Once a patient with severe suffocating Covid-19 is through the doors of a critical care unit, they should be in the safest place to receive life-saving help.
But a further danger may await — a fungus that experts warn is infecting the weakened lungs of one in three Covid patients in intensive care, and killing up to 70 per cent of those affected.
The fungus in question, Aspergillus fumigatus, is all around us — in the air, soil, food and in decaying organic material such as garden compost. It spreads via microscopic spores, although it can be visible as a grey, wrinkled cushion on damp walls. It has also been found in flower beds in hospital grounds.
Aspergillus fumigatus is an opportunistic fungus that preys on people whose immune systems are seriously weakened by illness.
A further danger may await — a fungus that experts warn is infecting the weakened lungs of one in three Covid patients in intensive care, and killing up to 70 per cent of those affected
When it invades humans, it causes a condition called aspergillosis, which primarily affects the lungs. There the fungus can grow into a lump up to the size of a tennis ball that can be extremely difficult to eradicate.
The infection can develop into invasive aspergillosis, where it spreads to the skin, brain, heart or kidneys.
Aspergillosis hit the news last month when the widow of a Scottish government official, who died after contracting Covid-19, called on the First Minister of Scotland to investigate the hospital where he was being treated.
Andrew Slorance, who led the Scottish government’s response and communications unit, died nearly six weeks after being admitted to Queen Elizabeth University Hospital, Glasgow, last year. He had gone in for cancer treatment, but then contracted Covid-19.
The hospital listed the cause of Mr Slorance’s death as Covid pneumonia. However, his widow, Louise, requested a copy of his medical notes and discovered her husband had also become infected with Aspergillus fumigatus at the hospital.
She believes this may have brought on his death and claims the hospital ‘never mentioned’ the aspergillus infection to her at the time despite the ‘many mentions of it in the medical records’.
The hospital has denied any ‘attempt to conceal information’. It has not, however, answered Good Health’s questions concerning the role of aspergillosis in Mr Slorance’s death.
Experts who have spoken to Good Health say countless Covid patients admitted to critical care units with severe breathing difficulties have then become infected by aspergillus.
Estimates vary over the exact number of critical care patients afflicted. A research press release by investigators at Exeter University in March puts it as high as one in three. An international study in the journal Emerging Infectious Diseases in October suggests one in six.
Why the disparity? According to one of Britain’s foremost experts, David Denning, a professor of infectious diseases at the University of Manchester, much depends on how good clinicians are at diagnosing severe fungal infection and their awareness of it.
‘If you don’t look for it, you don’t find it,’ he told Good Health. ‘There are probably lots of patients who have died in critical care with this who were never diagnosed.’
The standard treatment is with anti-fungal drugs called azoles.
Once a patient with severe suffocating Covid-19 is through the doors of a critical care unit, they should be in the safest place to receive life-saving help
‘If they are given in good time, these can cure 75 per cent of patients with aspergillus,’ says Professor Denning.
However, aspergillus fungus is developing resistance to these.
This is due primarily to the overuse of azoles both in medicine and agriculture. This has encouraged more virulent strains of the fungus to evolve that are resistant to even high doses of azoles, says Professor Denning.
Azole anti-fungal sprays are used on ornamental plants to keep them looking healthy in greenhouses and on stored bulbs.
In 2019 Matthew Fisher, a professor of fungal disease epidemiology at Imperial College London, searched for drug-resistant aspergillus strains in flower beds outside hospitals, in parks and gardens across southern England, where tulip bulbs are often grown.
Of the eight most worrying London soil samples he found, four were from flower beds outside the Royal Free Hospital and The Whittington Hospital.
All the samples had Aspergillus fumigatus strains that had evolved to resist at least one of three commonly used azole drugs.
‘Drug resistance is something to be very worried about,’ says Professor Denning. ‘Around 13 per cent of aspergillus infections in some areas of London now involve resistant strains.’
Professor Denning says NHS critical care staff must become ‘much more aware and much more careful’ about the threat.
‘With sick people coming into intensive care units (ICU), particularly with Covid, we need to be thinking about aspergillus, taking routine samples. We need a whole new level of vigilance. It is bad enough to be in ICU, but to have a fungus as well, it’s not good.’
Professor Adilia Warris, the co-director of the Medical Research Council Centre for Medical Mycology (the study of fungi), says specialists are trying to find precisely why aspergillus is potentially so lethal to Covid patients.
‘We don’t yet fully understand how the Covid virus interacts with the immune system and makes patients’ defences less able to fight the second hit of the fungal infection,’ she told Good Health.
‘I think coronavirus is damaging very sick patients’ lung structures and airways and doing something to patients’ immune defences. This makes them highly susceptible to acquiring aspergillus.’
One theory, suggested in the journal Microbial Ecology last month, is that both Covid-19 and Aspergillus fumigatus attack the same molecules inside our lungs. So when Covid has effectively breached those defences, aspergillus can come marching in.
‘If the aspergillus takes advantage of weakened patients and grows, then things get really messy,’ says Professor Warris. ‘Mortality rates are very high. Studies so far suggest that these infections can kill up to about 70 per cent of infected patients.’
But it is not only severe Covid that opens the way for aspergillus.
Up until very recently, invasive aspergillosis was seen only to afflict people whose defences were severely laid waste by, for example, chemotherapy, bone marrow transplantation or a disease of the immune system such as Aids.
But in 2019, evidence published in the journal Lancet Respiratory Medicine by Belgian and Dutch investigators revealed how aspergillus had evolved into a super-fungus that could afflict otherwise healthy people with heavy viral infections — particularly with flu.
‘We had not really seen this before,’ says Professor Warris. ‘It made us aware that we should be looking for such problems in people in ICU with severe lung infections.’
Professor Denning says the mortality rate among severe flu patients who contract aspergillus in the UK is around 85 per cent.
Yet aspergillus often goes undetected in intensive care units treating patients with Covid or flu, he says, because the diagnostic methods can be difficult and dangerous.
The main one, bronchoscopy, involves inserting a tube down the nose or mouth and into the airways to take lung samples.
‘This is especially tricky with an infectious virus, from which healthcare workers must protect themselves by taking strict precautions,’ Professor Denning explains. ‘Also, you are working with the lungs of someone who is already short of oxygen so you may cause them serious harm.’
Professor Warris adds: ‘Aspergillus is everywhere in the environment, so just finding some in a patient’s sputum does not mean that they have the disease. It is all very challenging.’
Dr Colin Brown, a consultant in infectious diseases at the UK Health Security Agency (UKHSA) told Good Health that a study of 200 critical-care Covid patients who had aspergillus isolated from lung-fluid samples showed only a quarter actually had been infected by the fungus; the rest had simply breathed in fungal spores from the atmosphere that had not become a problem.
One hope for faster, easier and more accurate diagnosis is being developed by an international team of scientists that includes Professor Chris Thornton, a fungal immunologist at the University of Exeter.
The new technique, revealed in March in the journal Nature Communications, involves injecting a specially engineered antibody that will bind to aspergillosis molecules in the lungs of infected people.
The antibody is painted with a radioactive material that can be spotted on lung scans. Professor Thornton hails the advance as a ‘step-change in the way we diagnose this devastating disease’.
It is however, only a diagnosis. There is still the fact that the infection is highly invasive and difficult to treat. Yet another good reason, then, to get fully vaccinated against Covid-19 — and the flu.
Secrets of an A-list body
How to get the enviable physiques of the stars. This week: Wonder Woman actress Gal Gadot’s calves
Gal Gadot recently showed off toned calf muscles on the red carpet to promote the Netflix movie Red Notice
Gal Gadot recently showed off toned calf muscles on the red carpet to promote the Netflix movie Red Notice.
The 36-year-old Wonder Woman star works out with a trainer to keep herself in shape. She follows a punishing weekly regimen of running, weights and circuit training in her gym at home.
‘I try to get to it every day, but sometimes it’s more like three to four times a week,’ she has said.
What to try: Bent knee calf raises are an excellent way to target the lower leg to tone your calf muscles. Stand with toes pointed forward and feet shoulder-width apart. Bend your knees slightly so that you assume a partial squat position with good balance.
Press the balls of your feet into the floor and slowly raise your heels as high as possible, pausing at the top, before slowly lowering back down. Keep your knees bent throughout the entire movement and hold the arms out in front or to the sides for balance. Perform four sets of 15 raises. Do this every other day.