The Host, its Microbiome and their Aspergillosis.

Infection

For a very long time, medical science has assumed that infectious diseases are caused by the presence of a pathogen and weakness in the infected person or the host as it is often known, which allows the pathogen to grow and infect. The weakness could be for example a weakened immune system caused by a genetic illness or immune-suppressive treatment such as is used for transplant patients.

We assumed that inside our bodies there was mostly a sterile environment, and one reason we might become ill could be a pathogen getting into one of those sterile areas and then growing uncontrollably. One of those sterile area’s was our lungs – so 30-40 years ago most would have concluded that aspergillosis was caused by an Aspergillus spore getting deep into the lungs of the recipient and then managing to grow.

Microbiome

Around the year 2000 we started to be able to look at our internal spaces in more detail and identify any microbes that might be present, What was found was a surprise, for example, we could find many microbes; bacteria, fungi and virus’ growing in our lungs without causing any harmful symptoms. It is common to find Aspergillus fumigatus (ie the pathogen that we assume causes aspergillosis most of the time) present in the lungs of most of us where it lives without causing aspergillosis. How is that possible and what is the difference between that situation and the allergy & infections caused in the lungs of an aspergillosis patient?

We quickly learned that microbes could establish harmless communities, living in harmony with each other and with our immune system. This community was named the human microbiome and included all microbes who live within and on us. Huge numbers live in our gut, especially in our large intestine which is the last section of our digestive system to receive our food before it is ejected via the rectum.

Our Microbial Friends

It has emerged then that A. fumigatus can be controlled by its microbial neighbours (our microbiome) working in a tightly controlled partnership with our immune system.

The fungal pathogen interacts with the host to calm the host’s response to the pathogen and uses parts of the host’s immune system to do this. In this way the host and pathogen tolerate each other and do little harm, however, it has been demonstrated that if parts of the host’s fungal recognition system are not working then the host will initiate an aggressive inflammatory response. This is not unlike the situation in ABPA where one of the major problems is the host over-responding to the fungus.

We are also given an example of the microbiome controlling the host’s immune response to a fungal pathogen. Resistance to infection can be increased by the microbial population in the gut sensing a signal – presumably in food ingested by the host. This means that environmental factors can influence the rejection of a pathogen by its microbial neighbours – the message we might take from this is to look after our gut microbiome, and it will look after us. This also holds for the microbes in our lungs, where we have seen differences in the types and location of bacteria in the upper and lower airways that seem to be consistent with the microbiome controlling inflammation – the authors speculate that we need to look at what happens when we challenge these lung microbiotas with a highly inflammatory pathogen such as Aspergillus fumigatus.

The microbiome is also self-regulating as long as it is kept healthy. Bacteria can attack fungi, fungi can attack bacteria in an ongoing battle for food. Host pathogens can be eliminated completely from the microbiome by other microbes.

Different microbiomes in a different part of our body can interact and control diseases such as asthma (ie. lung microbiome interacting with gut microbiome) – so what you eat may influence the microbes in your gut microbiome and that can have an impact on your asthma, for example.

 

I must warn you that lots of the observations mentioned above are based on very few experiments so far, and mostly on animal model systems and Candida rather than Aspergillus so we must be cautious in our interpretation with regard to aspergillosis, however there are a few take-home messages worth bearing in mind.

  1. Most healthy people seem to have very healthy, highly diverse microbiomes – so look after yours with a well-balanced diet containing lots of plant material, lots of fibre
  2. Researchers seem to be turning our assumptions of what infection is on its head – they seem to be saying that inflammation causes infection, rather than infection causes inflammation.
  3. What you eat can have a direct impact on the amount of inflammation your body uses in response to what it perceives as a pathogen.

It can’t be that diseases like asthma and ABPA are caused by an unhealthy microbiome can it?

Current research seems to be suggesting that it may play a part, so the value of someone with aspergillosis doing what they can to promote a healthy community of microbes within themselves cannot be overstated.

What should I eat for a healthy microbiome? (BBC website)

Human Microbiome Project

Microbiome-mediated regulation of anti-fungal immunity

Coronavírus COVID-19 (SARS-CoV-2): Precauções se você tiver Aspergilose (4 de abril)

Precauções com o coronavírus

Nas últimas semanas, muitos de nós no Reino Unido tivemos o cuidado de nos distanciar socialmente dos outros, a fim de diminuir a propagação do surto viral de SARS-CoV-2 (COVID-19). Os requisitos são os seguintes:

Ficar em casa

  • Saia apenas por motivos alimentares, de saúde ou de trabalho (mas somente se você não puder trabalhar em casa)
  • Se você sair, mantenha-se a 2 metros de outras pessoas o tempo todo
  • Lave as mãos assim que chegar em casa

Não conheça outras pessoas, nem amigos ou familiares.

Você pode espalhar o vírus mesmo se não tiver sintomas.

Consulte o link UK Gov para obter detalhes completos

Essas precauções são eficazes e apropriadas para quase todos; no entanto, existem algumas pessoas que são mais vulneráveis devido à idade ou a um problema de saúde específico e podem precisar tomar mais precauções. Alguns, mas certamente nem todos os pacientes com aspergilose se enquadram nessa categoria e, em alguns casos, terão que ser considerados individualmente pelo seu médico.

Se você se enquadra na categoria extremamente vulnerável, você será informado por uma carta do UKgov, seu médico de família, médico do hospital local ou para alguns (portadores de CPA) do Centro Nacional de Aspergilose. Isso é conhecido como letra de proteção.

Se você é extremamente vulnerável

O governo do Reino Unido forte asma e forte DPOC como condições que colocam as pessoas em alto risco com o surto de coronavírus COVID-19. O documento completo publicado pela Public Health England (24 de março), que também contém links para um grande número de outros documentos relevantes pode ser acessado aqui. Aspergilose refere-se a uma série de doenças e casos individuais, alguns dos quais podem se enquadrar na categoria de alto risco mas alguns não. 

Os pontos principais (além de manter uma boa lavagem das mãos, tosse nos tecidos) são:

  1. Evite estritamente o contato com alguém que esteja apresentando sintomas de coronavírus (COVID-19). Esses sintomas incluem alta temperatura e / ou tosse nova e contínua.
  2. Não saia de sua casa.
  3. Não participe de nenhuma reunião. Isso inclui reuniões de amigos e famílias em espaços privados, como casas de família, casamentos e serviços religiosos.
  4. Não faça compras, lazer ou viagens e, ao organizar entregas de alimentos ou medicamentos, estas devem ser deixadas na porta para minimizar o contato.
  5. Mantenha contato usando a tecnologia remota, como telefone, internet e mídia social.

Todas as pessoas em alto risco estão sendo informadas disso por texto / email / carta durante a próxima semana, para que estejam totalmente cientes do que devem fazer para se proteger.

Em nossas discussões com pacientes com aspergilose, foram levantados mais alguns pontos relacionados ao isolamento social que não são totalmente cobertos pelo documento acima; portanto, tentaremos respondê-los aqui - se você tiver mais perguntas, entre em nosso Grupo do Facebook e discuta-o lá.

Posso usar meu jardim?

Se você tem um jardim privado e pode manter um distanciamento social dos vizinhos e de outras pessoas que moram em sua casa, a resposta é sim.

Entregas: posso pegar o vírus?

Existe um trabalho de pesquisa específico que responde a algumas dessas perguntas. A sobrevivência do COVID-19 em uma variedade de superfícies foi medida sob um conjunto de condições:

 

O SARS-CoV-2 é o vírus atual (surto de 2020) que aparece como marcadores vermelhos em cada gráfico. Podemos ver que o tempo que leva para o vírus perder metade de suas partículas infecciosas (ou seja, a meia-vida) é mais curto para papelão (3-4 horas) e cobre (1 hora); portanto, qualquer vírus nas embalagens de papelão deve duram a menor quantidade de tempo, enquanto a meia-vida era de 6-7 horas para o plástico, ou aproximadamente o dobro do tempo.

Dado que alguém infectado pelo SARS-CoV-2 (COVID-19) pode produzir mais de um milhão de vírus na garganta, podemos ver que uma única tosse pode conter centenas de milhares. Se esse número pousasse em papelão, assumiria 2 dias para o vírus "morrer", o dobro do tempo como o do plástico. Claramente, é sensato tomar precauções com as entregas, dependendo do que elas envolvem, e limpe-as com um desinfetante contendo mais de 60% álcool ou alvejante, ou este documento da EPA dos EUA é muito útil para descrever uma grande variedade de desinfetantes.

Quão fácil é ser infectado se alguém está tossindo?

O artigo acima mostra que a meia-vida do vírus em condições padrão como aerossol, ou seja, após uma tosse ou espirro, é semelhante ao cobre e pode permanecer no ar por pelo menos uma hora, embora se pense que a maioria afunda no chão dentro de uma área de 2 metros em minutos. Levará de 12 a 24 horas para morrer no ar, talvez mais em condições fora do padrão (por exemplo, temperatura mais alta ou umidade mais alta), mas talvez mais quando aterrissar, dependendo da superfície em que aterrissar. É por isso que uma lavagem cuidadosa das mãos é vital para impedir a transmissão do vírus, e o espaçamento de 2 metros nos mantém afastados dos aerossóis diretos no caso de alguém tossir.

Devo limpar meu telefone?

Os números apresentados acima para a sobrevivência do vírus no plástico são úteis quando você percebe que todos carregamos uma tela de plástico, seguramos em nossas mãos e colocamos contra nossos rostos. Se algum vírus pousar em nossos telefones, eles podem permanecer viáveis por mais de 4 dias. Por esse motivo, devemos limpar nossos telefones regularmente, pelo menos diariamente. Use toalhetes à base de álcool - este artigo fornece mais detalhes.

Desinfecção de superfícies: O que devo usar?

Desinfetantes confusos e diferentes precisam ser usados de maneiras diferentes, e superfícies diferentes podem precisar de desinfetantes diferentes. Os melhores desinfetantes para as mãos e a pele são, de preferência, sabão e água corrente, pois o sabão desarma e desativa o vírus, e a água o lava e dilui o vírus em sua pele com muita eficiência - água quente com sabão, o melhor de tudo. Se você não puder acessar a água corrente, desinfetantes para as mãos que contenham pelo menos álcool 60% (NÃO apenas sabão e surfactantes) são eficazes até que você possa lavar as mãos adequadamente.

Observe que a maioria dos lenços umedecidos / lenços umedecidos é projetada para limpar e NÃO matar o coronavírus.

Para outras superfícies, há uma variedade de desinfetantes úteis, mas alguns não são bons para desinfetar superfícies cobertas por vírus e muitos precisam ser deixados na superfície por mais tempo do que você pensa! agradecidamente este documento da Agência de Proteção Ambiental dos EUA é muito informativo.

Limpeza e desinfecção em uma casa com SARS-CoV-2 confirmado ou suspeito

Limpar uma área que foi exposta ao SARS-CoV-2 por exemplo, depois que alguém em uma casa foi diagnosticado como positivo para Coronavírus e saiu

Monitoramento COVID-19

Ajude os pesquisadores a monitorar a propagação do coronavírus usando este aplicativo simples.

Mitos a ignorar

Autoridade Mundial de Saúde sobre Mitos

Mitos da Live Science (com sede nos EUA)

BBC parte 1

  • Alho
  • Beber água
  • Sorvete
  • Prata potável (prata coloidal)

e parte 2

  • Prendendo a respiração
  • Desinfetante para as mãos caseiro
  • O vírus pode sobreviver em superfícies por um mês
  • Urina de vaca

Não recebi uma carta de proteção, o que faço?

As cartas ainda estão sendo enviadas, você ainda pode receber uma e até então o conselho geral é distanciar-se socialmente de todos (veja acima), em vez de se proteger. Para pessoas com asma que não receberam uma carta A Asma do Reino Unido divulgou algumas diretrizes sugerindo ações adicionais

Para pessoas com doença pulmonar crônica, a A British Lung Foundation divulgou algumas diretrizes úteis.

How do I… cope with hair loss?

Certain medications prescribed for aspergillosis may cause some hair loss. Losing your hair can be very difficult, and can affect your self-esteem; unfortunately there is a social stigma attached to hair loss and this can affect many people’s confidence, but there are ways to cope.

Join a support group:

Joining a support group is a great way to meet other people going through the same experiences as you, and to share tips and coping skills with one another.

  • Local support groups: Alopecia UK has several local support groups based around the UK. Click here to find your closest meeting.
  • Online support groups: If you are unable to attend a local meeting, or you’d just prefer to find support online there are Facebook support groups for the UK and worldwide community: Alopecia UK Facebook group e World Alopecia Community. Here you can ask questions and share your experiences with others who suffer from hair loss. You can also use the aspergillosis support groups on Facebook to talk to others also coping with aspergillosis and associated problems: Aspergillosis Support (Private) e Suporte de Aspergilose

Talk about it:

Hair loss can hugely affect your confidence and self-esteem. Talking about it with your family and friends can help them understand what support you need from them, and help you to understand that they don’t see you any differently.

If you are really struggling, you might want to seek help from your doctor. The lack of control over this sudden change in your appearance (as well as coping with a chronic illness) can make people very vulnerable to mental illnesses. It is important to try and recognise this and tackle it as early as possible – for more information on recognising and avoiding depression, Clique aqui.

Cover up:

There are several different ways to cover up hair loss, from small bald patches to more severe cases. More detailed information on the tips listed below can be found here.

  • Haircuts and hairstyles: smaller bald patches can often be hidden with the right hairstyle. An experienced hairdresser will be able to help you choose the best haircut to cover up patches. If you’re worried about going into a salon, find a hairdresser who does home-visits. There are also many videos on YouTube that show you tips and tricks to style your hair over patches
  • Wigs: With more severe hair loss, you might want to try a wig. There are many different types out there, so Alopecia UK has put together a detailed guide to choosing a wig.
  • Head coverings: Headscarves, hats, head tattoos and camouflage products are all good and fairly cheap ways to cover up hair loss. These can be very individual and allow you to be flexible with your appearance.
  • Make up: Losing eyebrow and eyelash hair can change your appearance more than you think, which can be upsetting. Make up tips, such as wearing fake eyelashes or drawing eyebrows on with a pencil can help disguise facial hair loss. There are also more permanent options, such as eyebrow tattoos, that can help you achieve a more natural look.

However you choose to deal with hair loss, there is plenty of support, tips and advice out there for you to access!

How do I… describe symptoms to my doctor?

This subject is often glossed over, after all, how hard can it be to describe how you feel? The answer is that it is all too often pretty difficult!

The initial conversation between you and your doctor is usually one of the most vital few minutes you will spend with your doctor, as your subsequent diagnosis and treatment is strongly guided by what information you impart. For many of us, it may seem a simple process as long as the symptom is simple to describe and in an obvious place – for example, if you have a sharp pain in your knee it is easy to pinpoint. However, what if you have a rather less well defined uncomfortable sensation in your chest? You can’t describe it as a pain and you can’t point at the location with any accuracy other than ‘it’s on the left side’.

There might also be additional information that you can collect prior to the conversation (eg. for symptoms that come and go it can be useful to keep a diary). There are also apps for use on a smartphone that can help you record symptoms and other factors important to the management of your health.

Your doctor is skilled at guiding your thoughts to reach a quick conclusion, but it is worthwhile giving your first conversation some thought, to ensure that you are giving accurate information that you are happy describes what is happening. There are several tips and tricks that can help with this in this document in WikiHow. Some of the tips are reproduced below:.

Learn the basics of describing symptoms. There are four basic elements you should use to describe symptoms. Learning these will help you figure out your symptoms and best convey them to your doctor.[1]

  • Tell your doctor how your symptoms feel. For example, if you’re experiencing headaches, use descriptive words like sharp, dull, stabbing, or throbbing. You can use these kinds of terms to describe many physical symptoms.
  • Explain to or show your doctor the exact location in or on which you’re experiencing your symptoms. You want to be as specific as possible so say “the front of my kneecap is swollen and has throbbing pain” instead of something general like “I have pain on my leg.”[3] You should also note if the symptoms extend to another location.
  • Mention how long you’ve had your symptoms. The more specific date you can pinpoint, the easier it may be for your doctor to figure out what is causing your symptoms.[4]
  • Note how frequently you have or notice symptoms. This information can also help your doctor figure out what’s causing your symptoms. For example, you could say “I feel symptoms every day, especially after I work out,” or “I only notice my symptoms occasionally, like every few days.”

2. Figure out and write down your symptoms. It’s important to recognize your specific symptoms and write them down before you see your doctor. Not only will this help you best describe your symptoms, but will also ensure that you don’t forget to include any symptoms and how they affect you.[5]

  • Make sure to take your list of symptoms, including the basic information on them, to your appointment with you.
  • Note if symptoms are connected to specific activities, injuries, times of day, food or beverages, and anything else that exacerbates them. Also note if they affect your life in any way.[6]

3.  Bring a current and cumulative patient profile to the appointment. A comprehensive profile of yourself as a patient includes information on conditions, hospitalizations, or surgeries you’ve had, what medications you have taken or are currently taking, and any allergy to medications or foods. This will help ensure that you don’t forget any vital information and also help your doctor understand your medical history.[7]

  • You may not end up needing to refer to it, but if questions about your medical history come up, having your patient profile available will maximize the time you can spend discussing your current medical issue(s).[8]
  • Bring your current medication bottles, which list the name & dose information. Make sure to include any herbal supplements you take as well.[9]
  • You can create a patient profile by summarizing your medical history on a piece of paper.

4. Make a list of questions you have for your doctor. Write down a list of questions related to your most pressing concerns about your symptoms before you go to your doctor. This can also help maximize your visit and the time used describing your symptoms.[10]

  • Address any concerns or worries you have in your questions.

The article goes on to provide really good help with the conversation as it develops – it is well worth reading through next time you have to see your doctor!

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