This paper from the National Aspergillosis Centre, the University of Manchester and Gulu Referral Hospital, Uganda, reports that around 1 in 15 people affected by tuberculosis are likely to get aspergillosis.
TB leaves a cavity in the lungs in about 1 in 4 patients, and so with 7.7 million survivors from TB in the lungs, about 140,000 people worldwide will develop chronic pulmonary aspergillosis (CPA) every year after finishing TB therapy, assuming the results from Uganda are similar elsewhere.
Human anti-fungal Th17 immunity and pathology rely on cross reactivity against Candida albicans. (Bacher et al., 2019)
C. albicans is the major fungal inducer of human Th17 responses. In this paper it is shown that Th17 cells that react to Candida in the gut also react to Aspergillus in the lung, and this increases the levels of Aspergillus reactive Th17 cells in the blood of patients with cystic fibrosis, COPD and asthma, especially during ABPA. This indicates that there is a direct link between protective intestinal Th17 responses against Candia and lung inflammation by Aspergillus.
Posaconazole has better therapeutic efficacy in comparison with itraconazole and voriconazole in ABPA amongst cystic fibrosis patients (Periselneris et al., 2019)
In this paper the authors sought to discover whether posaconazole, which is known to be less toxic and better absorbed than other azoles, was more effective at treating ABPA.
Using a retrospective analysis of 596 cystic fibrosis patients, specific Aspergillus IgE levels and azole levels in blood samples were reviewed. The authors found IgE levels to be significantly reduced when posaconazole was used, but not the other azoles (itraconazole and voriconazole), suggesting that monitoring posaconazole drug levels, and altering dose to attain therapeutic serum levels, is associated with improved serological responses in ABPA.
Aspergillus species collected from environmental air samples in Portugal – molecular identification, antifungal susceptibility and sequencing of cyp51A gene on A. fumigatus sensu stricto itraconazole resistant (Monteiro et al., 2019)
This study is the first assessment of molecular resistance mechanisms in environmental A. fumigatus sensu stricto isolates in Portugal and reports on environmental azole-resistant A. fumigatus in air samples from 4 hospitals and a water treatment plant. The authors collected 84 isolates, of which 12 were cryptic species. Resistance to posaconazole, itraconazole and isavuconazole was observed. These was no resistance to voriconazole or amphotericin B. No mutations in cyp51A were reported in the environmental isolates.
Characterisation of novel-cell-wall LysM-domain proteins LdpA and LdpB from the human pathogenic fungus Aspergillus fumigatus. (Muraosa et al., 2019)
This study provides a functional analysis of two novel lysin motif (LysM) proteins, LdpA and LdpB, in A. fumigatus. LysM is a small protein domain that binds chitin and some LysM domain proteins have been shown to be virulence factors in fungal plant pathogens. No significant effects on morphology, growth, cell wall integrity or chitin levels were reported and deletion mutants did not affect virulence in a murine model of infection. However, some evidence for a role in biofilm formation and antifungal susceptibility is provided; the authors demonstrate that both proteins are found in the extracellular matrix.
Inpatient mortality after endoscopic sinus surgery for invasive fungal rhinosinusitis. (Burton et al., 2019)
In this paper, the authors use a large national database to better understand clinical factors associated with inpatient mortality for invasive fungal rhinosinusitis (IFR). 979 adult patients with mucormycosis or aspergillosis and a procedure code of sinus surgery were identified from the database. The most prevalent co-morbidity was haematological disorders and mucormycosis was associated with increased inpatient mortality. The authors conclude that underlying immune dysfunction and type of fungal infection are important predictors of early mortality.
Aspergillosis patients should note that we have switched from our old website for patients and carers (nacpatients.org.uk) to our new website that can be accessed using our new domain name aspergillosis.org
