and nasal passages, while the patient is under anesthesia. Disseminated cases in dogs are difficult to treat and rarely cured. Antifungal drugs are generally given to treat symptoms, and may cure the condition.

Living and Management
Continued treatment depends on the type and severity of aspergillosis.
Dogs with the nasal version should be monitored for reduced nasal discharge, while those with disseminated disease need to be monitored with urine analysis and via X-ray every one to two months.

Prevention
General good health will help ensure a strong healthy immune system to ward off this opportunistic disease.
Keeping dogs indoors may be helpful, as it will limit access to grass clippings, hay, straw, and other substances where the Aspergillus fungus can be found.

Article: Canine Aspergillosis in Dog. INDEX
http://www.k9puppydogs.com/canine-dog-health/html/canine_aspergillosis_in_dog.htm

The disease of dog Aspergillosis is produced by a fungus called Aspergillus which develops in the tissues of the bodies of birds and animals. It generally affects the different parts of the respiratory system, although it can also be found in the ears, the liver and although it may sound strange, in the throat and mouth. It follows a slow course and with time becomes chronic, presenting a similarity with tuberculosis.

These spores are found in straw, grass and grain, making their entry in the organism when the animal breathes. Its presence in the tissues produces the death of the cells and the formation of tiny abscesses.

The dog gets this infection from hen houses, and the course of the disease is fast, often accompanied by compulsions or symptoms that are similar to rabies. The animal scratches his snout and nose as if trying to get rid of an irritating object. He sneezes and usually blows out blood.

Nutrition: for Dogs - Eagle, Now. INDEX
http://www.waynepet.net/dog_nutrition.htm

... This article discusses two foods in particular.
For the puppy stage, Eagle Pack Puppy food and for the adult stage, Royal Canin Labrador Retriever

Puppy Nutrition

Artho Formula
This is a blend of New Life Colostrum (vital for the pups when first born to stimulate body functions), glucosamine sulfate, MSM, acetyl myristoleate, lipase enzyme, coated with beta-lipid.

Attributes

- Helps increase bioavailability and absorption of nutrients in the body and helps decrease the bioavailability of iron to pathogens

o MSM, a natural form of sulfur helps in the prevention of free radical damage and helps support joint and cartilage function

o Glucosamine sulfate contains sulfur, an element important to the biochemical synthesis of connective tissue

o Cetyl myristoleate helps support joint and cartilage function.
It is paired with a lipase enzyme in order to help increase its absorption and assimilation in the body ...

Eagle Pack Analysis

Some of the key ingredients include:
• 7 skin and coat conditioners consisting of; chicken fat, flax seed, avocado oil, herring meal, lecithin, vitamin E, and biotin. This is a rare combination and is only found in top quality puppy formula. The main purpose of these conditioners is to allow for a nice shiny healthy coat with healthy skin underneath

• Premium chicken meal, rice, and herring meal provide great taste as well as extra protein and fat which allow for a great foundation for growth

In order to show the extensive process of creating a high calorie-quality puppy food, below is the entire ingredient list with the above key ingredients included:

Chicken meal, brown rice, ground rice, rice bran, chicken fat (preserved with mixed tocopherols and ascorbic acid), flax seed, dehydrated alfalfa meal, avocado oil, herring meal, lecithin, brewers dried yeast, natural flavoring, monosodium phosphate, choline chloride, rosemary extract, sage extract, ferrous sulfate, dl-alpha tocopherol acetate (source of vitamin E), zinc oxide, sodium selenite, manganous oxide, riboflavin supplement (source of vitamin B complex), copper sulfate, zinc methionine, iron proteinate, manganese proteinate, copper proteinate, cobalt proteinate, niacin, vitamin B12 supplement, vitamin A supplement calcium pantothenate, d-biotin supplement, pyridoxine hydrochloride (vitamin B6), calcium iodate, thiamine mononitrate (source of vitamin B1), folic acid, vitamin D3 supplement, bromelain, papain, dried bacillus subtilis fermentation product, dried aspergillus oryzae fermentation product.

Advantages

1. With high protein, nutrient and fat content, the building blocks for continued growth are present and I would expect my pups to do very well while consuming this product

2. Low stool volume is a big advantage and is strictly due to the chicken meal and rice formula allowing for better digestibility, which in turn, allows for more nutrients and vitamins to be absorbed by the puppies

3. Palatability is maintained by the presence of vitamin E and C, meaning that no preservatives are used

4. Eagle Pack Puppy Formula is pressure cooked to ensure that the highest nutrient and vitamin level is present

Guaranteed Analysis
Ingredient Percentage

Crude Protein 26%
Crude Fat 16%
Crude Fibre 4%
Moisture 10%
Phosphorus 1%
Calcium 1.25% 

Now that phase two of my nutrition plan is complete, I need to move to phase three, which is the adult phase of life. I have always been a believer in the commonly used phrase, "you are what you eat" and with this in mind, I have researched the wide selection of adult dog food found on today's' market and in doing so have come across a company that goes the extra mile in regards to their research, dedication, and determination to provide the best adult dog food on the market.

Royal Canin, a dog food manufacturer based in Europe, ....

Labrador Retriever 30 - Formula
Unlike other similarly sized dogs, the Labrador tends to have less muscle mass, and an ability to gain weight just by looking at the food dish. When you combine the "labrador beg" which usually wins him something from the human supper table, with the lazy metabolism and chronic greed of the Labrador, you get the "porky Labrador."

This obviously is bad news and can promote numerous disease factors such as bloat, obesity, poor joints, etc. Taking all these factors into account, Royal Canin set out to develop a specifically formulated food for the Labrador retriever. They determined that by Promoting high protein and low fat, the Labrador would receive the building blocks to a well balanced diet and would be most likely to hold a proper bodyweight in relation to their specific height and activity level.

Ingredients List

Chicken meal, brown rice, corn gluten, oatmeal, barley, brewers rice, chicken fat (naturally preserved with mixed tocopherols), natural chicken flavor, beet pulp (sugar removed), cellulose, fish oil, zeolite, soya oil, potassium chloride, sodium tripolyphosphate, salt, choline chloride, chicory extract, borage oil, taurine, calcium carbonate, inositol, niacin supplement, vitamin E supplement, L-carnitine, glucosamine hydrochloride, ascorbic acid (source of vitamin C), chondroitin sulfate, calcium pantothenate, marigold extract, tyrosine, zinc oxide, pyridoxine hydrochloride (source of vitamin B6), rosemary extract, thiamine mononitrate (source of vitamin B1), riboflavin supplement (source of vitamin B2), zinc proteinate, iron sulfate, manganous oxide, vitamin A supplement, manganese proteinate, folic acid, copper sulfate, copper proteinate, biotin, calcium iodate, vitamin D3 supplement, sodium selenite, vitamin B12 supplement.

Guaranteed Analysis,

Ingredient Percentage

Crude Protein 30%
Crude Fat 13%
Crude Fibre 5.7%
Moisture 10%
Vitamin E 600mg/kg
Vitamin C 300mg/kg
L-Carnitine 200mg/kg
Lutein 5mg/kg
Glucosamine 780mg/kg
Chondroitin 220mg/kg

Advantages
1. Contains numerous skin and coat conditioners to help maintain a nice healthy shiny coat

2. Contains antioxidants such as glucosamine and chondroitin to aid in joint maintenance

3. Contains taurine which has been proven to aid in heart health

4. A high protein level allows for muscle mass maintenance

5. Specific components when combined together have been proven to slow down the aging process. Some of these include; vitamins C and E, taurine, zinc, selenium, chondroitin, and other antioxidents

6. Meets all standards provided by the Association of American Feed Control Officials (AAFCO)

The final stage of my nutrition plan is based on the nutritional requirements for .. a senior. (9-10 years of age) ...

... I have decided to keep my Labrador on the Labrador Retriever 30 - Formula.
I have decided this because this food has all the necessary components that senior dogs need ...

Advantages
1. We all know that as dogs get older, they tend to spend more of their time sprawled on the couch: therefore, by feeding my couch potato Labrador Retriever 30 - Formula, his fat intake will remain low and his protein intake will remain high to help him retain his muscle mass

2. Joint protection will be aided by the presence of glucosamine and chondroitin

3. In order to aid the digestive tract chicory extract has been added to help regulate this vital body system. (fructo-oligosaccharides)

Review: Holistic Select Dog Food ingredients. INDEX
http://www.dogfoodinsider.com/holistic-select-dog-food-review.html

Top 5 Ingredients Breakdown
The first ingredient is Duck Meal. If you are looking for a novel protein, then most dogs have probably not eaten duck, .... It’s different enough from chicken and turkey that a dog that is allergic to those items should not react to it, at least at first. But your dog could develop a generalized poultry allergy after eating the duck for a while. ... The fact that this is duck meal shouldn’t be a problem since meal is usually a denser version of the whole food with the moisture removed before processing.

... the next four ingredients ... are Ground Brown Rice, Ground White Rice, Oatmeal, and Chicken Fat (preserved with Mixed Tocopherols). The ground brown rice should be easy for dogs to digest and fairly nutritious, but the ground white rice is much less so. Oatmeal provides some soluble fiber and nutrients and it should help your dog feel full. The chicken fat, naturally preserved, is good since it’s a named source of fat. ....

Additional Ingredients Of Interest
After these first five ingredients there are some interesting things in the recipe but they are probably present in such small amounts that it’s doubtful how much impact they have, aside from the vitamins and minerals. Dried beet pulp is a good insoluble fiber that provides both energy and keeps the colon healthy. The Dried Egg Product is a good source of protein, as is the (organic) Quinoa. Flaxseed provides omega fatty acids, though it’s a plant source and not as good as an animal source like fish.

Many of the vegetables included in the food perform double duty and also contribute to better digestion such as the Pumpkin and Apples. Tomato Pomace and Peas are often used by dog food companies to provide more fiber in dog food, as well as contribute some nutrients. Cranberries are often added to dog food as an antioxidant. As for Dehydrated Alfalfa Meal, ... It has lots of chlorophyll, (and) ... some other nutrients and fiber, but it also has lots of calcium, ....

Most of the rest of the ingredients are vitamins and minerals – chelated minerals, so they are easier for your dog’s digestive system to absorb them. There are also some prebiotics and probiotics like Inulin, Yucca Schidigera Extract, and several fermentation products: Dried Lactobacillus acidophilus Fermentation Product, Dried Lactobacillus casei Fermentation Product, Dried Enterococcus faecium Fermentation Product, Dried Bacillus subtilis Fermentation Product, Dried Bacillus licheniformis Fermentation Product, Dried Aspergillus oryzae Fermentation Product, Dried Aspergillus niger Fermentation Product.

Do these fermentation products actually help dogs digest food better?
Well, I believe (note, I say “believe”) that when you give acidophilus and other products to dogs in addition to their meals, they do help. I’ve traveled with dogs enough to know that dogs can have sensitive digestion when they have a change in surroundings, but when I gave them acidophilus with their meals, they adapted better – no upset tummies. So, I do believe in these products to that extent. ....

References: INDEX

125. Ascioglu, S., J. H. Rex, B. de Pauw, J. E. Bennett, J. Bille, F. Crokaert, D. W. Denning, J. P. Donnelly, J. E. Edwards, Z. Erjavec, D. Fiere, O. Lortholary, J. Maertens, J. F. Meis, T. F. Patterson, J. Ritter, D. Selleslag, P. M. Shah, D. A. Stevens, and T. J. Walsh. 2002.
Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: An international consensus.
Clin Infect Dis. 34:7-14.

198. Bennett, J. E. 1995. Aspergillus species, p. 2306-2310.
In G. L. Mandell, J. E. Bennett, and R. Dolin (ed.),
Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases, 4th edition ed.
Churchill Livingstone, New York.

284. Boutboul, F., C. Alberti, T. Leblanc, A. Sulahian, E. Gluckman, F. Derouin, and P. Ribaud. 2002.
Invasive aspergillosis in allogeneic stem cell transplant recipients:
Increasing antigenemia is associated with progressive disease.
Clin Infect Dis. 34:939-943.

419. Cohen, M. S., R. E. Isturiz, H. L. Malech, R. K. Root, C. M. Wilfert, L. Gutman, and R. H. Buckley. 1981.
Fungal infection in chronic granulomatous disease.
The importance of the phagocyte in defense against fungi.
Am J Med. 71:59-66.

525. Denning, D. W., and D. A. Stevens. 1990.
Antifungal and surgical treatment of invasive aspergillosis:
Review of 2,121 published cases.
Rev. Infect. Dis. 12:1147-1201.

719. Fujimura, M., Y. Ishiura, K. Kasahara, T. Amemiya, S. Myou, Y. Hayashi, Y. Watanabe, E. Takazakura, A. Nonomura, and T. Matsuda. 1998.
Necrotizing bronchial aspergillosis as a cause of hemoptysis in sarcoidosis.
Am J Med Sci. 315:56-8.

765. Gerson, S. L., G. H. Talbot, S. Hurwitz, B. L. Strom, E. J. Lusk, and P. A. Cassileth. 1984.
Prolonged granulocytopenia: the major risk factor for invasive
pulmonary aspergillosis in patients with acute leukemia.
Ann. Intern. Med. 100:345-351.

783. Glimp, R. A., and A. S. Bayer. 1983.
Pulmonary aspergilloma. Diagnostic and therapeutic considerations.
Arch Intern Med. 143:303-8.

939. Herbrecht, R., D. W. Denning, T. F. Patterson, W. V. Kern, K. A. Marr, D. Caillot, E. Thiel, P. Ribaud, O. Lortholary, R. Greene, C. Durand, J. W. Oestmann, P. S. Stark, R. Sylvester, P. F. Troke, H. Schlamm, J. R. Wingard, R. H. Rubin, B. De Pauw, J. E. Bennett, and EORTC-IFIG. 2001.
Open, randomised comparison of voriconazole and amphotericin B followed by
other licensed antifungal therapy for primary therapy of invasive aspergillosis.
41st Interscience Conference on Antimicrobial Agents and Chemotherapy, Abstract No. J-680.

940. Herbrecht, R., V. Letscher-Bru, C. Oprea, B. Lioure, J. Waller, F. Campos, O. Villard, K. L. Liu, S. Natarajan-Ame, P. Lutz, P. Dufour, J. P. Bergerat, and E. Candolfi. 2002.
Aspergillus galactomannan detection in the diagnosis of
invasive aspergillosis in cancer patients.
J Clin Oncol. 20:1898-1906.

1062. Kauffman, C. A. 1996.
Quandary about treatment of aspergillomas persists [see comments].
Lancet. 347:1640.

1210. Letscher-Bru, V., A. Cavalier, E. Pernot-Marino, H. Koenig, D. Eyer, J. Waller, and E. Candolfi. 1998.
Aspergillus galactomannan antigen detection with Platelia (R) Aspergillus:
multiple positive antigenemia without Aspergillus infection.
J Mycologie Medicale. 8:112-113.

1287. Maertens, J., I. Raad, C. A. Sable, A. Ngai, R. Berman, T. F. Patterson, D. Denning, and T. Walsh. 2000.
Multicenter, noncomparative study to evaluate safety and efficacy
of caspofungin in adults with aspergillosis refractory or intolerant
to amphotericin B, amphotericin B lipid formulations, or azoles.
40th Interscience Conference on Antimicrobial Agents and Chemotherapy, Abstract No. 1103.

1288. Maertens, J., J. Van Eldere, J. Verhaegen, E. Verbeken, J. Verschakelen, and M. Boogaerts. 2002.
Use of circulating galactomannan screening for early diagnosis of
invasive aspergillosis in allogeneic stem cell transplant recipients.
J Infec Dis. 186:1297-1306.

1289. Maertens, J., J. Verhaegen, K. Lagrou, J. Van Eldere, and M. Boogaerts. 2001.
Screening for circulating galactomannan as a noninvasive diagnostic
tool for invasive aspergillosis in prolonged neutropenic patients and
stem cell transplantation recipients: a prospective validation.
Blood. 97:1604-1610.

1334. Massard, G., N. Roeslin, J. M. Wihlm, P. Dumont, J. P. Witz, and G. Morand. 1992.
Pleuropulmonary aspergilloma: clinical spectrum
and results of surgical treatment [see comments].
Ann Thorac Surg. 54:1159-64.

1444. Morrison, V. A., R. J. Haake, and D. J. Weisdorf. 1993.
The spectrum of non-Candida fungal infections following bone marrow transplantation.
Medicine (Baltimore). 72:78-89.

1585. Patterson, R., P. A. Greenberger, R. C. Radin, and M. Roberts. 1982.
Allergic bronchopulmonary aspergillosis: Staging as an aid to management.
Ann. Intern. Med. 96:286-291.

1614. Petraitiene, R., V. Petraitis, A. H. Groll, T. Sein, R. L. Schaufele, A. Francesconi, J. Bacher, N. A. Avila, and T. J. Walsh. 2002.
Antifungal efficacy of caspofungin (MK-0991) in experimental pulmonary
aspergillosis in persistently neutropenic rabbits: Pharmacokinetics,
drug disposition, and relationship to galactomannan antigenemia.
Antimicrob. Agents Chemother. 46:12-23.

1844. Salonen, J., O. P. Lehtonen, M. R. Terasjarvi, and J. Nikoskelainen. 2000.
Aspergillus antigen in serum, urine and bronchoalveolar lavage
specimens of neutropenic patients in relation to clinical outcome.
Scand J Infec Dis. 32:485-490.

1916. Severo, L. C., G. R. Geyer, and N. S. Porto. 1990.
Pulmonary Aspergillus intracavitary colonization (PAIC).
Mycopathologia. 112:93-104.

1973. Stanley, M. W., M. Deike, J. Knoedler, and C. Iber. 1992.
Pulmonary mycetomas in immunocompetent patients: diagnosis by fine-needle aspiration.
Diagn Cytopathol. 8:577-9.

1986. Stevens, D. A., V. L. Kan, M. A. Judson, V. A. Morrison, S. Dummer, D. W. Denning, J. E. Bennett, T. J. Walsh, T. F. Patterson, and G. A. Pankey. 2000.
Practice guidelines for diseases caused by Aspergillus.
Clin. Infect. Dis. 30:696-709.

1987. Stevens, D. A., H. J. Schwartz, J. Y. Lee, B. L. Moskovitz, D. C. Jerome, A. Catanzaro, D. M. Bamberger, A. J. Weinmann, C. U. Tuazon, M. A. Judson, T. A. E. Platts-Mills, A. C. DeGraff, Jr., J. Grossman, R. G. Slavin, and P. Reuman. 2000.
A randomized trial of itraconazole in allergic bronchopulmonary aspergillosis.
N Engl J Med. 342:756-762.

2027. Swanink, C. M. A., J. F. G. M. Meis, A. J. M. M. Rijs, J. P. Donnelly, and P. E. Verweij. 1997.
Specificity of a sandwich enzyme-linked immunosorbent
assay for detecting Aspergillus galactomannan.
J. Clin. Microbiol. 35:257-260.

2126. Verweij, P. E., K. Brinkman, H. P. H. Kremer, B. J. Kullberg, and J. Meis. 1999.
Aspergillus meningitis: Diagnosis by non-culture-based microbiological methods and management.
J Clin Microbiol. 37:1186-1189.

2127. Verweij, P. E., J.-P. Latge, A. J. M. M. Rijs, W. J. G. Melchers, B. E. De Pauw, J. A. A. Hoogkamp-Korstanje, and J. F. G. M. Meis. 1995.
Comparison of antigen detection and PCR assay using bronchoalveolar lavage
fluid for diagnosing invasive pulmonary aspergillosis in patients
receiving treatment for hematological malignancies.
J. Clin. Microbiol. 33:3150-3153.

2141. Viscoli, C., M. Machetti, P. Gazzola, A. De Maria, D. Paola, M. T. Van Lint, F. Gualandi, and M. Truini. 2002.
Aspergillus galactomannan antigen in the cerebrospinal fluid of
bone marrow transplant recipients with probable cerebral aspergillosis.
J Clin Microbiol. 40:1496-1499.

Related Sites and Therapy Information: INDEX

• The Aspergillus web site
  ... comprehensive resource on all aspects of diagnosis and management of invasive aspergillosis.
  http://www.aspergillus.man.ac.uk/

• The Infectious Disease Society of America-Mycoses Study Group (IDSA-MSG)
  Practice Guideline for treating aspergillosis is available at the IDSA website.
  http://www.idsociety.org/pg/toc.htm

COMMENT: INDEX
In politically governed healthcare systems, doctors are typically restricted, by their payment-to-time guidelines, to providing a diagnosis and prescription within 10 to 15 minutes. Those who take longer accept a reduced income or longer working hours, or, cautions and penalties from their supervising manager and/or medical association. This structure eliminates any meaningful consideration of patient history and any potential for extended awareness of medical conditions beyond the routine. The same cost minimization mandate also penalizes the practitioner who requests tests which look beyond the routine and/or may have a higher than minimum cost. (This policy was confirmed, many times, by direct contact with a number of practitioners.)

Government sanctioned laboratories are often limited in their test analysis to the confirmation or denial of any of a specific list of pathogens which usually excludes 50 to 80% of the valid possibilities. Few are authorized to check for aspergillosis, which may present as either of multiple strains of fungi. (This policy of restriction was confirmed by direct contact with laboratory personnel.)

Imaging tests carried out within a government healthcare service depend for their validity and effectiveness upon the assessment of the supervising doctor. A technically excellent test may be provided. Technicians are customarily penalized for voicing or sharing ANY opinions, awareness, or relevancies regarding the test with the patient or any member of the public. Assessments are completed by doctors within the policies noted above ... fast and cheap vs longer and valuable. Professionals who have worked in the imaging assessment field for 20 to 30 years have publicly shared that an assessment completed in less than 40 minutes is incomplete.

Some instructors in the reading of such images, have stated in their manuals for as long as 40 years, that such an activity is an ART. These, and others, have maintained that a collection of apparent minor findings may be as important, or more, than a major finding. In a number of direct observations, I have repeatedly witnessed imaging assessments being completed within 5 to 10 minutes in the Canadian provinces of Ontario, British Columbia, and Alberta. The truly independent and well rewarded private professionals would term these assessments as "incomplete, fraudulent, based on guesswork".

A DIAGNOSIS of an ongoing chronic problem which has been allowed to escalate to an Acute degree of experience can seldom be quick, devoid of relevant tests, minimized to an expectation of the common and routine treated with a guesswork prescription. Nor can it be constructed on the patient stereotype that the sufferer knows nothing about the factors of good health and illness and is devoid of both interest, self-responsibility, and skill in the maintaining and enhancement of their own health. If the patient has acquired a severe and chronic illness reality, they are either dead, most of the time, or, are coping. If they are coping, often with minimal financial resources and minimal access to health and medical data tools, they are doing something that partially works and has a relevancy which can contribute to a diagnostic effort.

Psychological factors, defined by medical instructors who have worked in the medical field for decades would caution further against assessment personnel framing their results with the superstitious reasoning of "looks like what I have seen before, expect, assume". Abdominal fungal and/or intestinal worm parasites masses can morph in one's imagination into intestinal gas or, paradoxically, a stool compaction. It requires experience, interest, sincerity, effort, patience (time), and a mind open to new discoveries ... to see a complex reality and explore possibilities which will return the patient to much improved health and a capacity to return to participating in society as both a service provider and a social and political member.

It is increasingly being voiced by medical researchers and healthcare professionals that MOST people tagged as dying from cancers or old age illness syndromes are actually dying from a fungal disease, either Candida Albicans, or, aspergillosis. With the evaluation limitations, noted above, few instances of acute aspergillosis are treated effectively, or even diagnosed before death. Operating under similar policies and regulations, medical examiners (formerly coroners) are frequently barred from declaring aspergillosis, and many other realities, as the actual cause of a death. (This also was confirmed by examination of the written policies and contact with employees.) Aspergillosis has been confirmed, by scientists (largely quietly and away from public scrutiny), as the cause of death of some whales in the St. Lawrence Seaway, The Vancouver Aquarium, and bays and estuaries near Vancouver, B.C. --- the influence of human sourced industrial and sewage pollution.

Risk Factors:
Common risk factors associated with ALL fungal pathogens include:

• darkness,
• lack of activity **
• cool temperature,
• an acidic environment,
• reduced oxygen presence,
• weakened immune functions,
• minimal use of alcoholic substances, ++
• a diet largely of carbohydrates, especially refined starches & sugars.

** Lack of Activity includes SLEEP, with the exception of REM cycles, and, Death.

The influence of one or multiple heavy metal toxicities produce symptoms of an acidic environment, depressed lung and other organ functions, and, through the cellular weakness and fatigue experienced ... lead to an even greater loss of activity and oxygen availability. Immune functions are distracted, weakened, and, minimized. The intestine and colon of a mammal experiencing a minimization of peristaltic action through heavy metal toxicity provides an IDEAL environment for subtle aspergillosis expansion.

Restrictions on the growth of fungi include:

• salt (of benefit to a person with chronic LOW blood pressure)
• heavy metals (present in many pesticides, fungicides, aging dental amalgams ...) ***
• an alkaline environment (which encourages the release of heavy metals from cells into the bloodstream)
• increased oxygen and activity (which encourages the release of heavy metals from cells into the bloodstream)
• strong immune function (which cannot exist in association with a strong pathogen or toxicity presence)
• minimal sleep (contributes to maintaining a degree of Activity)
• a diet largely of animal based protein (usually NOT health maintaining for a health person),
• considerable use of alcohol. ++

Heavy metals: These create a dynamic in which they encourage fungal and bacterial growth, and, mutation ... while at the same time depressing/retarding those activities. Possible developments become real; enhanced speed becomes Slow speed of activity.

++ Alcohol: many fungi, including Candida Albicans and Aspergillosis species, produce alcohol as one of their digestive products. For a variety of factors, there would appear to be a personal maximum threshold of alcohol presence in the body. Beyond that threshold, the individual will either be drunk, or, have reached a concentration which triggers "Neutralized Motivation", or, the strength of influence over other life functions will be depressed into inactivity.

Neutralized Motivation:
This is an emotional state which significantly weakens rational and body housekeeping-support abilities.
I find it almost impossible to adequately describe in words which others will understand who have not experienced it.
It will be a reflection of how the individual is transformed during alcohol intoxication. So many personal reports have been offered and recorded that it is a cultural stereotype to assume that alcohol intoxicated persons will express themselves in either of two extremes of attitude and behavior.

Aggression:
One form of alcoholic intoxication expression is increased aggressiveness beyond what is a norm for the individual.
This can take the form of increased levels of frustration, anxiety, impatience, swearing, anger, paranoia, violence. To the aware individual, this is a change in their personality. To others nearby, the perception is often clouded by cultural stereotypes supported by rationalizations which are most often incorrect and irrelevant and demonstrate the immaturity and lack of self-esteem of the observer. The consciousness of the subject has become stimulated. For the same individual it is possible that they also have a contradictory-to-norm response to caffeine, sedatives, and other drugs ... making them MORE awake, sensitive, and, reactive. This is a minor pattern of response within the species.

Passivity:
A Second, and much more familiar form of intoxication expression is often perceived by others as being more passive, calm, out-of-it ... by observers. I myself have never been intoxicated with alcohol either by choice, or, by social participation. I have never been drunk nor had to cope with an addiction to alcohol. Yet, my experience with an exaggerated presence of aspergillosis appears to parallel such an experience as described consistently by many others. WITHOUT the strong and persistent influence of one or more high level heavy metal toxicities, and, when my internal manifestation of Ball Aspergillosis seemed, by a number of other symptoms, to be intensely present, my normal and accessible intensities of motivation and self-directedness ... became NEUTRALIZED. It was NOT a negation or suppression of them. Including short-term memory and a temporary absence of longer-term memory, I consciously had no awareness of present or past motivation.

It is easy to understand that persons in a temporary or longer expression of Neutralized Motivation would make NO effort to find, develop, or participate in any form of CHANGE, activity, analysis, or prescription for ANY ailment or previously documented and confidentially expressed desire for improved health. This includes a desire to and ability to communicate with others the real nature of one's incapacity to participate in work, social activities, or intimacy by reason of health complications. One is not uncaring or unmotivated .. both of which require a Choice; one is simply in a state of feeling such that a state of Calm and Easy Going appearance actually conceals an Intensity of Nothing! A person may die by simply not requesting Help when their lifestyle signals that their life is slipping away.

North American societies have ignored Aspergillus because only pharmaceutical companies finance research.
They only look for, test, and provide drugs. NONE of those, indexed in the political infrastructure for healthcare is effective in treatment of aspergillosis. Some make it worse. As an opinion from an experienced and highly successful researcher, as much as 80% of the ill health symptoms currently (2017-11) being treated in North America are an extension of either or both of heavy metal toxicities and/or, systemic fungal invasions. Invasive fungal diseases for humans are typically whether Candida Albicans (the stress-mutated form of the healthy variety of Candida), and, Aspergillosis (one or other varieties). Trillions of dollars of public and private monies are wasted on the treating of ancillary secondary illness. Other trillions are lost through worker disability, lost or downgraded employment, lost tax revenue. Our dogs and cats receive better health care than we do. This is how we die with a whimper, not a bang.

INDEX

INDEX