A 24-year-old boy contracted fungal pneumonia after smelling his unwashed socks! Are “stinky socks” so toxic?

Recently, a netizen named "Haiyan" from Xinmi, Henan shared his experience of getting a fungal infection in his lungs after smelling the socks he had just taken off, which attracted the attention and heated discussion of netizens.

Is it too much to say that smelling stinky socks can cause lung infection? Not long ago, Zhejiang Provincial Tongde Hospital admitted a young man with a fungal lung infection. When describing his condition, he specifically mentioned that he picked up a pair of socks that had not been washed for several days and smelled them.

I picked up a pair of unwashed socks and smelled them.

The result was a fungal lung infection.

A few months ago, 24-year-old Xiao Lin started coughing intermittently. At first, he thought it did not affect his life, so he did not take it seriously and continued to stay up late and sleep late. Until recently, he was woken up by coughing for several nights in a row. When the coughing was severe, his abdominal muscles ached and he even couldn't fall asleep.

Xiao Lin went to the pharmacy to buy cough syrup, but it didn't work after he finished a whole bottle, so he went to the Department of Respiratory and Critical Care Medicine of Zhejiang Provincial Tongde Hospital for treatment. The CT imaging report showed that Xiao Lin had lung plaques with cavitation, and his condition was serious, so he was immediately admitted to the hospital.

During the hospitalization, Xiaolin quickly underwent a bronchoscopy. Samples were taken under the bronchoscopy, and the alveolar lavage fluid sent for NGS showed that it was positive for Cryptococcus neoformans (Note: a type of fungus, belonging to the histolytic yeast, a conditional pathogen, generally easy to infect some immunocompromised patients, and can be transmitted through the respiratory tract).

After asking about his medical history, we learned that Xiaolin was a migrant worker in Hangzhou. He came to Hangzhou to work after graduation and rented a small studio in Hangzhou. Because his hometown is in the north, he was not used to the relatively humid weather in Hangzhou when he first arrived. He lived on a lower floor, and the weather was rainy and cold recently, so his athlete's foot, which had not occurred for a long time, began to recur.

Xiao Lin said embarrassedly that because he neglected hygiene, he did not have time to wash his socks and just threw them in a corner. When he was cleaning up at the weekend, Xiao Lin found that the socks had mold spots and a strange smell, so he picked them up curiously and sniffed them.

After being admitted to the hospital, Xiaolin first received medication and symptomatic treatment such as nebulized expectoration. Later, lumbar puncture and cranial MRI were performed to rule out the possibility of cryptococcal meningitis. After a course of treatment, Xiaolin's cough and expectoration finally got better, and he could sleep well at night.

Since the treatment of fungal infection is a long process, after a period of treatment, Xiaolin will need to continue long-term oral treatment with antifungal drugs.

Are stinky socks really that powerful?

Two key factors in the disease:

The amount of inhaled pathogens and autoimmunity

Just smelling it can cause fungal lung infection. Are smelly socks really that powerful?

After Xiaolin's experience was reported, it sparked heated discussions among netizens, some were surprised, some were skeptical, and some were rational analysts.

"In the past, every dormitory in college had a few pairs of blue, green, gray and black socks under the bed..."

"Just kidding, I can wear a pair of socks for 2 months without any problems"

"If it's not a low immune system (such as AIDS), how can you get a fungal lung infection so easily?"

"There are often a pile of used socks in the boys' dormitory. If they smell the least smelly pair, they will wear it. Isn't that a big hidden danger?"

"My college roommate never washed his feet and wore socks to sleep. One day his feet were so swollen that they were like balls, so he was sent to the hospital."

"I smell it often. Is it because I am immune to all poisons?"

"In fact, not only socks, but also shoes that have not been washed for a long time may have this bacteria."

"Are people nowadays so fragile? Smelling socks can diagnose illness. I often smell them. Do I have to stop doing so in the future?"

…

On the evening of the 29th, the Express reporter contacted Dr. Xu Xianrong, director of the Department of Respiratory and Critical Care Medicine at Zhejiang Provincial Tongde Hospital. Dr. Xu said that during the consultation, he also discovered an important piece of information: Xiaolin usually works in a flower and bird market and has many opportunities to come into contact with birds. Since Cryptococcus neoformans is commonly found in bird feces, there may be a large number of Cryptococcus neoformans in Xiaolin's working environment, which may have stained his clothes with Cryptococcus neoformans.

Clothes stained with new cryptococcus were not washed frequently, the living environment was damp and stuffy, and Xiaolin stayed up late. As a result, a small act of "smelling socks" resulted in a painful price.

Hu Dandan, deputy director of the Department of Respiratory and Critical Care Medicine at Zhejiang Zhongshan Hospital and deputy chief Chinese medicine physician, believes that "in general, smelling smelly socks and causing lung fungal infection is a low-probability event." Hu Dandan said that whether lung fungal infection will occur after smelling socks depends mainly on two key factors: the amount of inhaled pathogens and one's own immunity.

"The amount of pathogens is easy to understand. There is a widely circulated saying on the Internet that 'talking about toxicity without considering the dosage is just hooliganism'. For the same kind of fungus, inhaling more or less will result in infection or non-infection. Except for the elderly, infants, and people with underlying diseases, for healthy adults, the low immunity we often talk about mostly refers to a transient decrease in immunity. For example, 24-year-old Xiao Lin works in a bacteria-prone environment and does not wash his socks frequently. It may be that the fatigue and insomnia caused by staying up late have caused a staged decrease in immunity. When he smelled his socks at this time, he was just 'taken advantage of'. If it was him a month ago, there might be no problem."

Which university dormitory doesn't have a few pairs of smelly socks under the bed?

Are the boys in danger?

It is not difficult to find that among the various comments related to smelly socks, there is a "faction" - the dormitory faction, and the dormitories here are almost uniformly assumed to be boys' dormitories. A netizen mentioned that boys always jump out of a pile of smelly socks to wear a pair of relatively non-stinky socks, and they really "hit" a large group. In this way, aren't boys who have accumulated a lot of smelly socks in danger?

"Healthy teenagers with normal immunity are not so easy to get infected, and it is impossible for the doors and windows of the dormitory to be closed all the time. The doors and windows should always be open for ventilation, which is much better. Some netizens said that they have never seen any problems from smelling socks every day. Combined with the two key factors of whether there will be infection mentioned just now, overall, it is still a low-probability event, and everyone does not need to worry too much." Hu Dandan said.

In fact, we should not just focus on "stinky socks". "Mold on objects and dark and humid environments such as basements can all cause fungal lung infections," said Xu Xianrong.

Compared with socks, we should pay more attention to air conditioning in daily life

If you don't use it for a long time, you must clean the filter before using it

"Compared to socks, there is one place that deserves our more attention, and that is the air conditioner." Hu Dandan said, the reason why it is always emphasized that the filter must be cleaned before using the air conditioner after not using it for a long time is because common bacteria such as mold and Legionella pneumophila will grow in the air conditioner filter and air outlet. Inhaling air containing a large number of bacteria will inevitably have an impact on the body, and problems such as "air-conditioning disease" may follow.

Develop good living habits

Preventing fungal infections

Both experts emphasized that through this case, what everyone should care about is not whether they can still smell their socks, but to develop or stick to good living habits to avoid the problems caused by them. Fungal infections can generally be prevented by improving living habits, washing clothes frequently, and disinfecting clothes regularly.

Develop good living habits: For example, try to avoid going to public baths, swimming pools, foot massage shops, etc. In daily life, patients should avoid sharing public items with others, such as toothbrushes or slippers, wear loose and breathable shoes and socks, and avoid eating unhygienic food.

Change clothes frequently: You need to change clothes regularly to clean the fungi and bacteria on the clothes, which can play a certain preventive role. Avoid staying in a damp and dark environment for a long time, and try to wear a mask when cleaning.

Disinfect clothes regularly: If people around the patient have fungal infections, they need to disinfect their clothes regularly to remove the fungi on the clothes, which can effectively prevent fungal infections.

Actively prevent and treat underlying diseases: It is necessary to actively prevent and treat diseases such as diabetes, tumors, anemia, etc. Diseases may lead to low immune function and increase the probability of fungal infection.

Avoid drug abuse: Avoid long-term or large-scale use of drugs that may easily induce fungal infections, such as antibiotics and corticosteroids.

Metropolis Express·Chengshi Interactive Reporter Zhang Jing Zhang Huili Correspondent Ying Xiaoyan Hu Danni Chen Ying