TY - JOUR
T1 - Cumulative arsenic exposure is associated with fungal infections
T2 - Two cohort studies based on southwestern and northeastern basins in Taiwan
AU - Hsu, Ling I.
AU - Cheng, Yu Wen
AU - Chen, Chien Jen
AU - Wu, Meei-Maan
AU - Hsu, Kuang Hung
AU - Chiou, Hung Yi
AU - Lee, Chih Hung
N1 - Publisher Copyright:
© 2016 Elsevier Ltd
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Long-term arsenic exposure results in atherosclerosis and cancers, along with aberrant immune responses. Animal-based and epidemiological studies indicate that arsenic exposure increases susceptibility to viral and bacterial infections. This study aimed to assess whether arsenic exposure is associated with the development of fungal infection, which is substantially attributed to as a cause of aberrant immunity. Based on two well-established cohorts from two basins in southwestern (SW; high arsenic area) and northeastern (NE; low arsenic area) Taiwan (n = 297 and 2738, respectively), the arsenic exposure in well water was estimated using HPLC-ICP-MS. Fungal infections were defined via clinical and mycological assessments (PCR of fungal 18S rRNA) of nail samples. Individuals in SW cohort with cumulative arsenic exposure > 10,000 μg/L ∗ years had a higher risk of developing fungal infections (OR = 1.57, 95% CI = 1.08–1.92) after adjusting for diabetes and occupation. In NE cohort, female sex, alcohol consumption, and chronic kidney diseases were associated with toenail infections. In contrast, fingernail infections (OR = 1.33, 95% CI = 1.05–1.68) were highly associated with arsenic exposure in a dose-dependent manner. We are the first to report palmar and plantar hyperkeratosis upon low arsenic exposure in 3.9% and 6.7% individuals, respectively. This is the first large-scale study showing arsenic exposure is associated with fungal infections in a dose-dependent manner.
AB - Long-term arsenic exposure results in atherosclerosis and cancers, along with aberrant immune responses. Animal-based and epidemiological studies indicate that arsenic exposure increases susceptibility to viral and bacterial infections. This study aimed to assess whether arsenic exposure is associated with the development of fungal infection, which is substantially attributed to as a cause of aberrant immunity. Based on two well-established cohorts from two basins in southwestern (SW; high arsenic area) and northeastern (NE; low arsenic area) Taiwan (n = 297 and 2738, respectively), the arsenic exposure in well water was estimated using HPLC-ICP-MS. Fungal infections were defined via clinical and mycological assessments (PCR of fungal 18S rRNA) of nail samples. Individuals in SW cohort with cumulative arsenic exposure > 10,000 μg/L ∗ years had a higher risk of developing fungal infections (OR = 1.57, 95% CI = 1.08–1.92) after adjusting for diabetes and occupation. In NE cohort, female sex, alcohol consumption, and chronic kidney diseases were associated with toenail infections. In contrast, fingernail infections (OR = 1.33, 95% CI = 1.05–1.68) were highly associated with arsenic exposure in a dose-dependent manner. We are the first to report palmar and plantar hyperkeratosis upon low arsenic exposure in 3.9% and 6.7% individuals, respectively. This is the first large-scale study showing arsenic exposure is associated with fungal infections in a dose-dependent manner.
KW - Arsenic
KW - Fungal infections
KW - Hyperkeratosis
KW - Immunity
UR - http://www.scopus.com/inward/record.url?scp=84989166096&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84989166096&partnerID=8YFLogxK
U2 - 10.1016/j.envint.2016.08.014
DO - 10.1016/j.envint.2016.08.014
M3 - Article
C2 - 27693976
AN - SCOPUS:84989166096
SN - 0160-4120
VL - 96
SP - 173
EP - 179
JO - Environment international
JF - Environment international
ER -