Common fungus, uncommon reaction??

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Posted on Mon, Jan. 30, 2006

DR. DONOHUE: FOR YOUR GOOD HEALTH

http://www.contracostatimes.com/mld/cctimes/living/health/13746280.ht

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Common fungus, uncommon reactionQ:

About four months ago, I started coughing up flecks of blood. My

doctor put me on antibiotics for bronchitis. They didn't do any

good. I went to a lung doctor, who made the diagnosis of

aspergillosis. By this time the blood had disappeared, and the

doctor said not to do anything at the present. Is that the usual

treatment of this infection?

A: Aspergillus is a fungus. If ever there was a fungus that fit the

ditty " there's a fungus among us, " it has to be Aspergillus. It's

everywhere -- in decaying vegetation, in soil, in food, in water and

in the air. No one on planet Earth escapes contact with it. However,

it causes trouble only in a few.

One Aspergillus-caused problem (not yours) is an allergic reaction

in those who have either asthma or cystic fibrosis. A typical story

is that of an asthmatic farmer who experiences a severe asthma

attack upon entering a barn containing moldy hay. The mold is

Aspergillus. Cortisone drugs control this kind of aspergillosis.

Invasive aspergillosis is a serious infection in which the fungus

infiltrates lung tissue and causes a pneumonialike illness. It

happens to people whose immune systems are not up to par. Antifungal

medicines are urgently needed for these people. This isn't your

variety of aspergillosis either.

Most likely you have a fungal ball, a skein of fungi, in a lung

cavity. The cavity could be from an old, healed TB infection,

emphysema or a similar lung problem. The fungal ball can erode blood

vessels and cause bleeding, which shows up as blood-tinged sputum.

Your bleeding has stopped. There's no consensus about what to do

with someone like you. Observation is often the wisest choice. If

the bleeding resumes, then surgical removal -- a quite delicate

operation -- is one possibility. Some suggest instilling antifungal

medicines into the lung cavity. For the present, your doctor has

chosen the safest approach.

Q: Some weeks ago, you wrote that Lamisil cream or ointment is a

treatment for toenail fungus. Information on the package says you

shouldn't use it for this. Whom are we to believe?

A The Lamisil item was a long-winded bit about toenail fungus. I

wrote that oral -- emphasis on oral -- Lamisil works, but it can

cause liver troubles and is expensive. I ended the piece by saying

that Lamisil creams and ointments don't cause liver damage. The

creams and ointments are for skin fungus, not toenail fungus.

I can see how people might have been confused about this -- if they

really tried to be.

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