Mold Remediation >> Black Mold Exposure

Although the largest group of patients had diffuse pulmonary infiltrates, a significant fraction had focal pulmonary disease, meningitis, Black Mold Exposure or other extrapulmonary disease. Six patients had only a positive serologic test with no other evidence of infection. Excluding the patients who had only a positive serologic test, 81% of the patients in this series had a positive serologic test for coccidioidomycosis, either for IgM or IgG antibodies. 

However, only 69% of patients with diffuse pulmonary disease had a positive serologic test, and the death rate in this group was also the highest (70%). In all clinical groups, death was correlated with the number of circulating CD4 T-cells at the time of diagnosis. For clinicians, Black Mold Exposure however, the most important message from this study is that coccidioidomycosis is not a uniformly fatal complication in patients with AIDS, and that many forms of this disease, including meningitis, respond to therapy. 

Patients with <200 CD4 T-cells/µl are more likely to have severe, Black Mold Exposure disseminated infections. A more recent prospective study of 170 HIV-infected persons in an area of Arizona where coccidioidomycosis is endemic showed a cumulative incidence of coccidioidomycosis of 25% over 41 months. 

The most important risk factors were the level of CD4 T-cells and the diagnosis of AIDS (as opposed to HIV infection). HIV-infected patients with AIDS or <250 CD4 T-cells/µl were 8 to 35 times more likely to Black Mold Exposure get coccidioidomycosis. History of coccidioidomycosis, a history of a positive skin test for coccidioidomycosis, or a prolonged stay in the disease-endemic area were not associated with an increased risk for infection. 

These data suggest that most cases were primary infections in severely immunosuppressed patients. Since patients with AIDS were not more likely to be exposed to the spores of C. immitis Black Mold Exposure and all patients were seen prospectively at 4-month intervals and tested for antibody to C. immitis, severe immunosuppression appeared to increase their risk for infection, as well as disease. 

As in the retrospective study reviewed above, the clinical symptoms varied widely, Black Mold Exposure ranging from mild to extremely severe. Only one patient had antibody titers to C. immitis by complement fixation test without any other evidence of disease. Treatment Various drugs are now available for treating coccidioidomycosis. 

In addition to amphotericin B, which must be given intravenously and is considerably toxic, Black Mold Exposure triazole compounds have been found to be active agents for treating most manifestations of coccidioidomycosis. Fluconazole, in an uncontrolled study, was reported to be effective primary therapy for coccidioidal meningitis; since untreated coccidioidal meningitis is uniformly fatal, robust conclusions could be drawn from this trial (39). 

Forty-seven consecutive patients were treated with 400 mg/day of fluconazole; Black Mold Exposure during the first 6 months of therapy, 33 (70%) of the patients responded to therapy. (A response was defined as a 40% reduction in a score, on the basis of clinical measurements and cerebrospinal fluid findings.) Two patients who did not respond to therapy died of coccidioidomycosis; both were HIV-positive. 

Because of previous experience with high relapse rates when azole therapy is stopped, the authors recommended lifelong treatment with fluconazole. In a small study, Black Mold Exposure four of five patients treated for meningitis with itraconazole as sole therapy responded favorably (40). A recent article emphasized the high relapse rate after azole therapy is stopped (41). 

The alternative treatment to the azoles is amphotericin B. If amphotericin B is used to treat meningitis, Black Mold Exposure however, it must be given intrathecally as well as intravenously, and this greatly increases the risk for a toxic reaction to that drug. Clearly, fluconazole and itraconazole can be used to treat patients with nonmeningeal coccidioidomycosis (42-44). 

Whether one of these drugs is superior to the other, or how either one compares to amphotericin B is not known. It seems prudent to treat extremely ill patients with amphotericin B, at least until their clinical situation stabilizes, Black Mold Exposure although no published studies support that point of view. However, few (if any) patients with the acute miliary form of coccidioidomycosis have been included in any of the reported studies of any of the azole drugs. 

New agents that are more active against coccidioidomycosis are still sorely needed. Prevention Simple environmental measures, Black Mold Exposure such as planting grass or paving roads in highly populated areas, decrease the amount of airborne dust and lower the risk for coccidioidomycosis (10). These measures do not necessarily eradicate C. immitis from the soil but lower the risk for airborne dispersion of the organism. 

At present, no practical method exists for eliminating C. immitis from the soil. Vaccine Development An alternative approach is to vaccinate persons at risk. A vaccine is feasible because natural infection almost always confers lifelong immunity from reinfection. Furthermore, Black Mold Exposure good animal models exist to test vaccine candidates. 

Finally, genetically susceptible mice can be successfully immunized, Black Mold Exposure which suggests that the genetically susceptible human population would also benefit from vaccination (21). One vaccine that has been tested is a killed spherule vaccine developed by Pappagianis and Levine. It protected mice and other animals from experimental infection with C. immitis (45). 

Between 1980 and 1985, a double-blinded human study compared results of a formalin-killed spherule vaccine with results obtained from a placebo. In this study, Black Mold Exposure which involved almost 3,000 people, only a minority of the vaccinated persons had positive skin test results to C. immitis. 

Although the incidence of coccidioidomycosis was low while this study was conducted, Black Mold Exposure no difference was found in the number of cases of coccidioidomycosis or the severity of the disease in the vaccinated group compared with that for the placebo-receiving control group(46). 

One explanation for the ineffectiveness of this vaccine may be that relatively small numbers of Black Mold Exposure killed organisms could be injected into human without unacceptable local side effects of pain and swelling. Nevertheless, the vaccine trial made it clear that immunization with tolerable numbers of whole killed-spherules does not provide immunoprotection against coccidioidomycosis in humans.

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