From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med,sci.med.nursing,sci.med.nutrition,sci.med.pathology,
	sci.med.laboratory
Subject: Re: Mucormycosis / life-threatening fungal infection / IRON
Date: 16 Jul 2005 14:49:11 -0700
Message-ID: <1121550551.432561.161970@z14g2000cwz.googlegroups.com>

ironjustice@aol.com wrote:
> Clin Microbiol Rev. 2005 Jul;18(3):556-69. Related Articles, Links
>
>
> Novel perspectives on mucormycosis: pathophysiology, presentation, and
> management.
>
> Spellberg B, Edwards J Jr, Ibrahim A.
>
> Division of Infect. Dis., Harbor-UCLA Medical Center, 1124 West Carson
> St. RB2, Torrance, CA 90502. bspellberg@labiomed.org.
>
> Mucormycosis is a life-threatening fungal infection that occurs in
> immunocompromised patients. These infections are becoming increasingly
> common, yet survival remains very poor. A greater understanding of the
> pathogenesis of the disease may lead to future therapies. For example,
> it is now clear that iron metabolism plays a central role in regulating
> mucormycosis infections and that deferoxamine predisposes patients to
> mucormycosis by inappropriately supplying the fungus with iron. These
> findings raise the possibility that iron chelator therapy may be useful
> to treat the infection as long as the chelator does not inappropriately
> supply the fungus with iron. Recent data support the concept that
> high-dose liposomal amphotericin is the preferred monotherapy for
> mucormycosis. However, several novel therapeutic strategies are
> available. These options include combination therapy using lipid-based
> amphotericin with an echinocandin or with an azole (largely
> itraconazole or posaconazole) or with all three. The underlying
> principles of therapy for this disease remain rapid diagnosis, reversal
> of underlying predisposition, and urgent surgical debridement.
>
> PMID: 16020690 [PubMed - in process]



COMMENT:

Interesting. Mucor, for those that haven't seen it, is a horrible
disease. It's a sort of breadmold looking fungus that attacks some
helpless diabetic in acidosis, and eats right though the center of the
head, out the eyes and into the brain. Something like you'd expect in
science fiction, except it's real.

If iron chelation with anything ELSE other than feferoxamine (a natural
molecule which the fungus absorbs to get iron!), then it's certainly
worth trying. Plain old IV EDTA, ala the alternative chelation
therapists, might be enough.

Liposomal amphotericin, also mentioned, is another development of
recent years. The original stuff was billed as an antifungal which
caused had antirenal activity, when the truth was closer to it being a
renal toxin which happened to have antifungal activity.

Picking up today's Lancet, I see that somebody has found a novel
treatment against the adult filaria that cause elephantiasis. They need
a bacterium to survive, and you can kill the bacterium with plain old
tetracycline derivatives. Which is good, because there's no good
treatment for the adult worms.

This is stuff just this week. You know, doofus Mr. Natural Health says
that 199 out of every 200 articles in medicine don't have anything new.
What he means is that he can't figure out anything new in 199 out of
every 200 he happens to read. Whether he reads the major journals or is
just not very bright, is hard to say.

SBH

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med,sci.med.nursing,sci.med.nutrition,sci.med.pathology,
	sci.med.laboratory
Subject: Re: Mucormycosis / life-threatening fungal infection / IRON
Date: 17 Jul 2005 09:09:07 -0700
Message-ID: <1121616547.419849.174290@z14g2000cwz.googlegroups.com>

ironjustice@aol.com wrote:
> Just out of curiosity .. do you have any idea WHAT type of 'nutrition'
> .. is found in the diabetics .. drip .. ?
>
> I assume there IS .. 'added nutrition' .. of some sort .. ?
>
> I would assume they INCLUDE .. iron .. since it is SOOOOOO ..
> 'important' .. ?


COMMENT:

No, iron is not a part of standard IV hydration fluids ever, and that
includes what they give diabetics. You rarely even find iron in IV
fluids in the mineral mix of patients getting total parenteral
nutrition (complete IV feeding) which in any case is a very small
subset of patients. Usually even the multiple trace element mix in TPN
contains NO iron.

Supplemental iron given by other routes than orally is almost always
given by IM injection. Very occasionally it can be given by IV now that
we have safer sucrose preparations, but doctors still don't like to do
it. And it's doen only in cases of manifestly iron deficient anemia
with no working gut.

Despite what you many think, very few doctors are unwise enough to give
iron supplements of any kind (even orally) to actively infected
patients. Though it sometimes can be continued by mistake when it was
being giving routinly in a patient who later becomes septic, and the ID
doc (or somebody on the ball) has to remind everybody to STOP.

SBH