Personal health, How to reduce the fish malodor syndrome.

Personal body malodor problem.

The Fish malodor syndrome, also known as the Fish odor syndrome or Trimethylaminuria (TMAU) is a rare metabolic disorder, a genetic disorder characterized by the presence of abnormal amounts of the dietary-derived tertiary amine, trimethylamine, in the urine, sweat, and breath, and other bodily secretions such as reproductive fluids, causing people who suffer from TMAU to emit the smell of rotting-fish (trimethylamine itself has the powerful aroma of rotting fish), and this gives the sufferer a highly objectionable body odor (body malodor), which can be destructive to the personal, social, and work life of the sufferers, some people with trimethylaminuria have a strong odor all the time, but most have a moderate smell that varies in intensity over time. People suffer from Fish malodor syndrome do not have any physical symptoms, and typically appear healthy, it has nothing to do with personal hygiene, TMAU is more common in women than men,

The fish malodor syndrome causes a defect in the normal production of the enzyme Flavin containing monooxygenase 3 / FMO3, The flavin-containing monooxygenase (FMO3) protein family consists of a group of enzymes that catalyze chemical reactions via the bound cofactor flavin. These reactions involve oxidation of heteroatoms, particularly nucleophilic atoms such as the nitrogen of amines.

When FMO3 is not working correctly or if not enough enzyme is produced, the body is unable to metabolize trimethylamine from food sources, the body loses the ability to properly breakdown trimethylamine (TMA) from precursor compounds in food into trimethylamine oxide / TMAO (non-odorous metabolite) through a process called N-oxygenation (trimethylamine-oxidase deficiency). Trimethylamine then builds up and is released in the person's urine, sweat, and breath, giving off a strong fishy odor, especially after consumption of cholin-rich foods, this malodor varies depending on many known factors, including diet, hormonal changes, other odors in the space, and individual sense of smell.

TMAU is a life-disruptive disorder caused by both genetic and environmental factors, living with TMAU is challenging, and it can adversely affect the livelihood of

adults who have it and their families, children with this condition could face rejection or a lack of understanding from their friends during school or at play

Trimethylamine is a product of decomposition of plants and animals. It is the substance mainly responsible for the odor often associated with unpleasant smell fish, some infections, and bad breath, trimethylamine is flammable tertiary amine has a strong "fishy" odor in low concentrations and an “ammonia-like” odor at higher concentrations, it is a gas at room temperature

The flavin-containing monooxygenase 3 (FMO3) protein family consists of a group of enzymes that catalyze chemical reactions via the bound cofactor flavin. These

reactions involve oxidation of heteroatoms, particularly nucleophilic atoms such as the nitrogen of amines.

There are two major subtypes of fish malodor syndrome :

1. That are related to a dysfunction of the normal enzyme activity due to genetic, hormonal, or inhibitory-chemical influences;
2. That are arised from substrate overload of the enzyme activity (normal or depressed) such as an excess of dietary precursors of trimethylamine or variations in the gut microflora resulting in enhanced liberation of trimethylamine.
   

Treatment

There is no perfect cure for trimethylaminuria, and treatment options are limited, it is possible for some people suffer from TMAU live relatively normal, healthy lives without the fear of being kept away / avoided from other people because of their unpleasant odor.

Ways of reducing the fish malodor syndrome :

Fighting Fish Odor Syndrome !

1. Reduce the intake of precursors of trimethylamine (TMA) by avoiding foods such as eggs, legumes, certain meats, fish, and foods that contain the amino-acid: choline found in fish, eggs, beans, and organ meats, carnitine, nitrogen, and sulfur (low protein diet), limiting lecithin, a common food additive that also occurs naturally in eggs, soybeans, and corn.
2. Avoid broccoli and greens, broccoli and other dark green vegetables contains indole-3-carbinol (I-3-C) which inhibits breakdown of TMA.
3. Increasing the intake of water, and taking a good probiotic to increase the number of friendly bacteria in the intestinal tract.
4. Taking low doses of antibiotics to reduce the amount of bacteria in the gut, or a short course of neomycin and metronidazole to reduce the activity of the gut micro flora.
5. Using slightly acidic detergents with a pH between 5.5 and 6.5.
6. Gene therapy with replacement of the human gene for FMO3.
7. Daily intake of gut absorbents like charcoal, ion-exchange resins, or copper chlorophyllin to modify the gut flora to reduce the bacterial species responsible for the conversion of precursors to trimethylamine, may be of significant use in improving the quality of life of individuals suffering mild forms of TMAU, but not always success.
8. Incorporate micro-organisms "engineered" with human FMO3 into the gut flora,
9. To oxidize any trimethylamine released to its non-odorous N-oxide,
10. Provide riboflavin supplements, a precursor of the FAD cofactor for flavin monooxygenase function, in an attempt to maximize any residual activity,
11. Use "malodor suppressants" in hygiene products to disguise the offensive smell of trimethylamine.
12. Behavioral counseling to help with depression and other psychological symptoms
13. Genetic counseling to better understand their condition.

Be aware of Hospital-acquired Infections (HAI,s)

Hospital-acquired infections (HAIs)

(Nosocomial infections)

overview for healthy life purposes:

A hospital-acquired infections is a health-care-associated infections, is an infection that first appears between 48 hours and four days after a patient is admitted to a hospital or other health-care service facility, or within 30 days after discharge. those are all clinically evident infections that do not originate from a patients themselves, so most infections that become clinically evident after 48 hours of hospitalization are considered hospital-acquired infections (HAIs). HAIs are usually related to a procedure used to diagnose the patient's illness. They can be caused by bacteria, viruses, fungi, or parasites, these microorganisms may already be present in the patient's body or may come from the hospital environment, e.g. contaminated hospital equipment, hospital’s workers, other patients, bad hospital indoor environment air quality, all of those circumstances can make a surgical wound of a patient become infected.

Infections that occur after the patient's discharge from the hospital can be considered to have a nosocomial origin if the organisms were acquired during the hospital stay (nosocomial infection), within hours of admission, colonies of hospital strains of bacteria develop in the patient's skin, respiratory tract, and genitourinary tract.

The main reason are the followings:

• Hospitals house large numbers of people who are sick and whose immune systems are often in a weakened state
• Increased use of outpatient treatment means that people who are in the hospital are sicker on average;
• Medical staff move from patient to patient, providing a way for pathogens to spread;
• Many medical procedures bypass the body's natural protective barriers;
• Sanitation protocol regarding uniforms, equipment sterilization, washing, and other preventative measures may be either unheeded by hospital staff or too lax to sufficiently isolate patients from infectious agents, health care workers do not strictly follow the good hygiene practices.
• Patients are often prescribed antibiotics and other anti-microbial drugs to help treat illness, overuse of the antibiotic during treatment cause antibiotic resistant. (Reference: Wikipedia)

Cause of hospital-acquired infections by medical procedures :

• the performance of surgical procedures,
• the catheters inserted into the urinary tract, nose, mouth,
• the catheters inserted into blood vessels (venous catheter), intravenous feeding, catheters going into the body allow bacteria to walk along the outside of the tube into the body where they find their way into the bloodstream.
• endotrachial tubes (tubes going through the mouth into the stomach).
• material from the nose or mouth that is inhaled into the lungs.
• poor post operative care.
• antibiotic resistant due to overuse of the antibiotic during treatment.

The most common types of hospital-acquired infections are :

• urinary tract infections : urinary tract infection is the most common type of hospital-acquired infection and has been shown to occur after urinary catheterization or placement of a catheter through the urinary tract into the urinary bladder to empty urine, or to deliver medication, a healthy urinary bladder should be sterile, with no harmful microorganisms present, although they may be in or around the urinary tract, they cannot enter the bladder. On the other hand a catheter can pick up microorganisms from the urinary tract and give an easy route into the bladder, causing infection.
• ventilator-associated pneumonia : pneumonia is the second most common type of hospital-acquired infection, microorganisms are easily introduced into the throat by treatment procedures of respiratory illnesses, the infecting microorganisms can come from contaminated equipment or the hands of health care workers, microorganisms quickly colonize the throat, so that it is easy for a patient to aspirate the microorganisms into the lungs, causes pneumonia.
• surgical wound infections : surgical procedures increase a patient's risk of getting an infection in sterile areas of the body, infection can be caused by contaminated surgical equipment or from the hands of health care workers, surgical wound can become infected from contaminated dressings or the hands of health-care workers who change the dressing.
• intravenous transfusion : for medication, delivering nutrient, blood or blood expander transfusions. microorganisms from the air and other surroundings, for example from the health care workers’ hands will contaminate the medical equipment used, beside an infection on the skin around the catheter may develop, the bacteria can also enter the blood, causes general infection.
• gastrointestinal treatment procedure.
• obstetric treatment procedure.
• kidney dialysis procedure.

Symptoms

• Fever
• Rapid breathing,
• Mental confusion,
• Low blood pressure,
• Reduced urine output, Patients with a urinary tract infection may have pain when urinating and blood in the urine
• High white blood cell count.
• Pneumonia may include difficulty breathing and inability to cough.
• Localized infection : swelling, redness, and tenderness on the skin or around a surgical wound or other open wound,

Prevent from the Hospital-acquired Infections (HAIs):

• Special air handling and ventilation are required to prevent airborne transmission, maintain a good hospital indoor air quality.
• Surface sanitation, using NAV-CO₂ (Non flammable Alcohol Vapor in Carbon dioxide) sanitizing method.

• Hand washing and /or use of alcohol rubs by all medical personnel (hand hygiene rule) and gloving, gloves must be changed between patient contacts and hands should be washed after gloves are removed.
• More careful use of anti-microbial agents, such as antibiotics, anti-fungi, and anti-viruses

Treatment of microbial infections :

1. Bacteria infections (legionella, mycobacterium tuberculosis): broad spectrum antibiotics : penicillins, cephalosporins, tetracyclines, erythromycin, vancomycin, imipenem.
2. Fungal infections (candida): amphotericin B, nystatin, ketoconazole, itraconazole, fluconazole,
3. Viruses infections (rubiola, varicella): acyclovir, ganciclovir, foscarnet, amantadine.

References :

1. Encyclopedia of Surgery
2. Nosocomial infections Wikipedia
3. HAI’s emedicine