Health Book Review

Welcome to my health book review, which consists of a summary and commentary! Also find me on Substack under the name "Of Books and Bible."  Find out about the water cure and salt for health, asthma allergies and more! Find out about brilliant and courageous physicians who know how to treat Lyme Disease! Find out how a courageous Navy Veteran cured his own Morgellons Disease! 

Each book review contains a summary of the author’s most important points followed by my commentary at the end, where I connect some dots for you and provide additional information. The order of the books reviewed was predetermined by me. This sequence is intended for one book to build upon another and coalesce into a picture. Sometimes I will venture down some rabbit holes encountered in any given book and I will post that too.

The first four books I consider to be foundational and these are: Your Body’s Many Cries for Water, ABC of Asthma Allergies and Lupus, Water Cures Drugs Kill, and Obesity Cancer Depression Their Common Cause & Natural Cure. All by Dr. Batmanghelidj.

All past book reviews can be found in the archives and downloaded as a PDF. I usually bundle them as five book reviews in one PDF.

Each book summary and commentary here is not intended to be a substitute for sound medical advice. These are for educational purposes only so that you can have a more productive consultation with you healthcare provider.

Book Review #8: Morgellons Disease, THE SILENT PANDEMIC, Armando Hernandez, Newmans Springs Publishing, 2020

Welcome to my book review! Here I provide a summary of the most important points in the book with my comments at the end. Neither the summary nor commentary are intended to replace sound medical advice. These are for educational purposes only so that you may have a more productive consultation with you physician.

This review is not a replacement for reading the book. I will indicate when you should consult the book for a deeper understanding of an important point. My aim is to inspire you to read it so you can benefit from this information as much as possible!

This is the story of a Navy veteran, Armando Hernandez, who became infected with the organism that causes Morgellons disease. Armando calls this disease an infestation inside and out. When he first started showing symptoms, naturally he went to see a doctor, who was not capable of helping him. Subsequently, he went to doctor after doctor after doctor.  These doctors told him that he is suffering from DOP (delusions of parasitosis). He was referred to a psychiatrist. Armando had no choice but to begin his own research on the web and in government medical libraries. He found a way to submit his own samples for testing to a laboratory which yielded various results before he got the correct result. The samples were many over several years, and the organisms that came back for the various samples were the following:

-Clostridium innocuum- found in AIDS patients.

-gram positive cocci

-Kytococcus aerolatus

-Parnibacillus odorifer 

-Penicillium citrinum 

-Penicillium chrysogenum 

-Burkholderia pyrrocinia 

-Burkholderia cepacian 

-Staphylococcus epidermidis

-Staphylococcus haemolyticus

-Staphylococcus hominis 

In November of 2016, Armando obtained a very good specimen from his body and sent it off to a lab (Sure Bio-Chem Laboratories LLC) for identification and DNA analysis.  The result of this sample came back as: Aspergillus fumigatus- a fungus. Armando felt vindicated because based on his own research, he was convinced that it was a fungus despite many samples testing for bacteria. This result showed that the bacteria were secondary to the fungus. Page 13 of the book contains the DNA sequence of this fungus. Please consult the book.

According to the National Library of Medicine, Aspergillus fumigatus has the following attributes:

-is an airborne fungus and has now become the most dominant airborne pathogen. It is spreading worldwide.

-is highly contagious and can be transmitted by air, by contact (touch and sexual), and by residue left by the host.

-it also infects pets, farm animals, insects and all other wildlife.

-once you are infected, you begin gaining weight.

-it multiplies rapidly and spreads throughout the body like a thin blanket with multiple layers.

-once a mycelial network is established in your body, it begins mass production.

-you are the host and you will produce spores in your body which will then be released into the air.

-the host becomes weak and depressed because the body is spending a big portion of its energy fighting this fungal infection.

-there will be times when you feel like there are particles flying around you; these particles are spores; under the microscope these appear as colorful threads.

Once Armando obtained this lab result, he approached the doctors again but their attitude had not changed. They treated him as if he were crazy so he had to take matters into his own hands. He was able to obtain large quantities of fluconazole from overseas and took it three times daily. Originally he wanted voriconazole, but that was too expensive ($9000 per gram from Canada).

Armando describes his experience with the Austin Medical Conference on Morgellons Disease

In April 2017:

“I was planning to go the medical conference on Morgellons disease in Austin, Texas, and already paid to attend. I planned to share with them all my data and reports that I had obtain from lab works I submitted. The people in charge of the medical conference disinvited me a few days later and sent back a refund. They told me that I was causing trouble and cornering people to speak with me. This was a total lie. They also suggested to me that I should set up my own conference so I could share my data. So, are these medical conferences really looking for the truth or fame and fortune? “

The Skin Becomes Transparent 

Morgellon patients have transparent skin, which the author states, is like a layer of something that looks like silicone, through which different color fibers can be seen.

The progression from infections looks as follows:

-fungi reproduce asexually (no need for a partner).

-once it is on you, the places that it likes to settle the most is on the head under the hair.

-then it forms a mycelium (a network of strands), which will be the nursery for mass production.

-as this fungus grows your vision will become blurry, this is because you are looking through multiple layers of something that resembles a layer of silicone.

-the fungus itself is clear (colorless).

-as time progresses the layers of the silicone-like substance will become thicker and thicker; you will find threads through your whole body; these are the hyphae coming from the mycelium.

-as the fungus grows it will build a neural network which will connect all the mycelium all over your body (inside and outside).

-from the moment of infection you will have a lot of itching, eventually you will have pain in your all your joints (knees, ankles, feet, back, legs, shoulders, arms, elbow, wrist, hand, fingers and neck; the pain will get worse and worse.

-you will also get a hacking cough and runny nose (this is not the cold or flu).

-this process is very slow and complicated.

The details of Morgellon’s symptoms by Armando:

Blurry vision- the fungus has deposited multiple layers of this silicone-like substance on and in your eyes. Sometimes this is very painful. Unfortunately, multiple doctors were not able to find anything in Armando’s eyes. 

Head- it will feel very lumpy; you will have sore-like craters, some of which will be very painful. Sometimes your head may seem bigger to you, this is due to the swelling. Your hair begins to turn white and transparent; this is not really hair. You may grow a full white-gray beard, even though you never had a full beard before. You will have headaches and migraines; it may feel like your head is solid like a rock; this is due to the fungi turning solid and squeezing your head. You will have brain fog. Based on his research of Morgellons disease, Armando found a lot of similar signs and symptoms of Alzheimer’s disease. He concluded that it is entirely possible that Aspergillus fumigatus is the real cause of Alzheimer’s disease.

Body- dry, rough and scaly patches appear; weight gain or weight loss; blistering red rash; chronic fatigue, weakness, always tired; lower back pain, neck pain and shoulder pain. Changes in appetite (increase or decrease). Feet, knee and hand swelling; joint pain; muscle cramping or twitching; disorientation and dizziness; arthritis throughout; whole body bloating; blood pressure problems (low or high); severe itching fever; chills; stools look different and may contain foreign looking matter; painful-skin cracking. There is a sensation of moving pain that comes out of nowhere and numb sensation that can be on all body parts. Lesions appear out of nowhere and then disappear within a few minutes or longer. Ingrown hair that is hard to remove and extremely painful. The presence of hair strands that are unusually thick but these do not look like other hair. The fingernails change shape and/or texture; they may become very brittle and crack/break easily. The presence of fibers visible just beneath the skin that may be blue, black, white or clear; some fibers may move lumps throughout your whole body or painful sores. The nose, sinuses and throat are loaded with constant mucus and you have a constant runny nose. A scratchy throat; sneezing attacks (you may sneeze out a ball of fibers); sores inside or on the side of your nose (these are not zits).

Feet- you may have painful lumps which make it hard to walk and sores on your heel from very dry feet.

On page 25 of the book there is a table that shows overlapping and unique symptoms that occur in Morgellons Disease, Fibromyalgia, Lyme Disease and Shingles. Please consult the book.

Indications that you may be infected according to Armando:

-the first sign that you are infected may be itching on the face, around the mouth, crotch, nose and ankle. You may also feel something moving around on your back or behind.

-you have gray hair but you ignore it thinking that you are just getting old.

-your sight starts to get worse and you need reading glasses.

-you may feel like things are falling off your body.

-you may find dandruff-like stuff on your clothes; this is not dandruff.

-you may start finding little “cotton balls” or lint on your inside your clothes.

-you may experience stomach problems, bloating or constipation (this is because the fungus has clogged your intestines and hardened your stool.

-you may or may not get sores and you won’t know how you got them. Your sores may not be visible if they are deeper inside your body. These hidden sores become visible if you take baking soda baths.

-bald people are infected even though it is not visible because the fungus covers your skin all over with a see-through layer preventing the hair from emerging. On a bald head there may be some dark spots and possibly sores.

-the head may appear bigger than it should be due to multiple layers of this fungus.

-the back of the head may have lumps.

-you may feel something moving on your head and you try to touch it and it scares you, so you pull your hand away; but then when you go to try to touch it again, it is no longer there.

-you will see sores all the way until this fight with the fungus ends and then as you get better the sores just get smaller

-you have gray or white hair – the fungus coats your hair shaft as your hair grows.

The Silent Pandemic

Armando believes that there is a pandemic of Morgellons Disease because doctors have been misdiagnosing it as shingles, Lyme disease, dermatitis, eczema, fibromyalgia, AIDS and other skin diseases. Key points:

-doctors like to jump on the “autoimmune” thing every time they cannot explain something. Perhaps the immune system is overwhelmed by a highly pathogenic predator and NOT attacking itself!

-some fungi can masquerade as bacteria and camouflage themselves to hide from the immune system.

Morgellons Disease treatment and cure from Armando’s health journey:

-it is not an overnight cure

-there are side effects 

-you will feel body burning, weak, dizzy, and unable to think clearly 

The Remedies

-undecylenic acid- start with one pill daily and work your way up slowly to three to four pills daily.

-caprylic acid-start with one pill daily and work your way up slowly to three to four pills daily.

-grapefruit seed extract-three to four times daily is recommended.

-castor oil-rub it on your whole body; your skin will develop little grains of sand. This treatment will kill the fungus.

-baking soda bath-take a bath at least once per day for twenty minutes, then rub the sores.

-epsom salt bath-take a bath at least once per day for twenty minutes, then rub the sores.

-baking soda and epsom salt together bath- works better together; rub the sores.

-colloidal silver-apply to your eyes and ears.

-fluconazole- a prescription antifungal

Dealing with the Sores

-these are the main bodies of the fungus.

-you can sprinkle baking soda or Epsom salt on them; rub it in and rinse with water.

-the fungus will come off in clumps that look like goo; you may or may not be able to see this goo in the water.

These items to not require a prescription. The fungus will fight back so you may experience chills and fatigue.

Items that require a prescription but obviously your doctor must be on board:

-voriconazole (Vfend)

-posaconazole (Noxafil)

-itraconaze (Sporanox)

-isavuconszonium (Gresemba)

Caprylic acid comes from coconuts, from the oil. Coconut oil has two ingredients that are antifungal, lauric acid and caprylic acid (most important). Caprylic acid stops fungal reproduction and weakens the cell body. 

Undecylenic acid-is made from castor oil, which is used to stop toenail fungus. It also stops fungal reproduction and weakens the cell body. 

Monolaurin-is converted from lauric acid, also found in mother’s milk. It also stops fungal reproduction and weakens the cell body. 

Grapefruit seed extract- has very strong antifungal properties. Armando also ate grapefruits and opened up the seeds to eat the inside.

Colloidal silver- worked a little to help ease the pain but worked well to get rid of the fungus in the eyes and ears. 

Castor oil-rub it all over your body; you will see grains of salt and lumps form on your skin; you must get rid of these.

Ground clove or clove oil- take once or twice a day with water. Clove is a very potent antifungal. Also rub it on your body and head. Keep away from your eyes because it stings.

According to Armando’s research the following conditions are misdiagnosed by the medical system and these in fact are caused by the same pathogen as Morgellons Disease: 

-Eczema

-Herpes simplex 

-Dermatitis

-arthritis in joints (including lower back)

-HIV/AIDS

-Shingles

-Lyme disease

-Candida

-Candida auris

-Canker sores

-Cold sores

-Blurry vision

-Pink eyes.

Armando describes a conversation he had with a hairdresser, who recounted the story of a customer who had goo coming out of his head. This was the aspergillus fumigatus and Armando had a goo-oozing (clear liquid) sore on his head. There was also the story of a man who had a sore on his nose, which never healed. The hairdresser also stated that he noticed a lot of redness/sores on the back of the neck among many people. 

As you continue on your treatment the last spot that remains is the one on top of your head. You will feel this mass shrinking. Then you will feel your skin getting back to normal, but you must continue with the treatment because this fungus has a tendency to grow back and it will fight back all the way until the end.

More about the fungus:

-has the ability to change from liquid to solid to threads; this makes it complicated for you to understand what is going on. The sea cucumber is another organism that has this ability.

-the fungal layers on your skin masquerade as your skin; you are covered completely. Unfortunately, doctors come up with “BS” names for this layer, like biofilm.

-bacteria like Borrelia (and others) are secondary infections to this fungus

-this is not local infection; most people believe that they got infected around the time they feel heavy symptoms but this is not correct; at the beginning of the infection you may only feel a minor itch; the infection takes many years to grow. It took four to five years for Armando to exhibit the first visible symptom other than an itch.

-you gain weight but it is not your weight; it is the fungus growing in you. During his treatment, Armando lost fifty pounds in less than one year

References provided by Armando:

Crum-Cianflone, Nancy, F., MD, MPH. 2009. Clostridium Innocuum Bacteremia in an AIDS Patient. United States

National Library of Medicine, National Institutes of Health.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732570/

Latgé, Jean-Paul. (1999). Aspergillus fumigatus and Aspergillosis.

US National Library of Medicine. https://www.ncbi.nlm.nih. gov/pmc/articles/PMC88920/

Armando also has a Youtube channel called the silent pandemic.  Below is a link to his website:

https://morgellons.us/ where you can find out more and purchase his book.

My Comments:

Welcome to the “Golden Age of Self-Care” and say goodbye to the age of experts. In all of my years of learning in the health space, I found people’s health journeys profoundly more helpful than some experiments conducted at the NIH (National Institute of Health). Researchers who work in a lab are completely disconnected from the world. The best example I can think to demonstrate this is when Robert Kennedy Jr. was fighting to clean up the Hudson River, the fisherman told him that all the pollution in the river is killing all the goldfish. When Mr. Kennedy took that message to government agencies, where the “experts” said that the Hudson does not have and never had any goldfish. So, this is the Clown Show we are living in, which is why I said that the age of experts confined to their laboratories is over!

Double-blind, placebo-controlled, randomized trials will come to an end too and very soon (this is just a choke hold that the pharmaceutical companies have on humanity). The world will move to anecdotal reports and outcome studies. If I know an old remedy for a sprained ankle (which I know, your foot is normal the next day) and I share it with others, and they try, and it works, and then they share with others and so on. This is the future of medicine, which will be exclusively self-care. People like Armando are just writing one section of “The Human-Body Self-Care Manual.”

Armando did not specify if he used colloidal silver orally or topically on his skin, but I will guess that it was topically. I always mention that I make a silver-bearing cream, but in this case specifically I would like to point out that the eight-ounce jar is formulated with castor oil as well (but not the four-ounce jar). Perhaps someone out there will find my cream helpful.

This is a summary of the below mentioned article. After reading the Morgellons Disease by Armando Hernandez I decided to go down this rabbit hole a little further. This is the article that Armando cited in his book. This article is very long and very involved from a scientific standpoint. If you are interested in all the details please read the article. Here are the key points.

Aspergillus fumigatus and Aspergillosis, Jean-Paul Latge, Clin Microbiol Rev. 1999 Apr;12(2):310–350. doi: 10.1128/cmr.12.2.310 

- Aspergillus fumigatus is one of the most common of the airborne saprophytic fungi. Humans and animals constantly inhale many conidia produced by this fungus. These conidia are normally eliminated in the immunocompetent host by innate immune systems. Thus, aspergilloma and allergic bronchopulmonary aspergillosis, uncommon clinical syndromes, are the only infections observed in such hosts.

-As a result, A.fumigatus was considered for years to be a weak pathogen. But with the increases in the number of immunosuppressed patients, there has been a dramatic increase in severe and usually fatal invasive aspergillosis, now the most common mold infection worldwide.

-Aspergillus fumigatus is a saprophytic fungus that helps to recycle environmental carbon and nitrogen. Its naturally found in the soil, where it survives and grows on organic debris. This species is not the most prevalent fungus in the world, but it is one of the most ubiquitous of those with airborne conidia. It sporulates abundantly, with every conidial head producing thousands of conidia. The conidia released into the air have a diameter small enough (2 to 3 μm) to reach the lung alveoli. 

-A. fumigatus does not have an elaborate mechanism for releasing its conidia into the air. The dissemination relies on disturbances of the environment and strong air currents. Once the conidia are airborne, their small size makes them buoyant, so they tend to remain airborne both indoors and outdoors. Environmental surveys indicate that all humans will inhale at least several hundred A. fumigatus conidia per day.  For most people, therefore, disease occurs predominantly in the lungs, but dissemination to virtually any organ occurs in the most severely predisposed.

-Inhalation of conidia by individuals with a competent immune system rarely has any adverse effect. The conidia are eliminated relatively efficiently by innate immune mechanisms. As a result, until recent years, A. fumigatus was considered a weak pathogen responsible for allergic forms of the disease, such as farmer’s lung, which is a clinical condition observed among persons exposed repeatedly to conidia, or aspergilloma (an overgrowth of the fungus on the surface of preexisting cavities in the lungs of patients treated successfully for tuberculosis).  As a result of the increase in the number of immunosuppressed persons, and the degree of severity of modern immunosuppressive therapies, the situation has changed dramatically in recent years.  A. fumigatus has become over the past ten years the most prevalent airborne fungal pathogen, causing severe and usually fatal invasive infections in immunocompromised hosts in developed countries.

-There has been a fourfold increase in invasive aspergillosis (IA) in the last 12 years. In 1992, IA was responsible for about 30% of fungal infections in patients dying of cancer, and it occurs in 10 to 25% (estimate) of all leukemia patients, who generally have a mortality rate of 80 to 90%, even when treated.  IA is now a major cause of death of leukemia patients, bone marrow recipients, and solid-organ transplant recipients.

-A. fumigatus is the most common etiologic agent, being responsible for approximately 90% of human infections but it is not the only pathogen in this genus. A. flavus, A. terreus, A. niger, and A. nidulans can also cause human infections. 

CLINICAL SYMPTOMS AND DIAGNOSIS OF RESPIRATORY ASPERGILLOSIS

-The main portal of entry and site of infection for most people for A. fumigatus is the respiratory tract. Other sites of infections have been described as well in the normal or immunocompromised person. These include the skin, peritoneum, kidneys, bones, eyes, and gastrointestinal tract. However, nonrespiratory infections are infrequent and are not discussed in this article.

-Pulmonary diseases caused by A. fumigatus is classified according to the site of the disease within the respiratory tract and by the extent of mycelial colonization. Both of these factors are influenced by the immunological status of the person. 

-Allergic diseases, including asthma, allergic sinusitis, and alveolitis, are not covered in this article because they occur after repeated exposure to conidia or antigens of Aspergillus in the absence of mycelial colonization. In these situations, the removal of the person from the environmental source of Aspergillus results in clinical improvement. However, allergic bronchopulmonary aspergillosis (ABPA), aspergilloma, and invasive aspergillosis (IA) involve mycelial growth of A. fumigatus in the body. Such instances usually require therapeutic intervention.

Allergic Bronchopulmonary Aspergillosis (ABPA)

-ABPA is currently the most severe allergic pulmonary complication caused by Aspergillus species. It occurs in patients who have atopic asthma or cystic fibrosis. About 1 to 2% of asthmatic patients get ABPA (15% of asthmatic patients sensitized to A. fumigatus). About 7 to 35% of cystic fibrosis patients get ABPA. 

-ABPA follows the same course as classic asthma, with a unique cellular immune response and pathophysiologic findings caused by the response of T-cell products. ABPA has effects that range from asthma to fatal destruction of the lungs with defined clinical, serological, radiological, and pathological features. Clinical manifestations of ABPA are bronchial asthma with transient pulmonary infiltrates that may proceed to proximal bronchiectasis and lung fibrosis.

-ABPA is very difficult to diagnose. The criteria classically listed for a definitive diagnosis are: 

    -asthma.

    -peripheral blood eosinophilia (>1,000 mm−3).

    -immediate skin reactivity to A. fumigatus antigenic extracts within 15 ± 5 minutes that precipitates immunoglobulin G [IgG] and IgM and IgE antibodies against A. fumigatus.

    -elevated levels of total IgE in serum (>1 μg/ml).

    -a history of pulmonary infiltrates

    -central bronchiectasis. 

Less important features (as stated in the article):

    -isolation of A. fumigatus from sputum, expectoration of brown plugs containing eosinophils and Charcot-Leyden crystals.

    -a skin reaction occurring 6 ± 2h after the application of antigen are also used diagnostically.
 

-All the above criteria are rarely fulfilled for each patient who has ABPA. Moreover, most diagnostic features are not specific and, as a consequence of the intermittent course of the disease, not all criteria are fulfilled at the same time.

Aspergilloma

-This is commonly referred to as “fungus ball,” and it forms in preexisting pulmonary cavities that were caused by tuberculosis, sarcoidosis, or other bullous lung diseases. It also occurs in chronically obstructed paranasal sinuses.

-A common symptom of aspergilloma is hemoptysis, which results from the disruption of blood vessels in the wall of the cavity occupied by the fungus or in the bronchial artery supply, centimeters away from the fungus ball. Internal bleeding can occur but hemoptysis can be massive and even fatal.

Invasive Aspergillosis

-This has become a leading cause of death, among hematology patients. The average incidence is estimated to be 

    -5 to 25% in patients with acute leukemia 

    -5 to 10% after allogeneic BMT

    -0.5 to 5% after cytotoxic treatment of blood diseases or autologous BMT and solid-organ transplantation.

-Invasive aspergillosis generally follows solid-organ transplantation and is most common in heart-lung transplant patients (19 to 26%) and is found, in decreasing order, in liver, heart, lung, and kidney recipients (1 to 10%). Despite the fact that IA is recognized today as the main fungal infection in cancer patients, its true incidence is probably underestimated because of the low sensitivity of diagnostic tests. In contrast invasive aspergillosis is rarely found in immunocompetent persons.

-The use of culture or microscopic examination of respiratory tract samples has been criticized because of the presence of airborne conidia of Aspergillus. This creates the possibility that a positive culture resulted from accidental contamination. However published data shows the following:

-For leukemia and BMT (bone marrow transplant) patients, microscopic examinations and/or cultures are positive in 50 to 100% of bronchoalveolar lavage fluid (BAL) samples from patients who have definitive or probable aspergillosis.

 -In some, but not all studies, cultures from nasal swabs of patients were positive repeatedly for Aspergillus spp.

Toxic Molecules Produced by Aspergillus fumigatus

-A. fumigatus produces several toxins. The most studied one is gliotoxin, a metabolite of the epipolythiodioxopiperazine family.  This substance is acutely toxic and it has extensive immunosuppressive capabilities. Because of these properties, gliotoxin was once considered useful as immunosuppressive therapy for BMT patients.

- Gliotoxin inhibits macrophage phagocytosis and induces apoptosis in macrophages by a mechanism that is different from its antiphagocytic properties. It also blocks T- and B-cell activation and the generation of cytotoxic cells. Gliotoxin has been detected in infected animals and humans at significant concentrations.

-Other secondary metabolites can impair the mucociliary action and result in prolonged residence of the fungus at the surface of the epithelium.

Immunosuppressive Drugs

-It has been known for a long time that invasive aspergillosis development is triggered by the down-regulation of the immune system by the use of immunosuppressive drugs in animals and humans. Corticosteroids play a critical role in the disease progression of invasive aspergillosis.

-It has been stressed that the primary role for glucocorticoids is to impair the anticonidial activity of macrophages. Unfortunately, macrophages exposed to pharmacological concentrations of glucocorticoids ingest conidia at a normal rate and respond adequately with a respiratory burst and secretion of ROIs but they fail to inhibit conidium germination and fail to kill conidia spores.

-Based on electron microscopy studies it appeared that glucocorticoids stabilized lysosome membranes and prevented phagolysosomal fusion during A. fumigatus phagocytosis. This prevented the destruction of this pathogen.

-Pharmacological concentrations of corticosteroids are also known to suppress infiltration by PMNs (polymorphonuclear cells) as well as their certain selected functions.

-Hydrocortisone succinate and dexamethasone suppressed PMN O2− (oxygen radical) production.

-In contrast, therapeutic concentrations of cyclosporin A do not suppress antifungal activity of PMNs and alveolar macrophages. However, in vitro at higher concentrations cyclosporin A may induce immunosuppresion of phagocyte antifungal activity, especially when combined with corticosteroids.

Immunosuppressive Molecules of Fungal origin

-Other small molecules, in addition to the ones mentioned, secreted by A. fumigatus conidia are also able to affect phagocytosis and the release of superoxide anion and hydrogen peroxide. One of these molecules is heat stable and gets secreted prior to germination to protect the fungus.

-This heat-stable molecule (conidial inhibitor) reduced the ability of phagocytes to migrate due to its interaction with the contractile elements of the cell cytoplasm. It also inhibits the production of IFN-γ and IL-6 at the level of transcription. These are transcription factors that normally stimulate cytokine gene expression in the macrophages become blocked by the conidial inhibitor. This molecule is distinct from gliotoxin, which also has similar effects on transcription factors.

TREATMENT OF ASPERGILLOSIS

Amphotericin B (AmB)

-AmB is still considered the drug of choice for invasive aspergillosis. It had been used for more than 30 years but its mode of action is not completely understood. This is what is known as:

-AmB binds to membrane sterols, creating transmembrane channels which result in an increased permeability to monovalent cations.

-It also inhibits proton ATPase pumps, depleting cellular energy reserves.

-promotes lipid peroxidation, resulting in a corresponding increase in membrane fragility and inducing Ca2+ leakage.

AmB drawbacks 

-it is insoluble in water and is mixed with a detergent called deoxycholate in a ratio of 3:7.

-The toxicity of AmB itself to the patient. Severe side effects, especially nephrotoxicty, are common. AmB damages fungal cells more than mammalian cells, but this selectivity is poorly understood.

Itraconazole

-In contrast to amphotericin B, its mechanism of action is well documented. The free azole nitrogen competes for oxygen with the heme iron atom of cytochrome p-450 enzymes. This inhibition prevents the synthesis of ergosterol in the fungal membranes. Without this ergosterol the membrane there is an alteration of the synthetic pathway that leads to the accumulation of phospholipids and unsaturated fatty acids within the fungal cells. Hydroxyitraconazole is a bioactive metabolite of itraconazole and has similar activity to the parent molecule. Itraconazole binds very weakly to mammalian cytochrome P-450, this in turn reduces the toxicity of the drug in humans.

Outcomes

Even though antifungal treatments have improved mortality due to invasive aspergillosis is still very high. Immunotherapy in highly immunosuppressed patients may be a helpful adjuvant to conventional antifungal therapy

Conclusion

Dramatic increases in the incidence of aspergillosis caused mainly by A. fumigatus have occurred in recent years. This is due primarily to an increase in the use of more drastic immunosuppressive therapies.