Cumulative arsenic exposure is associated with fungal infections: Two cohort studies based on southwestern and northeastern basins in Taiwan.
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 >10,000μg/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.
Laboratory for Epidemiology, Department of Health Care Management, and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
Ling-I
LI
Hsu
Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Yu-Wen
YW
Cheng
Genomic Research Center, Academia Sinica, Taipei, Taiwan.
Chien-Jen
CJ
Chen
School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan.
Meei-Maan
MM
Wu
Laboratory for Epidemiology, Department of Health Care Management, and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; Department of Urology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Kuang-Hung
KH
Hsu
School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan.
Hung-Yi
HY
Chiou
Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. Electronic address: dermlee@gmail.com.
Chih-Hung
CH
Lee
D000368:Aged; D001151:Arsenic / Q000032:analysis / Q000633:toxicity*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses; D014009:Onychomycosis / Q000139:chemically induced* / Q000453:epidemiology; D015995:Prevalence; D013624:Taiwan / Q000453:epidemiology; D014874:Water Pollutants, Chemical / Q000032:analysis / Q000633:toxicity*; D060986:Water Wells
D014874:Water Pollutants, Chemical; D001151:Arsenic
Arsenic; Fungal infections; Hyperkeratosis; Immunity