Fungal Nodules in Lung

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The town of Caravaggio is 40km east of Milan.


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Lisa Sanders, Agony. It seemed likely the older man had a [articular disease seen in those over 50. But the test results didn't add up. New York Times Magazine, June 9, 2019.
https://www.nytimes.com/2019/06/ ... tica-diagnosis.html

Note:
(a) "Timothy Quan, a rheumatologist i central Connecticut * * * The man [patient] gave a brisk nod. * * * The [primary care] doctor prescribed some ibuprofen"
(i) He is Asian. Judging from his last name, he might be Chinese. Education: BS Yale 1990; MD  SUNY Downstate Medical Center (Brooklyn) 1996. He is board-certified in rheumatology.
(ii) brisk (adj): "lively and quick; vigorous  <a brisk walk>"
https://www.collinsdictionary.com/dictionary/english/brisk

The Merriam-Webster dictionary gives another example: "at a brisk pace."
(iii) ibuprofen
https://en.wikipedia.org/wiki/Ibuprofen
(in the nonsteroidal anti-inflammatory drug (NSAID) class [the most prominent of which is aspirin]; table: Trade names  Advil, Motrin)

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(b) "The patient lived in rural Connecticut, so his physician figured it was probably Lyme disease. He sent him to be tested [for antibodies in blood against bacteria Borrelia] but felt confident enough in the diagnosis to start him on doxycycline, the antibiotic used to treat most of the infections carried by ticks."
(i) Lyme disease
https://en.wikipedia.org/wiki/Lyme_disease
(diagnosed for the first time in 1975 in Old Lyme, Connecticut)
(A) The town of Old Lyme is about 30-mile air-distance east of New Haven, Conn.
(B) The en.wikipedia.org for this Connecticut town says, "The town is named after Lyme Regis, England."  The same (Wiki) for Lyme Regis indicates, "A Royal Charter was granted by King Edward I in 1284 when 'Regis' was added to the town's name [Lyme].'

In Latin:
* regis is genitive case (the same as possessive, such as "my") of noun masculine rex king.
* "Latin is a heavily inflected language with largely free word order. * * * In Latin an adjective can come either before or after a noun, eg vir bonus or bonus vir 'a good man.' "  en.wikipedia.org for "Latin grammar."

Latin-English dictionary:
# vir (noun masculine): many definitions similar to "man" in English
https://en.wiktionary.org/wiki/vir
# bonus (adjective masuline; feminine bona): "good"  (English noun bonus is borrowed from this Latin adjective.)
https://en.wiktionary.org/wiki/bonus
# cōgitātus: (past participle of verb cōgitāre think, ponder): "[is] thought, pondered"
https://en.wiktionary.org/wiki/cogitatus
* Latin Word Order. In "Rebecca Harrison's Cogitatorium, a site for thinking and learning about Latin." Missouri: Truman State University, undated
https://rharriso.sites.truman.ed ... e/latin-word-order/
("Clarity of understanding takes precedence * * * Genitives usually come immediately before or after the noun that they go with")

Harrison made up the word Cogitatorium, a la auditorium, sanitorium etc. For definition of cogitatorum (without i), see the preceding item.
(C) A short history of Lyme Regis. Lyme Regis, undated
www.lymeregis.com/history/richfoxhis.htm
("Lyme takes its name from the river Lym [which flows by the town]; Lym meaning a torrent of water")
(ii) Borrelia
https://en.wikipedia.org/wiki/Borrelia
(The genus is named after the French biologist Amédée Borrel (1867–1936) [male] )
(iii) The doxycycline is a member of the tetracycline class or family, which inhibits the synthesis of bacterial proteins by binding to the 30S ribosomal subunit, which is only found in bacteria (but not humans or animals).

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(c) "The antibiotic didn't help — he was still in a lot of pain. So his [primary care] doctor called in a week of prednisone. The aches almost disappeared with the very first pill. * * * The Lyme test was negative, but some of the other tests [you need not know what these tests were, which are not specific and can only tell you there is inflamation somewhere, somehow] the doctor sent, looking for inflammatory causes of the pain, were sky-high. * * * the [primary care]  doctor referred him to Quan, the rheumatologist. * * * Given the location of the pain, the elevated inflammatory markers and the significant response to steroids, Quan thought the man probably had something called polymyalgia rheumatica (PMR). PMR is a poorly understood disease seen predominantly in those over 50. It's an inflammatory disorder affecting the soft tissue of the shoulder and hip joints. Diagnosis is based on the clinical presentation because there's no definitive diagnostic test."
(i)
(A) Evelyn Theiss, Prednisone Works well for Range of Conditions, But Can Have Many Side Effects. Plain Dealer, Mar 5, 2013.
https://www.cleveland.com/health ... _well_for_rang.html

four consecutive 3 1/2 paragraphs:

"More than a century ago, doctors knew that women with rheumatoid arthritis felt significantly better when they were pregnant. They began to wonder if a naturally occurring hormone could be the reason for that.

"Research began to be conducted in a number of countries, including the United States and Canada, in the 1940s.

"Clinical trials in the US in 1949 showed that a corticosteroid, cortisone, hugely improved the symptoms of rheumatoid arthritis. In 1950, a team at a major pharmaceutical company, Schering, converted cortisone into the stronger prednisone [with fewer side effects also].

"The team's leader, Arthur Nobile, was granted the patent in 1964 * * *

(B) Prednisolone is synthetic glucocorticoid
https://en.wikipedia.org/wiki/Glucocorticoid
("The name "glucocorticoid" is a portmanteau (glucose + cortex + steroid) and is composed from its role in regulation of glucose metabolism, synthesis in the adrenal cortex, and its steroidal structure")

There is no need to read the rest of this Wiki page, except jumping to the colored graphic: glucocorticoid is made (in the cortex of adrenal gland) from cholesterol 胆固醇 (so the numbering of carbon atoms in glucocorticoid is same as cholesterol). Corticoid is 皮质类固醇.

The prednisolone is different --chemically, reduced 还原 -- from prednisone by adding two hydrogen atoms at carbon 11 to prednisone, which in prednisone is =O but in prednisolone is -OH plus H (the latter not shown because there are simply too many -H's in chemical formula).
https://en.wikipedia.org/wiki/Prednisolone

Arthur Nobile earned bachelor's from University of California, Berkeley, was a microbiologist, and used bacteria to do the reaction needed to produce prednisolone.

Both prednisone and prednisolone (more commonly used) can be taken orally. The former is converted to the latter in liver. When a patient has liver problem *and can not do the conversion efficiently), prednisolone is prescribed.
(ii) The polymyalgia rheumatica (PMR) should not be confused with two other diseases: myofascial pain syndrome or fibromyalgia. But none of the  three has a specific text and causes are all unown. So who knows (what these three are()?

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(d) "After the operation [to remove lung nodules, by a thoracic surgeon], a new doctor, a specialist in infectious diseases, brought the results. I have good news and bad news, he told them. The good news — it's definitely not cancer. The bad news is that we still don't know what it is. * * * A few days later, the doctor conveyed something closer to a final diagnosis. It was a fungus [fungus takes longer time to grow in a lab than bacteria], though the lab still wasn't sure which one. It was either Blastomycosis [endemic to eastern US but not in Connecticut; caused by Blastomyces dermatitidis] or Cryptococcus [because it takes longer for a fungus to bear spores, by which the diagnosis can be made for certain, for different fungi bear vastly different spores under microscope]. Both are found in the environment, usually in moist soil [everywhere in the world] * * * as soon as the infected tissue was out of the man's body, his pain disappeared * * * As he [Quan] sees it, this man’s immune system, activated by infection in his lungs, mistakenly began attacking the man's muscles, along with properly going after the fungus. Once the bugs were gone, and his immune system went back to normal, the attack, and thus the pain, stopped, probably forever."
(i) First of all, it is hard to comprehend why this old man contracted the fungal disease, which affects mostly people who takes immunosuppressive drugs. See
Baddley JW et al, Geographic Distribution of Endemic Fungal Infections among Older Persons, United States. Emerging Infectious Diseases (published by CDC), 17: 1664 (2011)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322071/
("Fungal infections have become an increasing problem for older persons in the United States. Compared with years past, older adults today are more likely to be considered for transplantation, receive aggressive regimens of chemotherapy, or take immunosuppressive drugs for rheumatologic or autoimmune diseases") (citations omitted0.
(ii) What Dr Quan sees, it is all speculation: there was no pathologic biopsy of muscles or joints, no blood test for autoantibodies (antibodies against muscle or joint). And most important, there is nothing in medical literature that says these fungal diseases will cause autoimmune disease or muscle or joint pains. Why propose autoimmune reaction? Even if some of these fungal disease cause muscle or joint pain, can it be possible that the fungus release toxin(s) which causes muscle or joint pains directly (without triggering patient's own immune system to attack muscles or joints)? Another problem to propose autoimmune reaction to a fungal disease is that there must be something common in antigens between the fungus and muscle or joint, which is hard to believe.