Spreading southward, toxic fungus brings rare illness to Oregon

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Spreading southward, toxic fungus brings rare illness to Oregon

By Tim Christie

The Register-Guard,Eugene,OR*

Published: January 1, 2008 05:00AM

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It sounds like something out of a low-budget horror movie: a toxic

fungus, lurking in the woods of the Pacific Northwest, drifting

through the air and into people's lungs, causing debilitating

illness and even death.

But the fungus, called cryptococcus gattii, is real, and it's here,

afflicting a handful of Oregonians in recent years. Most recently,

the fungus sickened a Junction City woman, who was hospitalized for

more than four months this fall as doctors struggled to make her

well.

The epicenter for the organism in the Northwest is Vancouver Island,

where it was first detected in 1999. Since then, the fungus has

sickened about 180 British Columbians and killed eight, said

Bartlett, associate professor of environmental health at the

University of British Columbia.

The disease caused by the fungus is still extremely rare, but the

rate in British Columbia is 36 cases per 1 million population — far

higher than other parts of the world where the fungus exists. About

25 people get sick each year in British Columbia from the fungus,

and one dies, according to the B.C. Centre for Disease Control.

Before it was detected on Vancouver Island, the fungus was

associated with tropical and subtropical climates as in Australia,

New Zealand, India, Africa and South America. Scientists are trying

to figure out why and how cryptococcus gattii emerged over the past

decade in the Pacific Northwest.

One theory suggests that the microscopic, yeastlike fungus only

recently arrived in the Northwest from the tropics, where it's long

been established, Bartlett said. Perhaps it stowed away on a

tropical plant imported to Canada or was carried by migrating birds.

A competing theory holds that the fungus has been here for a long

time, unnoticed until changes in climate or land use patterns

allowed it to grow in high enough concentrations that it became

airborne and available for causing disease in humans and animals,

she said.

Because the fungus has been detected in such a large region, from

Vancouver Island to Oregon, some scientists suspect that global

warming has enabled the fungus to " establish a stable ecological

niche for itself " in the Northwest, she said.

Even small changes in climate, such as an increase in temperature of

a degree or two, can cause changes to microscropic organisms that

are in dynamic balance with one another, she said.

" When the ecology changes, those changes work their way up and they

affect higher animals or humans, " she said.

Once the fungus is established in soil or in trees, it can get

stirred up and float in the air in dry weather, she said. Humans

breathe in the fungus, where it can cause either an infection in the

lungs, or more seriously, in the central nervous system, causing

fungal meningitis. Symptoms include severe cough and shortness of

breath, often accompanied by chills, night sweats and anorexia,

according to an article published in January in the journal Emerging

Infectious Diseases.

Until 2004, the only human cases of cryptococcus gattii in Canada

were found among people who lived in or had traveled to Vancouver

Island. The fungus also was found in animals, including porpoises

and household pets such as dogs and cats.

In 2004, when the first case was found in someone who had never been

to the island, researchers decided to begin looking farther afield.

They found three cases in British Columbia and two in Oregon among

people who did not travel to Vancouver Island. One of the Oregon

cases lived near Portland; the other near Eugene, according to the

article.

The Portland case involved an 87-year-old man who died from fungal

meningitis in December 2005. The Eugene case involved a 59-year-old

man who suffered from cough, shortness of breath, fever, chills,

weight loss, nausea and muscle pain in December 2004. The man had

undergone a kidney transplant in September 2003 and reported

scarring of lung tissue as a result of his occupation.

Scientists went looking for the fungus in Oregon's environment. They

took 197 samples of air, soil, water, trees and other structures,

all of which came back negative.

" They did not find it in the environment in Oregon, but it kind of

has to be here because these cases did not travel to Vancouver

Island, " said Dr. Cieslak, manager of the communicable diseases

program in the state Public Health Division. " We don't know how long

it's been here. "

The researchers said they don't know whether the samples found

outside Vancouver Island means the fungus has colonized other areas,

or whether they just represented transient dispersal of the fungus.

The fungus poses a challenge for doctors who aren't used to seeing

it, Bartlett said.

" The initial symptoms of the disease are not very specific, " she

said — flulike symptoms and a general malaise.

" Only when the symptoms continue for several weeks or get worse — a

cough that doesn't go away, unexplained weight loss, night sweats —

do physicians realize they're dealing with something other than

normal flu, " she said.

Further confounding matters is that the disease has a long

incubation period: Illness occurs six to nine months after exposure

to the fungus.

Once doctors figure out what it is, the disease is " very treatable "

in most cases through antifungal medication. But if the disease gets

into the central nervous system, as happened to the Junction City

woman, it is harder to treat.

Last summer, the woman showed up at Sacred Heart Medical Center's

emergency department with symptoms of meningitis, said Dr.

Pelz, an infectious disease specialist. She was treated for

bacterial meningitis, but wasn't getting better. It wasn't until lab

tests came back a week or so later that Pelz's partner, Dr.

, figured out that she had fungal meningitis.

What makes the case unusual is that the woman did not have a

compromised immune system. Doctors are familiar with a more common

type of the fungus, called cryptococcus neoformans, which is known

to attack people with compromised immune systems, including people

with HIV.

Doctors don't know how or where she picked up the fungal infection,

Pelz said. They thought she might have been exposed when she walked

at Finley National Wildlife Refuge near Corvallis, but state

epidemiologists who went to the area and tested tree bark for the

fungus found nothing, he said.

She spent two weeks in the hospital in July, and two weeks in

August, and was readmitted on Sept. 5. All told, she spent about

four months in the hospital, including stints in the intensive care

unit and seven weeks at Oregon Health & Science University.

" The longer she goes without improving, you start to become

concerned about how it's going to turn out, " Pelz said.

She came home Dec. 10, and has gained about 15 pounds, her husband

said. " She's going gangbusters, " he said. She declined to be

interviewed.

He described her ordeal fighting " this weird disease from who knows

where " as " almost surreal. "

From a public health perspective, cryptococcus gattii is more " a

curiosity " than a real threat at this point, said Cieslak, the state

public health official. That said, Cieslak said he wants to learn as

much as he can about the fungus, where it is in Oregon and how it

works.

" You've got bigger things to worry about, " he said. " If we start to

get more reports and it's increasing, I'll sit up and take note. "

Pelz said while cryptococcus gattii is still " awfully rare, " it does

cause him concern.

" It is a new infection, and it's making its way south, " he said.