Tag Archives: pain

Migraine is a brain disorder according to latest research

Recent research advances strongly suggest genetic changes. People with migraines may have brains that not only look different structurally under an MRI but may function differently, allowing it to be labeled a neurological disorder.  Migraine patients could be more susceptible to pain and process stimuli differently.  These findings were published online March 26, 2013 in Migraine Radiology, and come from MRI scans of 63 adults with migraines, and 18 migraine-free men and women, entitled “Cortical Abnormalities in Patients with Migraine: A Surface-based Analysis”.

A summary of migraine research findings
An excellent article including detailed figures summarizing our current understanding of migraine as a primary brain dysfunction(s) and susceptibility to cortical spreading depression is in the scientific journal Cell, May 25, 2012 – Summary. Migraine is a common disabling brain disorder whose key manifestations are recurrent attacks of unilateral headache and interictal …

Neurologists present their opinions on this scientific discovery : WebMD presents the MRI studies that suggest changes in the brain regions associated with pain; the outer layers of the brain (cortex) is thinner and smaller than in headache-free adults, Mar 26, 2013 – That’s important because it helps “legitimize” migraine as a neurological disorder associated with “real structural changes in the brain”.

What is migraine?
Migraine is three times more common in women than in men and affects about 10 percent of the people world-wide. People with migraines tend to have recurring attacks. There is currently no treatment since the pathophysiology of this “throbbing unbearable pain in the head” condition remains to be understood. Prevention is very important from allowing this condition to become chronic.

More about migraine
1) More about what is a migraine is discussed in the National Institute of Neurological Disorders and Stroke Researchers believe that migraine is the result of fundamental neurological abnormalities caused by genetic mutations at work in the brain. New models are …

2) A New York Times article discussing Migraine causes, treatment, alternative names and as a brain disorder, Feb 11, 2012 – A migraine is caused by abnormal brain activity, which can be … are due to muscle tension, sinus problems, or a serious brain disorder.

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Aspergillus and Exserohilum: what turned them deadly?

The recent outbreak of Meningitis (July – October 2012) has been deadly. Of the approximately 13000 individuals exposed to tainted steroid back pain injection (click here for details) 18 had died until October 8, 2012. Fortunately, the average healthy individual is able to fight off the causal agents of this outbreak – two fungi. Well, lets get to know these fungi better.  The two fungi are Aspergillus and Exserohilum.  Here, we cover Exserohilum.

First described by Leonard and Suggs and subsequently reviewed by Sivanesan (see 11)

Exserohilum rostratum conidiophores
Fungal colonies are grey to blackish – brown
Source: Mycology, Adelaide University

Exserohilum sp. conidia
Note the strongly defined protruding truncate “exserted” hilum
Hilum is defined as the scar on the conidia at the point of attachment to conidiophore
Source: Mycology, Adelaide University

More commonly known as an invader of grasses (see 1;2), Exserohilum has rarely caused a disease in humans. While meningitis is known to have a fungal causal agent (see 5), it has never been by the genus Exserohilum (see 7,8). It is an emerging human pathogen and needs to be better understood (8). This genus while found to cause leaf spots and leaf stripes on certain plants (see 10), does not even invade healthy grasses, let alone healthy humans. Sivanesan described 20 species of Exserohilum in 1987 and is the established published source (see 11) on the illustrated biology, pathogenicity, toxin production and distribution of Exserohilum. Robert Leahy has added information on Exserohilum sp. leaf spots of Bromeliads (see 2). Bromeliads in their natural setting are fungus free. Since Bromeliads became increasingly desirable they are now cultivated under conditions where they are susceptible to destructive leaf streaks by this fungus. Hence, the study on how to recognize the symptoms and control them.

What turned the fungus deadly?

Very few scientists study human diseases caused by Exserohilum simply because they are so rare. They do cause  sinusitis (see 9). It has never been located in meningitis disease samples to date (see 8). Meningitis causing fungi are more commonly Aspergillus, Cryptoccocus and Candida (see 5), and Prof Robert Cramer’s laboratory is among the few who are studying the destructive process of human invasion by Aspergillus(see 5).

Certain types of Exserohilum are known to produce toxins, which could perhaps weaken or destroy/kill a weakened host like a plant or a human. A list of some of the toxins it produces are: Glyceolin, Cynodontin, Exserohilone, Monocerin, Monocerin, Ophiobolin A, and Ravenelin (see 10). The first two are produced by E. rostratum, the most commonly studied.

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What are the fungi that are causing the meningitis outbreak in USA?

Aspergillus fumigatus

75 clinics in 23 states in USA are monitoring their patients who received a spinal steroid injection for pain. They may be infected with a rare meningitis caused by a fungus. The name of the steroid is methylprednisolone acetate. The Calgary Herald’s Malcolm Ritter  discusses the fact that there were (on October 8, 2012), at least two fungi linked to this unusual meningitis outbreak and they are Aspergillus and Exserohilum. Therapy is limited by the fact that very few anti-fungals penetrate the blood-brain barrier and researchers are working on more effective antifungals (see scientists below).

The causal fungi were contaminating the vials of the steroid produced and packed only by the New England Compounding Center in Massachussetts. Dr.John Jernigan, an epideomologist at the CDC, is leading the charge against these fungi. He has been quoted by various news sources stressing the fact that unlike bacterial meningitis, this is a very rare type of meningitis with little clinical research (PBS – a video recording, NY Times, Wall Street Journal). According to Huffington Post’s Amanda Chen, patients in Tennessee, Indiana, Florida, North Carolina, Maryland and Virginia have developed Meningitis. Dr. William Schaffner, President of the National Foundation of Infectious Disease said that the causal fungus is commonly found all around us, normally does not make people sick, but does cause an illness in some immunocompromised people like those with AIDS, and is not contagious.

Meningitis may be caused by fungi, bacteria or virus. To get this disease from a tainted vial is highly unusual. Needless to say, this steroid has been recalled immediately. By October 7, 2012 there were 18 confirmed deaths from fungal meningitis linked to tainted steroid back pain spinal injections says the local Detroit CBS news. Only those patients who sought relief for back pain with a steroid spinal injection July to September 2012 should be concerned.  Senator Richard Blumenthal has called for extending the FDA’s monitoring authority, if necessary (Wall Street Journal)

The Centers For Disease Control and Prevention (CDC) USA, assures that fungal meningitis is not contagious. You may click here to reach the CDC site to learn about typical Fungal Meningitis. It talks about:
TREATMENT – usually IV medication and usually patients are immunocompromised already.

The Tennessean has done such a wonderful job explaining this disease that you should probably click here to learn more about their explanations on:
What is meningitis and how many types are there?
What is Aspergillus Meningitis?
How is it diagnosed?
Should I go to the doctor for Aspergillus Meningitis?
Should I pursue other pain management options until this has been cleared?

Do email these scientists and encourage them to continue their research. Send them dolloar bills if you must, but mostly tell them you appreciate their contribution.
ASPERGILLUS FUMIGATUS – involved in the tainted steroid outbreak

CRYPTOCOCCUS NEOFORMANS – not involved in this 2012 outbreak

EXSEROHILUM – involved in the tainted steroid outbreak (Old research click on 1 & 2; and 3 for Six newer citations)

Associate Professor William Steinbach
The source of the featured photo in this article

The Duke University’s mycology group studies several fungi that cause diseases of humans including Aspergillus. One of their researchers in the Division of Pediatric Infectious Diseases is Associate Professor William Steinbach. He is interested specifically in Aspergillus fumigatus because it is the leading killer of immunocompromised patients with cancer or following transplantation. You may write to him at: 427 Jones Bldg
Research Drive, Durham, N.C. 27710 or email him at bill.steinbach@duke.edu.

Texas A&M University has biologists who have recently discovered that ZOLOFT, a medication already FDA approved for and most commonly prescribed for depression, and can cross the blood-brain barrier, can pack quite the punch against Cryptococcus neoformans, a fungus that may cause meningitis. The two chief scientists who are working to discover anti-fungals against C. neoformans are Professor Mathew Sachs and Assistant Professor Xiaorong Lin and published in the July 2012 issue of the Journal of Antimicrobial agents and Chemotherapy, where they discuss how there are a limited number of anti-fungals today. Also, the fact that antifungals available today do not penetrate the blood-brain barrier thus complicating anti-fungal therapy. Their research so far is only in the lab but is promising. Sertraline or ZOLOFT acs by not allowing the fungi to synthesize proteins for their own use, thus destroying them. Address correspondence to Xiaorong Lin, xlin@bio.tamu.edu, or Matthew S. Sachs, msachs@bio.tamu.edu or you may write at Department of Biology, Texas A&M University, College Station, Texas, USA.

Professor Mathew Sachs

Assistant Professor Xiarong Lin

A meningitis causing fungus, Cryptococcus

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