A rare fungal infection called Cryptococcus gattii has been quietly and dangerous extension of British Columbia south to the PNW Pacific. And it evolves as it goes.
Researchers have discovered that a strain of the bug appeared only recently in Oregon, and has already widely used there, man and animal repellent. 
So far in the last 11 years has been approximately 220 cases reported in British Columbia. Since 2004, doctors in Washington and Oregon have reported about 50 cases. Of the 270 cases in total, 40 people died of overwhelming infection of the lungs and brain.
Public health officials are not it was a public health emergency. The fungus can not be spread from person to person, and there seems no prospect of an explosive epidemic. But they want doctors to be on the lookout for cases because of early diagnosis and appropriate treatment is essential to avoid death.
Tropical Source
The most striking aspect of this fungus is that it is in the process of consolidating and away from their usual range - perhaps because of climate change.
"The disease occurs almost exclusively in tropical and subtropical regions of the world," said Dr. Julie Harris, fungal disease specialist at the Centers for Disease Control and Prevention. "The hot spots are more of Australia and Papua New Guinea, and Egypt and parts of South America.
"So it was really surprising to note that in 1999 in the temperate climate of Vancouver Island, the sick of Cryptococcus gattii."
He is a cousin of another fungus that is all too familiar to doctors who treat people with AIDS and organ transplantation. This error is another, called Cryptococcus neoformans, cause difficult to treat an infection of the brain in people with weakened immune systems. Overall, nearly one million people infected each year and kills more than 620,000.
Besides this, Cryptococcus gattii is a rare bird. Researchers do not know why people and animals in the Pacific Northwest are infected with tropical fungus, and why only some patients who are exposed to it.
"This is an infection in the air," said Harris. "These spores are very, very small, and can be transported in the air. And although in theory everyone can breathe. "
The fungus likes to spend his time in the woods - in the trees and in the surrounding soil. Many of those who became ill worked in jobs such as forestry and construction. But many others have had such exposures obvious to many spores of Cryptococcus gattii.
The first cases
One of the first case of Vancouver Island in 2001, was a 45 year old woman who had been kayaking in a provincial park on the east coast of the island. During a period of several months, her symptoms have increased headaches and night sweats fulminant infection of the brain. At the time of his death in early 2002, she was blind and could not walk or talk.
Others have had only occasional exposure to the forest - or not at all. The cases occurred among residents of cities and suburbs as well as those who live in forested areas.
Researchers say that most cases so far have had a risk factor or another. They lived near a wooded area or have been involved in activities that disturb the soil. Have had underlying diseases of the lung, or cancer. Forty-two percent took a drug that suppresses immunity, such as corticosteroids. But more than a quarter had no identifiable risk factor.
Until now almost all cases have a range of 15-95 years. Very few children have received the fungal infection.
One problem in monitoring cases is that the incubation period of infection with Cryptococcus gattii averages six months.
"This makes it very difficult for us to know what was the most important exposure," said Harris. "Many times we will be able to tell whether a patient has been exposed, for example, salmonella.
"They get sick the next day, and remember what you ate yesterday. But with this disease, we are invited. You can take two months to one year of the disease to manifest. "
The researchers were also struck by the variety of different animal species infected. Domestic cats and dogs top the list, but it has been confirmed in reports sheep, goats and horses, elk and llamas, including porpoises and dolphins were found on the beaches of infected carcasses .
Symptom Climate Change
It is evident that this fungus is moving. You can survive and spread in a wide range of environments.
It is also changing. Edmund Byrnes and his colleagues at Duke University have discovered a new strain of fungus in Oregon. I attributed to infections that have occurred in recent years by a band of the state.
"The new strain has only been around for several years and has already spread throughout much of Oregon," said Byrnes. "I think it is likely that the body will lay in the northern California. "
The Duke researchers report is online journal Public Library of Science Pathogens, published Thursday.
Byrnes said that many experts believe that the spread of Cryptococcus gattii is a symptom of climate change.
organizations "As we know, climate change, and do not understand how small changes in climate can affect all organisms in the environment, and could allow people to begin to grow better in this environment," he said.
One thing is certain: These small spores can cause devastating diseases.
"Something is wrong with my chest"
Bob Lewis of Portland, Oregon, knows. He was generous Outdoor - Marine, fly fisherman, swimmer - when you have been infected.
"In spring 2007, I felt there was something wrong with my chest," said Lewis. "I saw the doctor and took x-rays and thought it was bronchitis."
Months passed and the infection worsened. Lewis has finally completed at Oregon Health Sciences University, where infectious disease specialists Sarah West was diagnosed as one of the first cases of Cryptococcus gattii Oregon.
Lewis had never heard of him.
"In fact, could not even pronounce the name of it for a week or something," he said.
His lung infection, indolent for many months, suddenly began to grow rapidly. His wife, Joan, said she was drowning.
"At this moment, our primary care doctor took me aside and said:" Joan, if we can not get the best out of breath by itself, can not survive more than three days, "said Joan Lewis. " Of course, this was a great shock. "
A course of intravenous antibiotic does not interfere with the fungus. Doctors argued over whether to perform surgery. Finally found expensive antibiotics which killed the fungus. But since Bob Lewis had to take an oxygen tank, and his health has never been the same.
"My heart could not do the work I had to do, so my left ventricle is enlarged," he said. "So, my kidneys developed a critical level of dysfunction. But I am one of the lucky ones. "
The Lewises were not aware until this week that 39 cases of the disease have been reported in Oregon.
"It makes me want to cry, to hear what kind of numbers," said Joan Lewis. "This was a tragic and very, very scary experience and not wish it on anyone."
CDC officials say there is nothing individuals can do to minimize risks. But they want the doctors to be attentive so that patients do not have to wait as long as Bob Lewis made the diagnosis and treatment.
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