Re: News on Fungal Sinusitis

[Guest guest]

penny paul was screaming fungi to you a long time ago yet you felt more bacteria were at blame. In my own case, fungi was very much part of the issue and evident when I took AF, in high doses and for long periods. That they caused yet another problem is path for the course that we all know and get pissed off with so well. Talk about shifting sands. Anyway the point I want to make is if your getting improvements from nasal topical solutions, I would consider going the full monty. I did lamisil as it is systemic at 250MG a day and Amp B. Be warned amp b IMO makes you go too loose and loss of electrolytes or something bloody iffy occurred with me. On a positive note. Now Im taking the bloody brewers yeast again (putting the fungi back in (lol)) for the first time in years Im actually getting a full nights sleep with no nightmares, (they stopped a few weeks ago). It is really refreshing to have a good nights sleep. Boy thank the fungi? for small mercies. On 11 Mar 2008, at 03:29, Penny Houle wrote:fwd:Fungal SinusitisAn article published in the Mayo Clinic Proceedings way back in September, 1999 by the Mayo Clinic suggested that fungal sinusitis may be much more common than previously thought. The disease is now know as EFRS (eosinophilic fungal rhinosinusitis) or EMRS (eosinophilic mucinous rhinosinusitis); possibly only a major point to a physician.  Of greater importance to the patient; those fungal infections may very well have been caused by toxigenic molds.Fungal growth was found in washings from the sinuses in 96% of patients with chronic sinusitis. Normal controls had almost as much growth, the difference being that those patients with chronic sinusitis had eosinophiles which had become activated. As a result of the activation, the eosinophiles released MBP (Major Basic Protein) into the mucus which attacks and kills the fungus but is very irritating to the lining of the sinuses. It is believed that MBP injures the epithelium and allows the bacteria to proliferate. The injury to the epithelium by the fungus and mucus led to the belief that treatment of chronic sinusitis should be directed at the fungus rather than the bacteria.Unfortunately the discussion above was not included in the original article by the Mayo clinic. As a result, the article was not well received initially. There was also no information about the success of treatment in the original article, and there was very little discussed about mechanisms. As more data has accumulated, there is more evidence that the problem may be as important as the Mayo Clinic suggests and the significance is starting to be accepted.The findings of the Mayo Clinic were confirmed in papers presented at The American Rhinologic Society. The well respected group from Graz, Austria were able to show positive fungal cultures in 92 % of their patients. Almost as many of the controls also had fungi. Clusters of eosinophiles were found around fungi in 94% of patients. This is important because we believe that this shows that the eosinophiles are involved in attacking and killing the fungi.Current techniques make it difficult for private practitioners to clearly establish EFRS. For example, it is possible to tell by electron microscopy that the degranulation of the eosinophile is in response to fungus. The granules will form a horseshoe shape after degranulation, which is specific to activation by fungi. There are also special stains (e.g. chitinase) which the Mayo Clinic has developed which hopefully will be available in the future.At the present time, some patients are being treated with irrigation with topical antifungals such as Amphotericin B. Many patients require other agents such as nasal or systemic steroids, however many patients were able to stop treatment with steroids.  Through current research, we have discovered, patients have an adverse reaction when they have been exposed to toxic molds.Given topically, Amphotericin B causes minimal problems. These can include burning due to the fact that it must be mixed with sterile water. It cannot be mixed with saline, and must be protected from light and refrigerated. It is therefore very inconvenient to use. We anticipate that patients will need to be treated indefinitely, or at least until we understand better why these problems are occurring.There is currently a compounded Nizoral Nasal Spray for minor fungal sinusitis and colonization of the sinus cavity, eustachian tubes, and throat.  Another remedy that is extremely effective is Nystatin oral powder applied directly to the sinus cavity with a clean swab. It can be mixed with saline as well.Because irrigation must get into the sinuses in order to be effective, it is often necessary for patients to have endoscopic sinus surgery before irrigation can be effective. It may be possible to use the Grossan irrigator to irrigate effectively without surgery. It is also speculated that since as many as 70% of patients with EFRS have a positive allergy skin test for fungi or mold it may be possible to treat them by standard allergy management. Since we cannot allergy test for all of the fungi, it can be a difficult proposition. We are also concerned about whether exposure to fungi in the environment may also contribute to part of the problem. In some cases, it may be necessary to ascertain what mold levels are in the home.There are numerous other types of fungal sinusitis which are more customary. The other forms of fungal sinusitis are broken down into several categories: Allergic, Fungul balls(images) (Mycetoma), and Invasive.Patients who have repeated bouts of sinusitis, as well as those who are immunocompromised should be considered to possibly have a fungal sinusitis. CT scan will sometimes show calcification, but MRI is more sensitive in diagnosis. Cultures are best obtained from the sinuses, as nasal cultures are rather unreliable.Allergic fungal sinusitis (AFS) is commonly caused by Aspergillus, as well as Fusarium, Curvularia, and others. Patients often have what appears is associated asthma. The criteria include CT or MRI confirmation, a dark green or black material the consistency of peanut butter called "allergic mucin" which typically contain a few hyphae, no invasion, and no predisposing systemic disease. Charcot-Leyden crystals, which are breakdown products of eosinophiles are often found. Sometimes, patients are found to be allergic to the fungus, although this is very controversial. This disease is analogous to Allergic Bronchopulmonary Aspergillosis.Surgery, irrigation and immunotherapy are helpful, but it can be extremely difficult to treat. It occurs much more commonly in the humid areas in the Southern United States.Fungus balls often involve the maxillary sinus and may present similarly to other causes of sinusitis including a foul smelling breath. In addition to radiological abnormalities, thick pus or a clay-like substance is found in the sinuses. There is no allergic mucin, but dense hyphae are found. There is an inflammatory response in the mucosa. Removal of the fungus ball is often the typical treatment, but this varies, depending on the circumstances.Invasive sinusitis can progress rapidly as any infection, and typically necessitates surgery, repeatedly on an emergent basis often requiring AmphotericinB as well. There have been some forms of invasive sinusitis which can cause proptosis. There is a form of chronic invasive fungal sinusitis which is associated with visual abnormalities due to bony erosion.Fungal sinusitis should obviously be treated by someone with extensive experience in treatment of this disease.   [return to menu]This site is not intended to give medical advice.  Seek the advice of a professional for diagnosis, medication, treatment options, and complete knowledge of any illness.  The opinions expressed here are exclusively our personal opinions do not necessarily reflect our peers or professional affiliates. The information here does not reflect professional advice and is not intended to supersede the professional advice of others.©2001-2005 Mold-Help  All rights reservedIt's Tax Time! Get tips, forms and advice on AOL Money & Finance.

[Guest guest]

I took lamisil for over 6 months. Doctor won't let me stay on it. I've now been on Ketakonazole for the last 4 months. Before that I was on Diflucan, then V-fend. I remember screaming about fungal infections, believe me. I didn't doubt his own experience, but I didn't feel the Mayo report gave enough evidence to support the claims made, and neither did the scientific community. This last article seems to expand on that original report. I've felt for a long time that the two are related (ala Shoemaker) and is why I've taken antifungals for the last few years at least. But I still believe it's completely wrong to discount the presence of bacterial infections in chronic sinus disease. Personally, while I've had bacterial organisms positively identified and have responded well to abx, I've never once had a positive fungal i.d. despite numerous testing attempts. That doesn't

mean it's not there, but I can't ignore bacteria that is known to eat bone and is currently eating through my jaw and sinuses as shown on xray. What I liked about this article (which was forwarded to me and is why the source is not cited), is the fact that they're suggesting positive ways to i.d. fungi, and also the necessity of long term treatment, possibly for life. We need more testing methods for all of these organisms. I tried to get my ENT to prescribe her own nasal spray over a year ago and she refused based on testing, sayiing it wouldn't help me. I finally got my gp to do it instead and it's helped tremendously. So even a doc who apparently believes in the fungal component is not easily swayed to give it a try without some kind of proof. penny Agentbleu <colourbleu@...> wrote: penny paul was screaming fungi to you a long time ago yet you felt more bacteria were at blame. In my own case, fungi was very much part of the issue and evident when I took AF, in high doses and for long periods. That they caused yet another problem is path for the course that we all know and get pissed off with so well. Talk about shifting sands. Anyway the point I want to make is if your getting improvements from nasal topical solutions, I would consider going the full monty. I did lamisil as it is systemic at 250MG a day and Amp B. Be warned amp b IMO makes you go too loose and loss

of electrolytes or something bloody iffy occurred with me. On a positive note. Now Im taking the bloody brewers yeast again (putting the fungi back in (lol)) for the first time in years Im actually getting a full nights sleep with no nightmares, (they stopped a few weeks ago). It is really refreshing to have a good nights sleep. Boy thank the fungi? for small mercies. On 11 Mar 2008, at 03:29, Penny Houle wrote: fwd: Fungal Sinusitis An article published in the Mayo Clinic Proceedings way back in September, 1999 by the Mayo Clinic suggested that fungal sinusitis may be much more common than previously thought. The disease is now know as EFRS (eosinophilic fungal rhinosinusitis) or EMRS (eosinophilic mucinous rhinosinusitis); possibly only a major

point to a physician. Of greater importance to the patient; those fungal infections may very well have been caused by toxigenic molds. Fungal growth was found in washings from the sinuses in 96% of patients with chronic sinusitis. Normal controls had almost as much growth, the difference being that those patients with chronic sinusitis had eosinophiles which had become activated. As a result of the activation, the eosinophiles released MBP (Major Basic Protein) into the mucus which attacks and kills the fungus but is very irritating to the lining of the sinuses. It is believed that MBP injures the epithelium and allows the bacteria to proliferate. The injury to the epithelium by the fungus and mucus led to the belief that treatment of chronic sinusitis should be directed at the fungus rather than the bacteria. Unfortunately the discussion above was

not included in the original article by the Mayo clinic. As a result, the article was not well received initially. There was also no information about the success of treatment in the original article, and there was very little discussed about mechanisms. As more data has accumulated, there is more evidence that the problem may be as important as the Mayo Clinic suggests and the significance is starting to be accepted. The findings of the Mayo Clinic were confirmed in papers presented at The American Rhinologic Society. The well respected group from Graz, Austria were able to show positive fungal cultures in 92 % of their patients. Almost as many of the controls also had fungi. Clusters of eosinophiles were found around fungi in 94% of patients. This is important because we believe that this shows that the eosinophiles are involved in attacking and killing the fungi. Current techniques make it difficult for private practitioners to clearly establish EFRS. For example, it is possible to tell by electron microscopy that the degranulation of the eosinophile is in response to fungus. The granules will form a horseshoe shape after degranulation, which is specific to activation by fungi. There are also special stains (e.g. chitinase) which the Mayo Clinic has developed which hopefully will be available in the future. At the present time, some patients are being treated with irrigation with topical antifungals such as Amphotericin B. Many patients require other agents such as nasal or systemic steroids, however many patients were able to stop treatment with steroids. Through current research, we have discovered, patients have an adverse reaction when they have been exposed to toxic molds. Given

topically, Amphotericin B causes minimal problems. These can include burning due to the fact that it must be mixed with sterile water. It cannot be mixed with saline, and must be protected from light and refrigerated. It is therefore very inconvenient to use. We anticipate that patients will need to be treated indefinitely, or at least until we understand better why these problems are occurring. There is currently a compounded Nizoral Nasal Spray for minor fungal sinusitis and colonization of the sinus cavity, eustachian tubes, and throat. Another remedy that is extremely effective is Nystatin oral powder applied directly to the sinus cavity with a clean swab. It can be mixed with saline as well. Because irrigation must get into the sinuses in order to be effective, it is often necessary for patients to have endoscopic sinus surgery before irrigation

can be effective. It may be possible to use the Grossan irrigator to irrigate effectively without surgery. It is also speculated that since as many as 70% of patients with EFRS have a positive allergy skin test for fungi or mold it may be possible to treat them by standard allergy management. Since we cannot allergy test for all of the fungi, it can be a difficult proposition. We are also concerned about whether exposure to fungi in the environment may also contribute to part of the problem. In some cases, it may be necessary to ascertain what mold levels are in the home. There are numerous other types of fungal sinusitis which are more customary. The other forms of fungal sinusitis are broken down into several categories: Allergic, Fungul

balls(images) (Mycetoma), and Invasive. Patients who have repeated bouts of sinusitis, as well as those who are immunocompromised should be considered to possibly have a fungal sinusitis. CT scan will sometimes show calcification, but MRI is more sensitive in diagnosis. Cultures are best obtained from the sinuses, as nasal cultures are rather unreliable. Allergic fungal sinusitis (AFS) is commonly caused by Aspergillus, as well as Fusarium, Curvularia, and others. Patients often have what appears is associated asthma. The criteria include CT or MRI confirmation,

a dark green or black material the consistency of peanut butter called "allergic mucin" which typically contain a few hyphae, no invasion, and no predisposing systemic disease. Charcot-Leyden crystals, which are breakdown products of eosinophiles are often found. Sometimes, patients are found to be allergic to the fungus, although this is very controversial. This disease is analogous to Allergic Bronchopulmonary Aspergillosis. Surgery, irrigation and immunotherapy are helpful, but it can be extremely difficult to treat. It occurs much more commonly in the humid areas in the Southern United States. Fungus balls often involve the maxillary sinus and may present similarly to other causes of sinusitis including a foul smelling breath. In addition to radiological abnormalities, thick pus or a clay-like substance is found in the sinuses. There is no allergic

mucin, but dense hyphae are found. There is an inflammatory response in the mucosa. Removal of the fungus ball is often the typical treatment, but this varies, depending on the circumstances. Invasive sinusitis can progress rapidly as any infection, and typically necessitates surgery, repeatedly on an emergent basis often requiring AmphotericinB as well. There have been some forms of invasive sinusitis which can cause proptosis. There is a form of chronic invasive fungal sinusitis which is associated with visual abnormalities due to bony erosion. Fungal sinusitis should obviously be treated by someone with extensive experience in treatment of this disease. [return to menu] This site is not intended to give medical advice. Seek the advice of a professional for diagnosis, medication, treatment options, and complete knowledge of any illness. The opinions expressed here are exclusively our personal opinions do not necessarily reflect our peers or professional affiliates. The information here does not reflect professional advice and is not intended to supersede the professional advice of others. ©2001-2005 Mold-Help All rights reserved It's Tax Time! Get tips, forms and advice on AOL Money & Finance.

[Guest guest]

the testing for fungi is total crap.On 11 Mar 2008, at 16:37, Penny Houle wrote:I took lamisil for over 6 months. Doctor won't let me stay on it. I've now been on Ketakonazole for the last 4 months. Before that I was on Diflucan, then V-fend. I remember screaming about fungal infections, believe me. I didn't doubt his own experience, but I didn't feel the Mayo report gave enough evidence to support the claims made, and neither did the scientific community.  This last article seems to expand on that original report. I've felt for a long time that the two are related (ala Shoemaker) and is why I've taken antifungals for the last few years at least. But I still believe it's completely wrong to discount the presence of bacterial infections in chronic sinus disease. Personally, while I've had bacterial organisms positively identified and have responded well to abx, I've never once had a positive fungal i.d. despite numerous testing attempts. That doesn't mean it's not there, but I can't ignore bacteria that is known to eat bone and is currently eating through my jaw and sinuses as shown on xray. What I liked about this article (which was forwarded to me and is why the source is not cited), is the fact that they're suggesting positive ways to i.d. fungi, and also the necessity of long term treatment, possibly for life. We need more testing methods for all of these organisms. I tried to get my ENT to prescribe her own nasal spray over a year ago and she refused based on testing, sayiing it wouldn't help me. I finally got my gp to do it instead and it's helped tremendously. So even a doc who apparently believes in the fungal component is not easily swayed to give it a try without some kind of proof. penny  Agentbleu <colourbleufree (DOT) fr> wrote:penny paul was screaming fungi to you a long time ago yet you felt more bacteria were at blame. In my own case, fungi was very much part of the issue and evident when I took AF, in high doses and for long periods. That they caused yet another problem is path for the course that we all know and get pissed off with so well. Talk about shifting sands. Anyway the point I want to make is if your getting improvements from nasal topical solutions, I would consider going the full monty. I did lamisil as it is systemic at 250MG a day and Amp B. Be warned amp b IMO makes you go too loose and loss of electrolytes or something bloody iffy occurred with me. On a positive note. Now Im taking the bloody brewers yeast again (putting the fungi back in (lol)) for the first time in years Im actually getting a full nights sleep with no nightmares, (they stopped a few weeks ago). It is really refreshing to have a good nights sleep. Boy thank the fungi? for small mercies. On 11 Mar 2008, at 03:29, Penny Houle wrote:fwd:Fungal SinusitisAn article published in the Mayo Clinic Proceedings way back in September, 1999 by the Mayo Clinic suggested that fungal sinusitis may be much more common than previously thought. The disease is now know as EFRS (eosinophilic fungal rhinosinusitis) or EMRS (eosinophilic mucinous rhinosinusitis); possibly only a major point to a physician.  Of greater importance to the patient; those fungal infections may very well have been caused by toxigenic molds.Fungal growth was found in washings from the sinuses in 96% of patients with chronic sinusitis. Normal controls had almost as much growth, the difference being that those patients with chronic sinusitis had eosinophiles which had become activated. As a result of the activation, the eosinophiles released MBP (Major Basic Protein) into the mucus which attacks and kills the fungus but is very irritating to the lining of the sinuses. It is believed that MBP injures the epithelium and allows the bacteria to proliferate. The injury to the epithelium by the fungus and mucus led to the belief that treatment of chronic sinusitis should be directed at the fungus rather than the bacteria.Unfortunately the discussion above was not included in the original article by the Mayo clinic. As a result, the article was not well received initially. There was also no information about the success of treatment in the original article, and there was very little discussed about mechanisms. As more data has accumulated, there is more evidence that the problem may be as important as the Mayo Clinic suggests and the significance is starting to be accepted.The findings of the Mayo Clinic were confirmed in papers presented at The American Rhinologic Society. The well respected group from Graz, Austria were able to show positive fungal cultures in 92 % of their patients. Almost as many of the controls also had fungi. Clusters of eosinophiles were found around fungi in 94% of patients. This is important because we believe that this shows that the eosinophiles are involved in attacking and killing the fungi.Current techniques make it difficult for private practitioners to clearly establish EFRS. For example, it is possible to tell by electron microscopy that the degranulation of the eosinophile is in response to fungus. The granules will form a horseshoe shape after degranulation, which is specific to activation by fungi. There are also special stains (e.g. chitinase) which the Mayo Clinic has developed which hopefully will be available in the future.At the present time, some patients are being treated with irrigation with topical antifungals such as Amphotericin B. Many patients require other agents such as nasal or systemic steroids, however many patients were able to stop treatment with steroids.  Through current research, we have discovered, patients have an adverse reaction when they have been exposed to toxic molds.Given topically, Amphotericin B causes minimal problems. These can include burning due to the fact that it must be mixed with sterile water. It cannot be mixed with saline, and must be protected from light and refrigerated. It is therefore very inconvenient to use. We anticipate that patients will need to be treated indefinitely, or at least until we understand better why these problems are occurring.There is currently a compounded Nizoral Nasal Spray for minor fungal sinusitis and colonization of the sinus cavity, eustachian tubes, and throat.  Another remedy that is extremely effective is Nystatin oral powder applied directly to the sinus cavity with a clean swab. It can be mixed with saline as well.Because irrigation must get into the sinuses in order to be effective, it is often necessary for patients to have endoscopic sinus surgery before irrigation can be effective. It may be possible to use the Grossan irrigator to irrigate effectively without surgery. It is also speculated that since as many as 70% of patients with EFRS have a positive allergy skin test for fungi or mold it may be possible to treat them by standard allergy management. Since we cannot allergy test for all of the fungi, it can be a difficult proposition. We are also concerned about whether exposure to fungi in the environment may also contribute to part of the problem. In some cases, it may be necessary to ascertain what mold levels are in the home.There are numerous other types of fungal sinusitis which are more customary. The other forms of fungal sinusitis are broken down into several categories: Allergic, Fungul balls(images) (Mycetoma), and Invasive.Patients who have repeated bouts of sinusitis, as well as those who are immunocompromised should be considered to possibly have a fungal sinusitis. CT scan will sometimes show calcification, but MRI is more sensitive in diagnosis. Cultures are best obtained from the sinuses, as nasal cultures are rather unreliable.Allergic fungal sinusitis (AFS) is commonly caused by Aspergillus, as well as Fusarium, Curvularia, and others. Patients often have what appears is associated asthma. The criteria include CT or MRI confirmation, a dark green or black material the consistency of peanut butter called "allergic mucin" which typically contain a few hyphae, no invasion, and no predisposing systemic disease. Charcot-Leyden crystals, which are breakdown products of eosinophiles are often found. Sometimes, patients are found to be allergic to the fungus, although this is very controversial. This disease is analogous to Allergic Bronchopulmonary Aspergillosis.Surgery, irrigation and immunotherapy are helpful, but it can be extremely difficult to treat. It occurs much more commonly in the humid areas in the Southern United States.Fungus balls often involve the maxillary sinus and may present similarly to other causes of sinusitis including a foul smelling breath. In addition to radiological abnormalities, thick pus or a clay-like substance is found in the sinuses. There is no allergic mucin, but dense hyphae are found. There is an inflammatory response in the mucosa. Removal of the fungus ball is often the typical treatment, but this varies, depending on the circumstances.Invasive sinusitis can progress rapidly as any infection, and typically necessitates surgery, repeatedly on an emergent basis often requiring AmphotericinB as well. There have been some forms of invasive sinusitis which can cause proptosis. There is a form of chronic invasive fungal sinusitis which is associated with visual abnormalities due to bony erosion.Fungal sinusitis should obviously be treated by someone with extensive experience in treatment of this disease.   [return to menu]This site is not intended to give medical advice.  Seek the advice of a professional for diagnosis, medication, treatment options, and complete knowledge of any illness.  The opinions expressed here are exclusively our personal opinions do not necessarily reflect our peers or professional affiliates. The information here does not reflect professional advice and is not intended to supersede the professional advice of others.©2001-2005 Mold-Help  All rights reservedIt's Tax Time! Get tips, forms and advice on AOL Money & Finance.

[Guest guest]

Another concern I had about the initial Mayo report which was so widely cited, was that I knew people who talked with other Mayo experts who completely discounted that study. Again, it's not that I didn't believe that fungi is involved big time, it was the way the report was slanted to make it seem like the majority (like 98%) of chronic sinus problems were fungally based completely discounting the bacterial component. I think the two go hand in hand. The good news about that report is it certainly brought a lot of public attention to a very serious and largely unaddressed issue. I truly believe that a lot of pwc are struggling with unknown sinus/jaw infections that involve a number of infectious organisms both bacterial and fungal. In some cases the infection may be originating in some other part of the body, (i.e. bones or organs), but these two areas in particular are so susceptible and so traumatized by poor

dental and medical treatment practices (i.e. ineffective antibiotic treatment) that I think they are a widespread but mostly unknown cause of chronic illness. It also seems so clear to me why various treatments have had some limited success for pwcs. Just one example would be the old guaifenison treatment for FMS patients. Some people got moderate relief and while they had all kinds of rationale for it, when it comes down to it, gaui thins mucous and reduces inflammation, and those things alone are going to provide some symptom relief. I think it's very likely that so many people are just like me, never really having any sinus symptoms or clear cut tooth pain, and yet CT scans and biopsies show degenerative disease in both areas due to chronic infection. pennyAgentbleu <colourbleu@...> wrote: the testing for fungi is total crap. On 11 Mar 2008, at 16:37, Penny Houle wrote: I took lamisil for over 6 months. Doctor won't let me stay on it. I've now been on Ketakonazole for the last 4 months. Before that I was on Diflucan, then V-fend. I remember screaming about fungal infections, believe me. I didn't doubt his own experience, but I didn't feel the Mayo report gave enough evidence to support the claims made, and neither did the scientific community. This last article seems to expand on that original report. I've felt for a long time that the two are related (ala Shoemaker) and is why I've taken antifungals for the last few years at least. But I still believe it's completely wrong to discount the presence of bacterial infections in chronic sinus disease. Personally, while I've had bacterial organisms positively identified and have responded well to abx, I've never once had a positive fungal i.d.

despite numerous testing attempts. That doesn't mean it's not there, but I can't ignore bacteria that is known to eat bone and is currently eating through my jaw and sinuses as shown on xray. What I liked about this article (which was forwarded to me and is why the source is not cited), is the fact that they're suggesting positive ways to i.d. fungi, and also the necessity of long term treatment, possibly for life. We need more testing methods for all of these organisms. I tried to get my ENT to prescribe her own nasal spray over a year ago and she refused based on testing, sayiing it wouldn't help me. I finally got my gp to do it instead and it's helped tremendously. So even a doc who apparently believes in the fungal component is not easily swayed to give it a try without some kind of proof. penny Agentbleu <colourbleufree (DOT) fr> wrote: penny paul was screaming fungi to you a long time ago yet you felt more bacteria were at blame. In my own case, fungi was very much part of the issue and evident when I took AF, in high doses and for long periods. That they caused yet another problem is path for the course that we all know and get pissed off with so well. Talk about shifting sands. Anyway the point I want to make is if your getting improvements from nasal topical solutions, I would consider going the full monty. I did lamisil as it is systemic at 250MG a day and Amp B. Be warned amp b IMO makes you go too loose and loss of electrolytes or something bloody iffy occurred with me. On a positive note. Now Im taking the

bloody brewers yeast again (putting the fungi back in (lol)) for the first time in years Im actually getting a full nights sleep with no nightmares, (they stopped a few weeks ago). It is really refreshing to have a good nights sleep. Boy thank the fungi? for small mercies. On 11 Mar 2008, at 03:29, Penny Houle wrote: fwd: Fungal Sinusitis An article published in the Mayo Clinic Proceedings way back in September, 1999 by the Mayo Clinic suggested that fungal sinusitis may be much more common than previously thought. The disease is now know as EFRS (eosinophilic fungal rhinosinusitis) or EMRS (eosinophilic mucinous rhinosinusitis); possibly only a major point to a physician. Of greater importance to the patient; those fungal infections may very well have been caused by toxigenic molds. Fungal growth was found in washings from the sinuses in 96% of patients with chronic sinusitis. Normal controls had almost as much growth, the difference being that those patients with chronic sinusitis had eosinophiles which had become activated. As a result of the activation, the eosinophiles released MBP (Major Basic Protein) into the mucus which attacks and kills the fungus but is very irritating to the lining of the sinuses. It is believed that MBP injures the epithelium and allows the bacteria to proliferate. The injury to the epithelium by the fungus and mucus led to the belief that treatment of chronic sinusitis should be directed at the fungus rather than the bacteria. Unfortunately the discussion above was not included in the original article by the Mayo clinic. As a result, the article was not well received initially. There was also no information about the success of treatment in the original

article, and there was very little discussed about mechanisms. As more data has accumulated, there is more evidence that the problem may be as important as the Mayo Clinic suggests and the significance is starting to be accepted. The findings of the Mayo Clinic were confirmed in papers presented at The American Rhinologic Society. The well respected group from Graz, Austria were able to show positive fungal cultures in 92 % of their patients. Almost as many of the controls also had fungi. Clusters of eosinophiles were found around fungi in 94% of patients. This is important because we believe that this shows that the eosinophiles are involved in attacking and killing the fungi. Current techniques make it difficult for private practitioners to clearly establish EFRS. For example, it is possible to tell by electron microscopy that the degranulation of the

eosinophile is in response to fungus. The granules will form a horseshoe shape after degranulation, which is specific to activation by fungi. There are also special stains (e.g. chitinase) which the Mayo Clinic has developed which hopefully will be available in the future. At the present time, some patients are being treated with irrigation with topical antifungals such as Amphotericin B. Many patients require other agents such as nasal or systemic steroids, however many patients were able to stop treatment with steroids. Through current research, we have discovered, patients have an adverse reaction when they have been exposed to toxic molds. Given topically, Amphotericin B causes minimal problems. These can include burning due to the fact that it must be mixed with sterile water. It cannot be mixed with saline, and must be protected from light and

refrigerated. It is therefore very inconvenient to use. We anticipate that patients will need to be treated indefinitely, or at least until we understand better why these problems are occurring. There is currently a compounded Nizoral Nasal Spray for minor fungal sinusitis and colonization of the sinus cavity, eustachian tubes, and throat. Another remedy that is extremely effective is Nystatin oral powder applied directly to the sinus cavity with a clean swab. It can be mixed with saline as well. Because irrigation must get into the sinuses in order to be effective, it is often necessary for patients to have endoscopic sinus surgery before irrigation can be effective. It may be possible to use the Grossan irrigator to irrigate effectively without surgery. It is also speculated that since as many as 70% of patients with EFRS have a positive allergy

skin test for fungi or mold it may be possible to treat them by standard allergy management. Since we cannot allergy test for all of the fungi, it can be a difficult proposition. We are also concerned about whether exposure to fungi in the environment may also contribute to part of the problem. In some cases, it may be necessary to ascertain what mold levels are in the home. There are numerous other types of fungal sinusitis which are more customary. The other forms of fungal sinusitis are broken down into several categories: Allergic, Fungul balls(images) (Mycetoma), and Invasive. Patients who have repeated bouts

of sinusitis, as well as those who are immunocompromised should be considered to possibly have a fungal sinusitis. CT scan will sometimes show calcification, but MRI is more sensitive in diagnosis. Cultures are best obtained from the sinuses, as nasal cultures are rather unreliable. Allergic fungal sinusitis (AFS) is commonly caused by Aspergillus, as well as Fusarium, Curvularia, and others. Patients often have what appears is associated asthma. The criteria include CT or MRI confirmation, a dark green or black material the consistency of peanut butter called "allergic mucin" which typically contain a few hyphae, no invasion, and no predisposing systemic disease. Charcot-Leyden crystals, which are breakdown

products of eosinophiles are often found. Sometimes, patients are found to be allergic to the fungus, although this is very controversial. This disease is analogous to Allergic Bronchopulmonary Aspergillosis. Surgery, irrigation and immunotherapy are helpful, but it can be extremely difficult to treat. It occurs much more commonly in the humid areas in the Southern United States. Fungus balls often involve the maxillary sinus and may present similarly to other causes of sinusitis including a foul smelling breath. In addition to radiological abnormalities, thick pus or a clay-like substance is found in the sinuses. There is no allergic mucin, but dense hyphae are found. There is an inflammatory response in the mucosa. Removal of the fungus ball is often the typical treatment, but this varies, depending on the circumstances. Invasive sinusitis can progress rapidly as any infection, and typically necessitates surgery, repeatedly on an emergent basis often requiring AmphotericinB as well. There have been some forms of invasive sinusitis which can cause proptosis. There is a form of chronic invasive fungal sinusitis which is associated with visual abnormalities due to bony erosion. Fungal sinusitis should obviously be treated by someone with extensive experience in treatment of this disease. [return to menu] This site

is not intended to give medical advice. Seek the advice of a professional for diagnosis, medication, treatment options, and complete knowledge of any illness. The opinions expressed here are exclusively our personal opinions do not necessarily reflect our peers or professional affiliates. The information here does not reflect professional advice and is not intended to supersede the professional advice of others. ©2001-2005 Mold-Help All rights reserved It's Tax Time! Get tips, forms and advice on AOL Money & Finance.

[Guest guest]

Speaking of fungal infections, does anybody know what my high aspergillus

IgG blood level means? Does it indicate allergy or infection, for

example? If infection, would it be local or systemic?

Tim

[Guest guest]

,

Thanks for your reply. I do feel very ill. What I've been told is that I likely have "sick building syndrome," but to my knowledge, SBS is more of an allergy than an infection. I'm in the USA, and have seen Dr. Shoemaker, who is our best mold expert. He says I have the genes to be sensitive to mold, but I was negative on all of his tests, which did not include aspergillus IgG. About 5 years ago, I had a CAT scan that showed an unidentified spot, about 1/4 inch in diameter on my lung. So I'm quite confused and trying to get this sorted out without much help from the medical profession. Can you tell me anything more from your personal experience?

Tim

Tim , IgG antibodies against aspergillus in the blood is an indication thatyou either have an ongoing systemic infection or have suffered an infectionin the past ..I find it strange that you have such a dramatic resultwithout anyone explaining the possible consequences of the result ..If youfeel ill , which I assume you do ,an ongoing infection is likely …..searchon IgG and testContact the group below to be included in the newsletter …they are reputedto be the world leading authority on Aspergillus infections ..i was apatient at one time to Professor Denning who is head of the organisation..that’s another story as they say