Update with dr's here making comments.Re:Mysterious Death After Gardening

[Guest guest]

Mysterious Death After Gardening

Local Doctors and Experts Disagree on How U.K. Man Died From Mulch

Exposure

By LAUREN COX

ABC News Medical Unit

June 13, 2008

http://www.abcnews.go.com/Health/Story?id=5058799 & page=1

RSS When a man in England opened some bags of old gardening mulch

last spring, a dense cloud of dust billowed up around him.

Doctors in the U.K. say the aspergillus spore caused a gardener's

deadly infection, but medical practioners in the U.S. say the death

could have been the result of a centuries-old " farmer's lung " or a

rare genetic disease.

(Getty/ABC News)The 47-year-old welder did not know that the cloud

he and his partner saw wasn't dust but spores of a common fungus.

Nor did he know that his day of gardening would lead to his untimely

death days later.

Doctors in the local intensive-care unit raced to diagnose him as

his lungs slowly shut down. Now, a year after his death, specialists

at the local Buckinghamshire Hospital have published their

explanation for this unusual case in the journal Lancet.

The doctors say an extremely rare infection — once in a medical

career rare — from the aspergillus spore caused his deadly

infection. However, top minds in the United States have a different

solution to this mystery: from a centuries-old " farmer's lung "

reaction to a rare genetic disease diagnosis.

The doctors knew that the gardener smoked 10 cigarettes a day and

wondered whether his welding career had exposed his lungs to other

dangers. If these two factors weakened his lungs' defenses, the

cloud of spores could have sent him to the hospital with severe

aspergillosis.

For Waghorn and his colleagues, the spore dust was a puzzle solved

but rarely seen. However, an American expert in aspergillosis and

lung disease believes the U.K. doctors missed a key point in their

case.

For Brahm Segal, chief of the Division of Infectious Diseases at

Roswell Park Cancer Institute in Buffalo, N.Y., smoking, welding and

spit are not enough proof for a diagnosis of aspergillosis.

" The gold standard would have been an autopsy, " says Segal, who also

said he would have been satisfied if the doctors had taken a tissue

sample and tested for the fungus. " He may or he may not have it. "

Segal says he sees cases of aspergillosis quite frequently in his

hospital. In fact, he warns against gardening for patients receiving

chemotherapy for leukemia or people on potent drugs to suppress

their immune systems before transplant operations. People who smoke,

on the other hand, aren't at the same risk.

" This is in the category of people's Bic lighters spontaneously

exploding, " says Segal, who adds that it's " irresponsible " to warn

the public against gardening because of the U.K. welder's case.

However, Segal has his own idea about what happened. " The opposite

side of the coin is that this patient may very well have a very rare

inherited disorder called CGD, " or chronic granulomatous disease.

Segal says with the lung disease CGD, an exposure to a cloud of

aspergillus spores could send someone to the emergency room. Yet, an

infectious disease expert in California has a more common

explanation: a reaction similar to " farmer's lung. "

Another Diagnosis: An Unusual Allergy

" I think they got this a bit wrong, " says s, chief of

the Division of the Infectious diseases at Santa Clara Valley

Medical Center in San , Calif.

s doesn't think it's an inherited disorder that weakens the

lungs, nor does he think the gardener contracted the acute infection

the way the British doctors propose. However, s does blame the

aspergillus spores.

s, who writes medical textbook entries on the subject of

aspergillosis, says he recently has cut out the paragraphs

describing " extrinsic allergic alveolitis … an unusual form of

aspergillus lung disease " for space concerns.

We are right now inhaling aspergillus spores, " s says. " And

many of us, many people, do have an allergy to aspergillus, and if

they get hit with this massive amount of spores, the problem just

cascades. "

s guesses by the chest scans, blood tests and spit test result

from the gardener that he may have had an unknown allergy.

" It's less common than it used to be, because the setting that you

used to see it was in a farmer who would go someplace where hay was

wintering, and the farmer goes in there and starts shoveling it or

rotate it, " s says. Massive amounts of spores are more likely

to grow in barns or silos. " But with less than 5 percent of the

population farming, it's not really an issue now, " he says.

Whatever the gardener had, all the doctors agreed that, aside from

industrial composting or farming, careful backyard gardening won't

put most people at risk.

" I would not want to give the impression that this sort of thing is

a danger to an everyday gardener, " Waghorn says. " What happened with

this poor gentlemen is incredibly rare. "