Lethal Fungal Infection Histoplasmosis Linked to Arthritis, Crohn's Disease, Psoriasis Meds

Histoplasmosis, a disease that seeks out the patient's lungs as primary target for its workings, has been known since 1905 as Darling's disease. Tom Volk from the University of Wisconsin-La Crosse reports that in the 1950s histoplasmosis was sometimes mistaken for tuberculosis, and the subsequent course of antibiotics served to strengthen the disease rather than stop it.

At the root of the problem is a simple fungus -- histoplasma capsulatum - that occurs naturally in the United States. Most concentrated around the lower Mississippi, histoplasma capsulatum primarily grows in bird and bat feces. Human beings inhaling the spores of this fungus are at risk of developing histoplasmosis symptoms, such as prolonged coughing and wheezing, which nowadays may also be confused with a flu, cold, or other ailment.

While this may appear like a jaunt into the world of fungi, it may actually present a life saving bit of information. Yesterday the Food and Drug Administration issued a press release ordering the drug manufacturers that produce Cimzia, Enbrel Humira and Remicade to warn consumers that use of these drugs will weaken the immune system and heighten the susceptibility of fungal infections, including histoplasmosis, blastomycosis, and coccidioidomycosis (San Joaquin Valley Fever).

The drugs mentioned are used in the treatment of Crohn's disease, plaque psoriasis, and also arthritis. The FDA underscores the gravity of this warning by reporting that out of 240 patients who presented with histoplasmosis, 12 died because the condition was not immediately recognized and treatment with antifungal agents was delayed.

WebMD states that the makers for Enbrel will, of course, comply and that it is the manufacturer's goal to make the information on its warning label more understandable for physicians and patients. This causes me to wonder just how well acquainted physicians are with the drugs they are prescribing.

Mistakes happen and there is little doubt that doctors are careful when prescribing drugs for the various ailments, but with the recent reports of off-label use in unrelated amphetamine and diabetes drugs, I cannot help but become concerned that some physicians are prescribing drugs with which they might not have as much familiarity as ought to be required.

Since the average doctor's visit lasts less than about 10 minutes, it is understandable that the magic bullet that are antibiotics is overused but in the case of histoplasmosis, coccidioidomycosis, and blastomycosis, it may actually do more harm than good. Be honest, if you had shown up at your doctor's office with histoplasmosis symptoms before today, and if you had been on either Cimzia, Enbrel Humira or Remicade, do you believe you would have received an antibiotic or an antifungal treatment?

Sources:
http://botit.botany.wisc.edu/toms_fungi/jan2000.html
http://www.fda.gov/bbs/topics/NEWS/2008/NEW01879.html
http://arthritis.webmd.com/news/20080904/deaths-heighten-arthritis-drug-warning?page=2