Tuesday, October 10, 2006

Fungus Among Us

About three years ago I was having more than my share of sinus infections, and more asthma symptoms than usual. My doctor tried medication after medication, most of which were nasal sprays and antihistamines for my allergies. Nothing was working. One fall morning I blew my nose and was shocked to see that what came out of my nasal passage was something unlike I'd ever seen before--and for a person with CF who has seen every disgusting bit of mucus imaginable, that's saying something!

It was blue. And it was fuzzy.

The chances that a very tiny Muppet had crawled into my sinuses and had just exited into my tissue were highly improbable. I took the mysterious blue booger with me to my doctor appointment that afternoon.

"Ah yes, that is mold," she told me. "Aspergillus."

As if I hadn't already been a walking science project for the better part of two decades, now I had to deal with the fact that a very persistent mold/fungus had taken up residence in my body. Not only that, but since I am allergic to mold spores, pollen and basically anything else that likes to grow in God's great outdoors, my body was reacting to the aspergillus in a manner consistent with a condition referred to as ABPA.

What is ABPA?

ABPA stands for "allergic broncho pulmonary aspergilliosis." It means that in addition to culturing aspergillus (a fungus), the body reacts to it with an allergic response. Some people can culture aspergillus but don't have ABPA. The body responds to the allergen by increasing the amount of IgE (immunoglobulin E) in the blood. To bring the IgE back down and control the fungal infection, doctors prescribe antifungal medications like Vfend or Sporanox in combination with corticosteroids (such as prednisone) to reduce inflammation in the lungs and/or sinuses.

A IgE number of 100 or greater is considered "high" for adults. Mine has run in the thousands when I'm experiencing an accute exacerbation from the aspergillus that has colonized me. Normally, the first thing the doctors would try is prednisone. For me though prednisone is worse than the infection itself since it brings about so many horrible side effects, and I avoid it to the greatest extend possible. These days I do the antifungal meds all the time, and do what I can to make sure my home environment is free from the conditions that would encourage mold growth (i.e. moisture, dampness, live plants, etc.)

High IgE levels are presumed to be associated with a decrease in lung function. The significance and danger of a high IgE number is that if IgE numbers stay high for a prolonged period of time, the degree of severity of lung damage can potentially increase. However, this is largely just a hypothesis on my part based on things I've read. IgE and its connection with CF and lung function is something that isn't fully understood at this point in time but several studies are ongoing.

Antifungal Therapies for ABPA

Current mood: detached
Current snack: strawberry yogurt
Health-o-meter: 95%
Emotional weather: patchy clouds

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