Aspergillus Newsletter
February 2015

Interactions with Antifungal drugs: A New Tool

Antifungal drugs have a high propensity to interact with other medications e.g. azoles are stongly affected by CYP-mediated metabolism and many commonly used medications can accelerate or slow down that system, making drug levels unpredictable. If drug levels rise then side effects can be increased, if drug levels fall then their effectiveness can also fall - both scenarios can be highly problematic.
 
The Aspergillus Website has for some time offered a database of interaction information for nearly all prescription drugs (www.antifungalinteractions.org) for use by patients. It uses a traffic light warning scheme red(severe): orange(moderate): green(minor) to advise on the potential harm caused by the interaction and advises on an appropriate course of action.
 
There is now a version (Pro version) of the database intended for the healthcare professional. Antifungal drugs are used rarely and the availability of this quick reference tool should assist professionals as they manage use of these drugs.
 
Both versions of the antifungal interaction database are also available as smartphone APP's for iOS and Android, free of charge.
 
We hope that the availability of these tools will enhance safe use of these important medications.
News
Dr Jenny Long is going to run the London Marathon 2015 in aid of the Fungal Infection Trust. A trainee ENT surgeon Jenny will be running this distance for the first time and we should offer her all the encouragement we can! 
 
Read about this challenge and donate to support FIT at www.fit.care.
 
NIAID news: Of particular note to the mycology community in the January cleared concepts within the SBIR Contract Solicitation Topics is Vaccines Against Pathogens With Small Market Potential which plans to support investigators ‘developing vaccines against pathogens affecting a relatively small segment of the U.S. population [that includes most of our invasive fungi] as a critical priority. Examples of unmet needs include vaccines for selected high-risk populations, Valley Fever, and Lyme disease. If you would like to learn more about whether your favourite fungus might qualify or you have other questions about the announcement, please contact Eileen Webster Cissel
 
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Articles
NOTE access to all articles now requires registration (free of charge)
 
Aspergillus fumigatus is a fungal pathogen that is capable of adapting to different host niches and to avoid host defenses. An enhanced understanding of how, and which, A. fumigatus signal transduction pathways are engaged in the regulation of these process is essential for the development of improved disease control strategies.
These results stress the importance of the HOG pathway in the regulation of pathogenicity determinants and virulence in A. fumigatus.
 
Very few studies have been conducted on cystic fibrosis (CF) patients' exposure to the indoor environment and, to our knowledge, there are no studies dealing with the link between specific fungal environmental exposure at home and fungal colonization resulting in allergic bronchopulmonary aspergillosis (ABPA).
Results indicate that indoor fungal contamination could be a factor favoring ABPA and suggest that environmental surveys could help in preventing fungal risk in CF patients.
 
Invasive aspergillosis (IA) is associated with poor outcomes in patients with hematologic malignancies (HMs) and hematopoietic cell transplantation (HCT). Small studies suggest a role for combination antifungal therapy. OBJECTIVE: To assess the safety and efficacy of voriconazole and anidulafungin compared with voriconazole monotherapy for treatment of IA.
CONCLUSION: Compared with voriconazole monotherapy, combination therapy with anidulafungin led to higher survival in subgroups of patients with IA. Limitations in power preclude definitive conclusions about superiority.
Reviews/Overviews
The genus Aspergillus contains etiologic agents of aspergillosis. The clinical manifestations of the disease range from allergic reaction to invasive pulmonary infection. Among the pathogenic aspergilli, Aspergillus fumigatus is most ubiquitous in the environment and is the major cause of the disease. Patients that are at risk for acquiring aspergillosis are those with an altered immune system. Early diagnosis, species identification, and adequate antifungal therapy are key elements for treatment of the disease, especially in cases of pulmonary invasive aspergillosis that often advance very rapidly. Incorporating knowledge of the basic biology of Aspergillus species to that of the diseases that they cause is fundamental for further progress in the field.
 
Survival rates among immunocompromised patients with invasive mold infections have markedly improved over the last decade with earlier diagnosis and new antifungal treatment options. Yet, increasing antifungal resistance, breakthrough infections with intrinsically resistant fungi, and potentially life-threatening adverse effects and drug interactions are becoming more problematic, especially with prolonged therapy. Evidence-based recommendations for treating invasive aspergillosis and mucormycosis provide excellent guidance on the initial workup and treatment of these molds, but they cannot address all of the key management issues. Herein, we discuss 10 general treatment principles in the management of invasive mold disease in immunocompromised patients and discuss how these principles can be integrated to develop an effective, individualized treatment plan.
Deadlines
 
 
Courses
Masters in Medical Mycology, University of Manchester, UK 2015-2016 Applications for this one-year taught Masters programme in Medical Mycology are now open. Following its launch in 2013 this unrivaled degree has attracted scientists and clinicians from all over the globe who have acquired practical and clinical science skills which will help them succeed in becoming mycology ambassadors and practitioners in their home countries. The Faculty for the Manchester Medical Mycology programme is world-renowned with a number of leading scientists, clinician scientists and medical mycologists.
 
The first workshop on antifungal susceptibility testing in the routine laboratory will be held in the Turkish language in Ankara, Turkey, on 28 February, 2015.
 
 
 
Veterinary

Detection of Aspergillus-specific antibodies by agar gel double immunodiffusion and IgG ELISA in feline upper respiratory tract aspergillosis.

Feline upper respiratory tract aspergillosis (URTA) is an emerging infectious disease. The aims of this study were: (1) to assess the diagnostic value of detection of Aspergillus-specific antibodies using an agar gel double immunodiffusion (AGID) assay and an indirect immunoglobulin G (IgG) ELISA; and (2) to determine if an aspergillin derived from mycelia of Aspergillus fumigatusAspergillus niger and Aspergillus flavus can be used to detect serum antibodies against cryptic Aspergillus spp. in Aspergillus section Fumigati.
Aspergillus-specific antibodies against all four cryptic species were detected in one or both assays. Assay Se was not associated with species identity. Detection of Aspergillus-specific antibodies by IgG ELISA has high Se and Sp for diagnosis of feline URTA.
Attention Clinicians & Scientists
Nominate fungal (incl. non-pathogenic) genomes for sequencing at the Joint Genome Institute (JGI) here
 
Contribute to clinical data on rare infections:
 
 
 
Patients
Please note that the Aspergillosis Community Meeting for 6th March 2015 normally heald monthly at the National Aspergillosis Centre has been CANCELLED for this month only - see newsletter for details.
 
Patients and carers newsletter - please click here to access
 
NOTE: Financial support for patient organisations in the UK is available from Pfizer
Visit our Website
Donate to help upkeep of the Aspergillus Website
 
Current Fundraising events:
 
 
Dr Jenny LongJenny Long running the 2015 London Marathon
 
Floral Teddy in Memory of Denise Barnes
Wendy Fuller's runners in memory of Denise Barnes
 
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Fungal Infection Trust, PO Box 482, Macclesfield, Cheshire SK10 9AR, UK,www.fungalinfectiontrust.org.uk