Tag Archives: Pathogenic Fungi

Fungal Meningitis Outbreak

Sorry for the lack of posts as of late, I’ve been a little swamped lately with writing and researching; unfortunately this blog has to suffer sometimes.

I don’t have time to write a complete post right now – maybe soon in the future – but I’ve been closely following the cases of fungal meningitis derived from contaminated injections of the steroid methylprednisolone acetate.  Looks like the main culprit is Exserohilum rostratum, although one person has been infected with a species of Aspergillus. Both of these fungi are extremely common in soils and are plant pathogens.

Here’s some links from the CDC on the current infections:

CDC fungal infections page

CDC information on fungal meningitis

CDC page on the current fungal meningitis ourbreak

As of today, October 12th, the number of infections have been reported from numerous states:

map of fungal meningitis cases

Here’s a quick informational video on fungal meningitis:

Here are some links to news articles published over the few weeks:

CDC: Multistate Meningitis Outbreak Investigation

NYT: Interactive Map – Tracking an outbreak

Meningitis: Top 10 Things CDC Says You Should Know

Fungal Meningitis From Injections: Not Even Close To Over

Republicans Grill FDA Chief On Meningitis Outbreak

Despite Antifungal Treatment, More Woes For Some Meningitis Patients

Pharmacy Owners Had No Hand In Meningitis Outbreak: Lawyers

Second Illness Is Infecting Those Struck by Meningitis

Fungal Meningitis: 404 Cases, 29 Deaths

More bacteria, fungi in drugs from Mass pharmacy

Elio Schaechter’s Small Things Considered: Fungal Meningitis

‘Worried Sick’: Meningitis Risk Haunts 14,000

Documents in Meningitis Case Show Complaints in 1999

Meningitis Outbreak: FDA re-releases list of customers

Meningitis Outbreak Spurs Calls To Strengthen FDA

Meningitis spreads to 19th state, sickens 347

PDF of Food & Drug Administration Assessment of Pharmacy Sterility

FDA: Mold seen in 83 vials of the steroid linked to fungal meningitis outbreak

FDA: Meningitis-linked Pharmacy Knew of Bacteria

Records Show Problems at Steroid Pharmacy as Far Back as ’06

Investigators visit office tied to meningitis cases

Steroid shot near spine gives illness an opening

Fungal meningitis outbreak tied to steroid shots isn’t the first, reports show

NBC News – Experts: Many ways for fungi to taint drugs / Four more die in fungal meningitis outbreak

Sterility Found Lacking at Drug Site in Outbreak

FDA warns of further risk from tainted drugs

Meningitis outbreak rises to 205 cases: CDC

Meningitis: 5th case reported in Minnesota, all women

Another death reported in meningitis outbreak

Legal recriminations begin over major U.S. meningitis outbreak

Lawmakers focus on small drugmakers as meningitis death toll rises

Rare fungal meningitis outbreak spreads to six states

Seven deaths reported in growing meningitis outbreak; second fungus found

U.S. meningitis deaths rise, prompting call for tighter drug rules

Meningitis cases raise questions about steroid shots

CDC: 12 more people infected with fungal meningitis linked to Framingham pharmacy

F.D.A. says avoid drugs from company tied to meningitis

When leaf mold gets in your steroid injection

Meningitis outbreak: 13,000 got suspect steroid shots

Epidural steroid shots debated amid meningitis scare

Rare fungal meningitis outbreak rises; 7 dead, 64 sick

Meningitis outbreak kills seven; continues spreading to ninth state

Fungal meningitis: Know the subtle symptoms

More patients linked to fungal meningitis infections, CDC says

Meningitis outbreak 2012: Steroid related fungal meningitis cases rise to 47

Seven deaths reported in growing meningitis outbreak; second fungus found

U.S. fungal meningitis infections rise to 47

CDC: Death toll in rare fungal meningitis outbreak linked to steroid injections rises to 7

Boston: Former regulator calls for more oversight of compounding pharmacies

UPDATE (December 21st, 2012): CDC Recommends Assertive Clinical Evaluation of Potential Fungal Meningitis Patients

UPDATE (December 21st, 2012): Tainted steroids cause spine infections in addition to meningitis; all patients face grueling recovery

UPDATE (January 6th, 2013): Massachusetts governor offers new pharmacy rules

Carbohydrate binding gene family expansion in the amphibian pathogen Batrachochytrium dendrobatidis

You’d have to be living under a rock – as some amphibians do – to not be aware of the massive extinction facing our vertebrate friends living within aquatic habitats.  Researchers still don’t fully understand what is causing the amphibian mass-extinction – stress from habitat loss, increased chemical concentrations in the environment, and an auto-immune degrading infection have all been proposed.  What is known is that the chytrid fungus Batrachochytrium dendrobatidis – opportunistic or not – is infecting and killing a large number of amphibians.

What is not fully understood about B. dendrobatidis is its pathogenicity and what mechanisms it employs to cause infection.  A recent paper, “Species-Specific Chitin-Binding Module 18 Expansion in the Amphibian Pathogen Batrachochyrium dendrobatidis”, published in the mBio journal by John Abramyam & Jason Stajich at UC Riverside, begins to address this pathogenicity.  As the authors point out – more than 100,000 species of fungi have been described to date and very few of them are pathogenic.  This means that the ability to be pathogenic is derived from somewhere: genome expansion events, gene family duplication and diversification events – and we’re only starting to understand horizontal gene transfer events in fungi. This paper addresses the expansion of a gene family across two B. dendrobatidis genomes that are associated with pathogenicity.

When comparing the genomes of B. dendrobatidis with the genomes from other chytrid fungi there has been an expansion of genes within the family Carbohydrate-Binding Module Family 18 (CBM18).  The CBM18 family is a large group of proteins that have been implicated in other fungal pathogenic infections on both plants and animals.  The authors here question whether this interesting lineage specific expansion of CBM18 in B. dendrobatidis could be associated with the virulence of its pathogenicity on amphibians.

The authors used the CBM18 protein family domain HMM to search across the B. dendrobatidis genomes and found an increase in the number of domains when comparing it to genome of its closest relative.  When constructing phylogenetic trees of the CBM18 gene family, three monophyletic and strongly supported clades emerged.  When focusing on divergence of the protein domains, the authors determined that individual domain groups were monophyletic and showed a general pattern with regards to their genome locations.

More specifically, clades of the CBM18 family appears to possess different gene functions, some of which appear to be similar to lectins (LL), tyrosinase/catechol oxidases (TL), and chitin deacetylases (DL).  The function of these genes has yet to be experimentally determined, but the authors make some deductions based on DNA sequences.  The lectin-like genes may be involved in the sequestering of chitin, which could then be disrupting the amphibian immune response.  The tyrosinase/catechol oxidase gene family is associated with melanin synthesis, which could be disrupting the electron transport of the infected amphibians.  Lastly, chitin deacetylases may be involved in suppressing defense mechanisms in place to suppress the fungal infection of the host.  The authors plan to continue to elucidate the pathogenicity of B. dendrobatidis in an attempt to understand the ecology and evolution of its infection on amphibians.