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 曲霉 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 烟曲霉 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 曲霉 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

冠状病毒COVID-19(SARS-CoV-2):曲霉病的预防措施(4月4日)

冠状病毒预防措施

在过去的几周里,我们许多英国人一直在谨慎地与他人保持社交距离,以减慢SARS-CoV-2(COVID-19)病毒爆发的传播速度。要求如下:

呆在家里

  • 仅出于食物,健康原因或工作而外出(但仅当您不能在家工作时)
  • 如果您外出,请始终与他人保持2米(6英尺)的距离
  • 到家后立即洗手

不要见别人,甚至不见朋友或家人。

即使没有症状,您也可以传播病毒。

查看英国政府链接以获取完整信息

这些预防措施几乎对每个人都是有效且适当的,但是,有些人由于年龄或特定的健康状况而更容易受到伤害,可能需要采取进一步的预防措施。有些但当然不是所有的曲霉病患者都属于该类别,在某些情况下,您的医生必须单独考虑。

如果您属于极度脆弱的类别,您将收到UKgov,您的全科医生,您当地的医院医生或国家曲霉病中心的一些信(包括CPA的人)的来信。这被称为屏蔽字母。

如果您极度脆弱

英国政府有 严重 哮喘和 严重 COPD是使人遭受冠状病毒COVID-19爆发高风险的条件。英格兰公共卫生部(3月24日)发布的完整文件,其中还包含指向许多其他相关文件的链接 可以在这里访问。 曲霉病是指一系列疾病和个别病例,其中一些可能属于高风险类别 但有些人不会。 

要点(除了保持良好的洗手效果外,还要咳入组织中):

  1. 严格避免与显示冠状病毒(COVID-19)症状的人接触。这些症状包括高温和/或新的持续咳嗽。
  2. 不要离开你的房子。
  3. 不要参加任何聚会。这包括在私人空间中的朋友和家人聚会,例如家庭住宅,婚礼和宗教仪式。
  4. 请勿外出购物,休闲或旅行,在安排食物或药物运送时,应将它们留在门口,以尽量减少接触。
  5. 使用电话,互联网和社交媒体等远程技术保持联系。

下周将通过文本/电子邮件/信件将所有高风险人士告知此情况,以便他们充分意识到自己必须采取的保护措施。

在与曲霉菌病患者的讨论中,提出了与上述文档未完全涵盖的与社会隔离有关的其他几点,因此,我们将在此处尝试回答这些问题–如果您还有其他问题,请加入我们 Facebook小组并在那里进行讨论。

我可以使用我的花园吗?

如果您有私家花园,并且可以与邻居和其他居住在您家里的人保持社交距离,那么答案是肯定的。

交货:我可以感染病毒吗?

有一个 具体研究论文 回答了其中一些问题。在一组条件下测量了COVID-19在各种表面上的存活率:

 

SARS-CoV-2是当前的病毒(2020年爆发),在每个图中均以红色标记显示。我们可以看到,病毒损失一半传染性颗粒所需的时间(即半衰期)对于纸板(3-4小时)和铜(1小时)而言是最短的,因此纸板包装上的任何病毒都应最短的时间,而塑料的半衰期为6-7小时,或大约是其两倍。

假设被SARS-CoV-2(COVID-19)感染的人可以在其喉咙中产生超过一百万种病毒,我们可以看到一个咳嗽可能包含数十万个。如果那个数字落在纸板上,它将接管 2天 为了使病毒“灭绝”, 两倍长 和塑料一样显然,明智的做法是根据包裹的包装情况采取预防措施,然后用含有更多成分的消毒剂擦拭干净。 60%酒精或漂白剂,或 该美国EPA文件对描述多种消毒剂非常有用。

如果有人咳嗽,容易被感染?

上面的论文表明,在标准条件下,作为气溶胶,即咳嗽或打喷嚏后,该病毒的半衰期与铜相似,并且可以在空气中停留至少一个小时,尽管大多数被认为会沉在地板上。在几分钟内2米范围内。空气中的死亡将需要12-24小时,在非标准条件下(例如,温度较高或湿度较高),它可能会更长,而在其着陆时,则可能会更长(取决于其所附着的表面)。这就是为什么彻底洗手对于防止定居病毒继续传播至关重要的原因;如果有人咳嗽,那么2米的间距可使我们远离直接的气溶胶。

我应该清洁手机吗?

当您意识到我们都随身携带一个塑料筛网,将其握在手中,并贴在我们的脸上时,上面给出的有关病毒在塑料上的存活率的数据将很有帮助。如果任何病毒落在我们的手机上,它们可以存活超过4天。因此,我们应该至少每天一次定期清洁手机。使用酒精湿巾– 本文提供了更多详细信息.

消毒表面:我应该使用什么?

令人困惑的是,不同的消毒剂需要以不同的方式使用,并且不同的表面可能需要不同的消毒剂。最适合您的手和皮肤的消毒剂最好是肥皂和自来水,因为肥皂可以解粘并禁用病毒,而水可以将其洗掉并有效地稀释皮肤中的病毒-最好是用肥皂热水。如果您无法获得自来水,请使用至少含60%酒精的消毒剂(不只是肥皂和表面活性剂)有效,直到您可以正确洗手为止。

请注意,大多数湿纸巾/婴儿湿纸巾旨在清洁而不杀死冠状病毒。

对于其他表面,有多种有用的消毒剂,但有些对消毒被病毒覆盖的表面没有好处,许多表面上的残留时间比您想象的要长!谢天谢地 美国环境保护署的这份文件非常有用。

确认或怀疑SARS-CoV-2的房屋中的清洁和消毒

清洁暴露于SARS-CoV-2的区域 例如在某人被诊断为冠状病毒阳性并离开后

COVID-19监控

帮助研究人员使用此简单的应用程序监控冠状病毒的传播。

神话不容忽视

世界卫生局神话

活科学(基于美国)的神话

英国广播公司 第1部分

  • 大蒜
  • 喝水
  • 冰淇淋
  • 饮用银(胶体银)

第2部分

  • 屏住呼吸
  • 自制洗手液
  • 该病毒可以在表面存活一个月
  • 牛尿

我还没有收到保护函,该怎么办?

信件仍在发出,您可能仍会收到信件,在此之前,一般的建议是在社交上与每个人保持距离(参见上文),而不是保护自己。对于未收到信件的哮喘患者 英国哮喘组织发布了一些指南,建议采取进一步行动

对于有 慢性肺病英国肺基金会已经发布了一些有用的指南。

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 groupWorld 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)曲霉病支持

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, 点击这里.

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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