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The fungus among us

Late last week, the U.S. Food and Drug Administration issued an unsettling report on the conditions at New England Compounding Center in Framington, Mass., the facility that produced the fungus-contaminated steroid injections that have (at last report) killed 25 people and sickened 338 in 18 states.

The report describes serious and systemic problems with keeping production areas sterile. Cleanliness is, of course, essential in the manufacture of drugs. Microbes rule the world and, without conscious, relentless resistance, they will always, inevitably win.

That’s true of viruses, bacteria and fungi, including those apparently implicated in this latest, fatal outbreak.

Meningitis is an inflammation of the protective membranes covering the brain and spinal cord, collectively known as the meninges. The inflammation can be caused by viruses, bacteria or fungi (also by some drugs). Bacterial meningitis is typically the most serious and life-threatening, but fungal meningitis also kills.

Multiple strains of fungi have been linked to meningitis, but the most common is Cryptococcus neoformans, a soil-dwelling microbe found everywhere in the world. Generally speaking, only people with immune system deficiencies, such as those caused by cancer, HIV or other serious illnesses, are notably at risk for a cryptococcal infection becoming meningitis.

In these cases, symptoms include headache, fever, nausea, vomiting, stiff neck, aversion to bright lights, changes in mental state and hallucinations. Unlike bacterial meningitis, in which symptoms are abrupt, symptoms of fungal meningitis appear gradually. Treatment is an antifungal medication like amphotericin B, flucytosine or fluconazole. Many patients are required to maintain therapy indefinitely. In other words, for the rest of their lives.

They’ve been called ‘solar-powered slugs’ and ‘leaves that crawl’ — species of sacoglossan sea slug that assimilate the photosynthetic organelles in the algae they eat, causing their bodies to turn bright green. But it turns out that these slugs can survive months of starvation even when their photosynthetic capacity is massively reduced, casting doubt on the widely-accepted theory that they rely on photosynthesis to feed themselves when there’s nothing around to eat.

Plastid-bearing sea slugs fix CO₂ in the light but do not require photosynthesis to survive Gregor Christa, Verena Zimorski,Christian Woehle,Aloysius G. M. Tielens,Heike Wägele,William F. Martin andSven B. Gould. Proc. R. Soc. B 7 January 2014  vol. 281  no. 1774  20132493 

The sea slug Elysia timida extracts the photosynthesizing organelles from single-cell algae it feeds on — but it is unclear whether it actually can use them as its personal solar panel. Sven Gould/Jan de Vries