How your compost heap can hide a lethal superfungus that destroys lungs and kills 85 per cent of those infected. Doctors warn of growing threat as sufferer Lisa says: 'My life was stripped away.' Special report by JOHN NAISH
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Lisa McNeil, 54, a married mother of two from Blackpool, knows all too well the gruelling rigours of living with a chronic fungal infection.
For the past 13 years she's had to take highly toxic medication to keep the potentially lethal fungus at bay – including one drug so poisonous that no one can be in the room with her when she administers it.
Lisa's lungs are afflicted with a fungus called Aspergillus fumigatus, which is in the air and soil all around us and thrives in compost heaps and other warm, damp places. Severe infection with this fungus, a condition called invasive aspergillosis, already affects around 4,000 UK patients each year.
Even when treated with antifungal drugs, aspergillus infection can have a mortality rate of up to 85 per cent, according to researchers at the University of Manchester.
Now these experts are warning that climate change is breeding new and even more dangerous generations of mutant superfungi that are set to spread across the UK and rapidly evolve resistance to our most powerful drug defences.
And whereas currently fungal infections such as this opportunistically prey on people with weakened immune defences (due to illness, infections or chemotherapy, for instance), experts are predicting that emerging strains of fungi will develop strengthened infectious abilities that mean they increasingly pose a threat to healthy people.
Lisa believes that her problems began when she suffered a severe lung injury in 1997 when pregnant with her first baby.
'I'd developed a blood clot in my lungs, called a pulmonary embolism, as a complication of my first pregnancy – I spent six weeks in a high-dependency unit,' she says. 'I nearly died and so did my unborn child. Thankfully the doctors managed to keep us both alive.'
All seemed well for the next year or so, but in 1998 Lisa began to get repeated chest infections.
'It was just infection after infection. I was coughing up mucus and returning to hospital despite constant antibiotics,' she says. 'My life was stripped away. Just taking the kids to the park was so exhausting I had to go straight to bed.'
Lisa was diagnosed with bronchiectasis, a chronic condition where the lungs' tiny airways, called bronchi, become widened, leading to excess mucus pooling and making the lungs vulnerable to infection.
Such infections injure the bronchi further, sparking a vicious cycle of increased mucus, further infections and worsening damage and a chronic cough.
For more than a decade Lisa suffered this cycle of infection, hospitalisation and recovery.
It was only in 2011 – 14 years after her symptoms started – that doctors ascertained that the primary culprit was not bacterial infection: instead her lungs had been colonised by aspergillus. Lisa was diagnosed with aspergillus bronchitis and referred to the National Aspergillosis Centre in Manchester, where doctors prescribed a series of powerful antifungal drugs.
'These are very toxic with strong side-effects,' says Lisa.
'I was put on one, voriconazole, which attacks the fungus's cells and stops it growing. But it's also known to cause disturbed vision – for me it was like having a light-show happening in my eyes.'
It didn't work for her, so for three years Lisa was on another antifungal, amphotericin B, which she had to inhale twice a day using a nebuliser.
'Only one in five patients can tolerate it,' she says. 'It gives you a sore throat and nausea for about an hour after taking it.
'Because of the toxicity, you have to be on your own in a room with an open window, and no one can enter the room for 30 minutes,' she says.
'Despite all that, it was brilliant. The drug made such a difference for my health and energy levels. Even my constant cough went away.' Unfortunately, Lisa could not be left on it long term as it can cause complications such as anaemia and kidney damage.
Most recently, she's been put on another antifungal drug called itraconazole. 'I still get a lot of flare-ups, chest infections that get co-infected with bacteria and have to be treated with antibiotics as well as antifungals,' she says. 'I was really poorly earlier this year and suffered with massive fatigue.'
Now researchers at the University of Manchester are warning that the threat of severe fungal infection is about to become significantly worse for many more of us, due to climate change.
Aspergillus can grow at high temperatures in compost and has evolved to thrive in the human body's temperature of around 37c – and in a new study, published last month, the researchers showed that warming temperatures are fuelling the growth and spread of infectious strains of aspergillus across Europe.
The lead author, Dr Norman Van Rhijn, a research fellow in climate change and infectious diseases, warned that world is now approaching a 'tipping point' in the evolution and spread of infectious fungi.
Dr Van Rhijn told Good Health: 'Aspergillus is a master of adaptation. It will adapt to challenges such as rising temperatures and attack by fungicides.' He adds, worryingly, that 'infections with these aspergillus funguses are difficult to diagnose – and they are associated with drug resistance and higher mortality rates'.
'If you get a chronic infection it could go on for years. The longest that we have had a patient at Manchester now is 25 years. With our current drugs, people face the prospect of being on antifungals for the rest of their life.' And the drugs can be toxic – as Lisa's story highlights.
Dr Van Rhijn warns studies in the UK already show 'elevated levels of Aspergillus fumigatus across compost bags, heaps and garden plots'.
These conditions 'enable high aerial dispersal, especially when compost is disturbed'.
Indeed Lisa believes that her injury-compromised lungs were infected by the fungus in the winter of 1997.
'I was with my child in the Lake District, playing with a pile of leaves, throwing them around – unaware of the dangers that I know of now from aspergillus thriving in dead leaves and compost. I suspect that was how I got exposed.'
Furthermore, as Dr van Rhijn's study concluded: 'Extreme weather events such as droughts, floods, and heatwaves, which are expected to increase in frequency and intensity, can contribute to higher levels of fungal spores within the air.'
Already, invasive fungal infections kill three times more people than malaria worldwide.
About 3.8 million people each year die globally with invasive fungal infections, with aspergillus being the main cause of death in two-thirds of those cases, according to research published last year in the journal The Lancet Infectious Diseases.
It is not only the prospect of faster spread and proliferation that worries fungal experts.
Michael Bottery, an evolutionary microbiologist at the University of Manchester, warns that aspergillus strains are evolving to become ever-better at resisting existing antifungal drugs – and even new drugs.
In the journal Nature last December, he explained that aspergillus strains that have already evolved resistance to commonly used antifungal drugs (called azoles) are also now genetically able to rapidly develop resistance to newly invented medicines – creating new generations of super-mutant infectious fungi.
Dr Bottery told Good Health these new strains are much faster than normal at developing drug resistance, because they have effectively taken the brakes off their evolutionary speed.
'Aspergillus has now subtly changed its DNA-copying system to enable it efficiently to create new strains that are resistant to azole drugs,' he says.
'This change means that they can evolve five times faster than other strains. Thus they are also five times more likely to evolve resistance to new drugs.'
Such strains may have already arrived in Britain, he says: 'Evidence suggests that they are already being found in compost heaps in the UK, though more likely in industrial compost than the heaps we have in our gardens, but no one can currently be sure.'
The threat is worsened by the fact that we only have a very small arsenal of drugs, because the basic biology of humans and fungi are so similar.
So a drug that can kill fungi is also very likely to harm or even kill humans.
More worrying still, the drugs used in humans are chemically the same ones that are routinely used on agricultural crops in industrial quantities to keep fungal blights at bay.
This gives the fungi a highly effective lesson in how to resist these chemicals.
This dual use threatens the development of new antifungal chemicals to treat humans, says Dr Bottery – because they can easily get approved as agricultural sprays before they are cleared as safe and effective for people – so they then become ineffective in humans.
He warns that this is currently happening with two new types of antifungal medication called olorofim and fosmanogepix, which are in the final clinical trials in humans and expected to start use in hospitals within two years. However, two new fungicides, which work in exactly the same way, are already currently being approved for use in agriculture.
'There is clear concern that the widespread use of these agricultural agents will promote the selection of resistance to our next-generation antifungals in the environment prior to their availability in the clinic,' he says.
Finding a solution to this will be difficult – but 'one idea would be to ringfence certain types of drugs for the clinics and certain others for the environment'.
Dr Bottery is also worried about the rise of another potentially lethal new infectious fungus, called Candida auris.
This was first detected in the ear canal of a Japanese patient in 2009. Since then it has spread across the world – causing tens of thousands of cases in over 40 countries.
The mortality rate for this infection may be as high as 60 per cent when it affects the blood, bone and internal organs, the UK Health Security Agency (UKHSA) reported in April.
Dr Bottery warns: 'As the climate changes, there are fears that Candida auris will become more dominant in the environment especially where fungicides are abundant, and more resistant to drug treatment.' Already, according to the UKHSA, English hospitals recorded more than 630 cases of Candida auris between January 2023 and December 2024.
By comparison, the annual total in 2015 was only 20.
And the later figures are likely to be an underestimate, the UKHSA admits: 'There is likely to be significant under-detection of cases due to incomplete reporting, coupled with a lack of routine screening and non-identification of candida in many settings.'
Candida auris is now resistant to many available classes of antifungal treatments, says the UKHSA. Such is its concern that in April, the agency made the fungus a notifiable organism.
This means that laboratories that test humans for candida in England will be required to report all new cases to the UKHSA.
This move has been welcomed as a 'big improvement' by Sumi Robson, a senior research manager at the Wellcome Trust, the UK-based global health charity.
She told Good Health that the charity takes the threat from fungi so seriously that it is dedicating more than £50 million in funding to support fungal research over the next year.
'The threat to humans is increasing,' she says.
'Fungi are very adaptable and resilient. They have been found on the International Space Station and at the sites of nuclear catastrophes.
'They are adapting well to climate change, with species becoming a threat to humans that weren't problematic before.
'And we're also seeing more fungal infections in people who don't have compromised immune systems – people who seem otherwise healthy. The evidence is small but building.
'The good news is that the UK is now one of the world's leaders in this field of research.'
Professor Andrew Borman, head of UKHSA National Mycology Reference Laboratory, agrees with the need for action.
He told Good Health: 'Climate change will play a role in the spread of fungal infections as warmer conditions encourage fungi to adapt to higher temperatures and grow better in the human body.
'We are working to monitor changing patterns of infections and provide the healthcare system with guidance to halt their spread.'
But Dr Bottery warns: 'This area is relatively underfunded and neglected.'
Lisa, meanwhile, has co-founded a charity, the Aspergillosis Trust, to raise awareness of the condition among healthcare professionals and the wider public.
'There are still a lot of healthcare professionals who don't know what aspergillus is. We have 1,500 people in our support group and 300 new visitors every month to our website.
'It's a start, but we all know that we are a long way away from where we need to be.'
