Fungus fighters

Ross Rommel knows about pursuing the enemy.

For decades, he served as a Harris County prosecutor and later entered the private legal sector. But over the past 12 years, he has defended himself against a cancer diagnosis and another pernicious predator – an invasive fungal infection.  

In 2007, Rommel was diagnosed with prostate cancer. He underwent a radical prostatectomy – an operation to remove the prostate gland and the tissues surrounding it, followed by radiation treatment. Ten years later, Rommel, now 72 and retired, began to experience intense pelvic pain. The radiation he’d had a decade earlier had damaged his bladder and led to an infection in his pelvic area.

“I was in so much pain, I could barely walk,” Rommel recalls.

The former marathoner dropped 50 pounds in two-months.

Rommel’s MD Anderson prostate cancer doctor, Christopher Logothetis, M.D., turned to Dimitrios Kontoyiannis, M.D., Sc.D., Ph.D. (Hon), professor of Infectious Diseases, for help. Kontoyiannis determined that Rommel had osteomyelitis, an inflammation in the pelvic bone.  

Weighing the options

When Rommel failed to improve on antibiotics that target only bacteria, Kontoyiannis, an internationally recognized expert in mycology, or fungal infections, suspected that Rommel had a mixed bacterial and invasive fungal yeast infection called Candida.

Fungi can thrive as harmless colonizers in the mucous membranes that line various cavities in the body, such as the mouth and nose, and cover the surfaces of internal organs. In healthy people, the fungi cause no problems. But for cancer patients like Rommel, an immune system weakened by chemotherapy or surgery is fertile ground for invasive fungal infections to take over and invade the body.  

“Commonly, the fungi thwart the ability of doctors to deliver life-saving chemotherapy,” Kontoyiannis explains. “This can sometimes, directly or indirectly, result in failure of the chemo treatment or even death, particularly in patients with leukemia and those who have had stem cell transplants.”

For the past 20 years, Kontoyiannis and his research team have studied the main fungi that afflict cancer patients. As a result, they’ve introduced several concepts and strategies designed to control these frequently devastating infections.

“Our group is known for our out-of-the-box thinking for fungal infections,” says Kontoyiannis, director of the MD Anderson Mycology Research Center.

Kontoyiannis says much of his lab research begins in the clinical setting.

“I do most of my clinical work on the leukemia service, so I’ve made numerous clinical observations and developed questions on the behavior of fungi causing invasive fungal infections. I take these ideas to the lab, test them, and then take my learnings back to the patients.”

On the attack

Kontoyiannis and colleagues “persistently and tenaciously” treated Rommel for several months with the most potent fungal drugs on the market. During this time, Rommel also underwent surgery to remove dead or contaminated tissue from his infected bone. The treatment worked.

“Mr. Rommel was fortunate,” Kontoyiannis says. “He had a beautiful recovery and is now living a full life with no problems.”

Because antifungal drugs are limited in number, Kontoyiannis says existing drugs that treat other conditions must sometimes be repurposed to treat fungal infections. New antifungal drugs that all patients to ward off fungal infections before they occur are needed, Kontoyiannis says, but new drug development can take years, even decades.

 “We need to find more robust antifungals,” he says. “But more importantly, we need to develop strategies that strengthen the patient’s immune system response, which will allow them to fight the fungus better.”

Now that he’ on the mend, Rommel can fully focus on recovering from prostate cancer. He calls Logothetis and Kontoyiannis “shepherds who guided me through some of the darkest days of my cancer journey.”

Diamond Excellence in Mycology Center

Last year, the European Confederation of Medical Mycology designated MD Anderson as a Diamond Excellence in Mycology Center, the only center in the U.S. to receive this level of distinction. This designation is awarded to institutions that combine clinical and microbiological mycology – the study of fungi – with targeted research, while maintaining a commitment to the highest quality in diagnosis and treatment of fungal infections. The center’s director is Dimitrios Kontoyiannis, M.D., Sc.D., Ph.D. (Hon), who recently was named the leading expert in mycoses by Expertscape, a website that ranks people and institutions by their expertise in more than 27,000 biomedical topics, and Medscape, a Web MD-owned website that provides information and continuing education to physicians and health professionals.