Former Marion County couple warns of fungal infection danger

HALSTEAD—When the rumbling machines churn up the dirt for that long-awaited backyard construction project, the earth can smell sweetly satisfying. When Paul Britton of Halstead finished such a project this summer, he and his wife, Kerry, began to wonder what was in that dirt. 

Paul developed a harsh cough with fever that felt like the flu. Later, a chest x-ray by his doctor suggested pneumonia. When Paul was finally admitted to Via Christi Hospital St. Francis with serious trouble breathing, no one expected that the cause was actually a life-threatening lung infection. The infection, called histoplasmosis, is from fungal spores living in soil that became airborne and entered his lungs, where his body could not fight them off.

Kerry heard from Paul’s infectious disease doctor that “The very old, the very young, and those with weakened immune systems due to disease or medication are the most susceptible.” 

Paul is a Peabody native, and Kerry (Stepanek) lived in Hillsboro for 20 years. Both still have family in Marion County. The couple has lived in Halstead for the past nine years, where Paul has been serving as the city’s animal control officer since June 2016.

“Paul did not contract the fungus as part of his job duties,” Kerry said. “We are very confident that it was the soil disruption.”

Paul was apparently vulnerable to infection by the fungus, called histoplasma, because of medication he was taking for his psoriatic arthritis. The medication, Humira, states on its warning label that its use leads to “Increased risk of serious infections leading to hospitalization or death, including…invasive fungal infections (such as histoplasmosis).”

This warning label presumably complies with a 2008 directive by the FDA for a class of medicines called TNF alpha blockers (such as Enbrel, Remicade, Humira and Cimzia) to carry stronger warnings regarding the serious risk of histoplasmosis infection. 

Kerry wishes they had heard about this serious risk from their doctor. The Brittons, like most families, were not aware that the Centers for Disease Control and Prevention (CDC) have found histoplasma to be a natural part of the soil in much of the central and eastern parts of the U.S., including all of Kansas. It is known to thrive especially well in soil rich with nitrogen, such as from bird manure or bat droppings.

Once the fungus is floating in the air, the spores can be breathed into the lungs. A strong immune system can kill the spores before you even notice them, but a compromised or suppressed immune system may not be able to overcome the infection. The fungus is only spread through the soil, not from person to person. 

Kerry encourages anyone in the area on a medication that might weaken their immune system to talk with their doctor. If your doctor has not brought it up, Kerry says, “then you need to be bringing it up with them.”

Kerry emphasizes, “If you have the kind of system that needs to be protected, please do.” The CDC warns anyone with a suppressed immune system in an area where the fungus is found to take precautions when doing dirt work, cleaning chicken coops with dirt floors, or renovating old buildings with accumulations of bird or bat droppings. This includes wearing a NIOSH-approved respirator or working in an air-conditioned cab, and making the soil and/or droppings damp before beginning work. 

In early July, while Paul was fighting for his life on a ventilator in ICU at St. Francis, 12 boys and their soccer coach were being rescued from a cave in Thailand. After two weeks trapped inside the cave, Thai officials said the boys had to be isolated and monitored for “cave disease” before their parents could see them. “Cave disease” is the name the officials used to describe the potential histoplasmosis that might develop from the boys’ exposure to bat droppings in their weakened state.

Though it is impossible to know precisely where Paul picked up the fungus, its danger is clear. Kerry is certain that if they had not brought Paul to hospital when they did, he “probably would have died because he was so compromised at that point.” She wants anyone with a mysterious lung issue to “get it checked out right away.”

Kerry posts regular updates and photos on Paul’s condition in a blog at https://www.facebook.com/powerforpaul/. Kerry blogs that she and her husband are trusting in the power of prayer to sustain them. The Facebook page also links to fundraisers that friends and family have initiated to support the Brittons.

According to Kerry’s blog, Paul spent the first four weeks in deep sedation in the Intensive Care Unit while powerful anti-fungal medications took effect. Paul spent three more weeks gaining enough strength to be moved to Select Specialty Hospital at St. Francis to begin a regular schedule of physical, occupational, and speech therapy. Now at week seven, he continues to use a tracheotomy tube to breathe, but requires much less supplemental oxygen than when he was admitted.

Paul is expected to remain hospitalized at Select Specialty in the St. Francis complex for three more weeks, followed by four weeks or more in a rehab facility. He will take antifungal medications for up to a year to completely eradicate the infection.By Casey Jacob.