Fungal Infection Trust
July 2017
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Highlights of this month...

Fungal Awareness Week

The US Centers for Disease Control and Prevention (CDC), responsible for the health and safety of US citizens has launched a 'Fungal Disease Awareness Week (FDAW)' to take place on the 14th-18th August 2017 and to recur annually.
 
The aim of the week is to highlight the importance of recognising serious fungal diseases early enough in the course of a patients illness to provide life-saving treatment. As with most other serious fungal infections, Aspergillosis is difficult to diagnose as its symptoms closely resemble those of other, more common illnesses such as asthma. While time is spent treating a much more common illness it becomes more difficult to treat the fungal infection and eventual outcomes gradually become worse. In other fungal infections, the outcome can be death.
 
To counter this delay FDAW urges clinicians and patients to 'Think Fungus' when faced with an illness that isn't getting better despite medications for other types of infection.
 
Join CDC and the entire fungal infection community in sharing information to increase awareness in your community about fungal diseases. The quicker doctors can diagnose the right illness, the quicker a patient can be treated the right way.
 
One way everyone can support Fungal Disease Awareness Week is to support their social media Thunderclap. If you click on this link you will be given the opportunity to add all of your Facebook, Twitter or Tumblr contacts to the Thunderclap. They will receive information asking if they will also add their contacts and in this way, a single thunderclap can reach many thousands of people in one big event. You have until the start of Awareness Week (August 14th) to join in
News
The Lancet launches a new article series on neglected serious fungal infection

The Lancet has commissioned a new series of articles highlighting the many millions of people who are suffering from one of the several serious fungal infections including aspergillosis that diminish the quality of life unless diagnosis and treatment are initiated quickly and accurately.

Currently, 1.5 million people are recorded as dying from serious fungal infection but many more may die as death by fungal infection is often hidden, many recorded as cancer deaths for example.
 
The Lancet series of papers include one written by Prof Donald Cole (Toronto) that addresses the shortcomings in healthcare systems of many countries and provides examples of better 'combined healthcare systems and public health approaches' currently in place in India, Kenya,  Mozambique, and South Africa.
 
“The evidence gathered in this article series shows not only the scale of the global problem but also that hundreds of thousands of deaths a year could be avoided."
 
“The expertise is available, now it just needs government and international action to make it a reality.”
 
There are nine new papers in this series, all of which can be found listed here and in the Aspergillus Website library.
 
 
Fungal Infection Trust Supports the Thunderclap
Fungal Infection Trust (FIT) is a UK charity that is dedicated to supporting information, research, and awareness on all fungal diseases. Consequently, they will be joining in with the Fungal Disease Awareness Week Thunderclap and hosting material to raise awareness of Aspergillus and aspergillosis and the impact Aspergillus has on the lives of its patients. In some cases, we will be using patients own pictures and comments to highlight some of the very personal journeys that this fungus takes them and their carers on.
Articles
There have been 58 new articles & reviews uploaded in July. Some of the highlights are:
 
Chronic sinusitis (CRS) is a significant burden on the quality of life of over 10% of the population of Europe. Despite its commonality very little is known about the influence living in a damp home might have on this condition.
This study used a large number (over 26 000) of patient-reported dampness records to detect correlations between self-reported damp living conditions and several different respiratory conditions. Damp correlated significantly with chronic sinusitis, rhinitis, asthma, wheeze, nocturnal dyspnea, nocturnal cough and chronic bronchitis, regardless of socioeconomic factors or smoking.
 
The authors describe these two forms of aspergillosis as complications of invasive aspergillosis. Diagnosis is rare as these infections are usually not suspected by clinicians and mortality is extremely high at 87.5%. Blood cultures are usually negative and fungal vegetations frequently large.
This work attempts to define risk factors that may help diagnosis and several are identified including cardiac abnormalities, prosthetic valves, malignancy, solid organ transplants, bone marrow transplants and several more.
Of the 8 patients in the study, only 3 patients were neutropenic. However, despite this, the angio-invasive nature of the infection suggests that there still may be an immune defect so the authors suggest that further research is needed in order to further investigate.
 
This is the first report of a patient being successfully treated for ABPA using the new antifungal isavuconazole. The patient improved with minimal side effects.
 
Post translational processing of proteins is an important mechanism that mediates subcellular localisation and protein-protein interaction in all eukaryotic cells including fungi. This paper uses a strain of the fungal pathogen A. fumigatus that expresses no RamA to test whether post-translational processing carried out by this subunit is important for pathogenicity.
The study shows that loss of RamA caused significant loss of growth and virulence in a murine model of invasive aspergillosis, however, resistance to triazole antifungal drugs was increased.
Reviews
As the immunocompromised population of the world continues to increase due to increasing numbers of those infected with HIV and treating those with some cancers. Unfortunately, the effectiveness of existing antifungal drugs has not increased at the same rate. They have limitations such as toxicity and increasing drug resistance, new classes of antifungal drugs are needed.
The author discusses new antifungal treatments that are currently in development in some depth, describing targets, strategies, compounds and potential outcomes.
 
There is a mismatch in the rate at which new antifungal drugs are being developed and the rate at which antifungal resistance is emerging. Several studies in vitro suggest that the use of more than one current antifungal drug in combination may be a useful approach to combat the rise of resistance but the cost can be prohibitive. Clinical studies have thus far given weak results leading to a lack of consensus on which drugs are best combined and how. The authors call for the development of guidelines for clinicians to follow.
Indoor Air & Allergies
An association between dampness at home and respiratory conditions has been convincingly demonstrated in children. Fewer studies have been performed in adults and data are lacking for chronic rhinosinusitis (CRS). With a prevalence of 10.9% in Europe, CRS imposes a significant burden on quality of life, as well as economy.
This paper analyses data from 26 577 adults who completed the GA2 LEN (asthma, smoking, environmental exposures) questionnaire and found dampness affects 11.3% of all people. They found a strong and independent association between dampness in the home and CRS.
Veterinary
A case of aspergillosis in a 13-year-old castrated male cat. Aspergillus fumigatus was confirmed as the infecting species and was treated with itraconazole after endoscopic debridement but this animal relapsed after 4.5 months. Further debridement and treatment with posaconazole was administered for 6 months and resulted in the cat still being well 14 months from diagnosis.
This is the first case of rhinoscopically confirmed sinonasal aspergillosis to be diagnosed in a cat in the UK. Endoscopic confirmation of resolution of infection is useful in cases where mild nasal discharge persists after treatment.
Courses
We have modified our listing of courses (many of which have no fixed starting date) so that you can now see them as a list as well as on a calendar.
 
Omics of host and pathogens during infections, La Tronche, France September 6-8 2017
 
Specialization Course in Medical Mycology, KU Leuven Campus Gasthuisberg, Belgium Sept 11-21 2017 (Registration deadline 1st May).
 
Antimicrobial Stewardship: Principles and Practice, Istanbul, Turkey October 5-7 2017
Attention!
Contribute to clinical data on rare infections:

Patients & Carers
A research group in Innsbruck, Austria is making significant progress in the development of artificially reproduced lung tissue in the laboratory. Parul Chandorkar is visiting our group here in Manchester from that institute and gave us an amazing talk on the progress made in Innsbruck reconstructing the lung tissue that lines our airways in laboratory dishes. All features of the tissue are grown perfectly along with a simulated blood circulatory and immune system and they are now starting to experiment with what happens when they ‘infect’ the artificial tissue with Aspergillus spores.
 
The first thing that they noted was that the cells lining our airways can grab hold of spores and absorb them – not something that has been seen before. They can now add in components of the normal immune system and watch as they find the spores and destroy them.
 
The next stage may well be to use donated human airways cells from aspergillosis patients and watch how those cells deal with Aspergillus infection. If they act differently to cells from people who have not got aspergillosis it could not only tell us what some of the problems are in aspergillosis patients airways but also provide us with a system to test how we can start to solve those problems – and all without harming a single patient or animal.
 
 
We are also running a successful Skype meeting every week! We are a chatty group of 8 - 12 most weeks but we can accommodate up to 24. If you have a computer or phone that has APP's you will be able to join in - just click on https://join.skype.com/nbubWMUM8teC andyou will be asked to register, then taken to the group. Skype at 11am BST every Thursday
 
Aspergillosis Community (National Aspergillosis Centre) normally meets on the first Friday of each month at the Altounyan Suite, North West Lung Centre, Manchester at 1.30pm BST/GMT. If you can't make it in person, you are welcome to listen in to our live Facebook broadcast.

If you want a text reminder when each meeting is approaching (UK only) then send us an email at admin@aspergillus.org.uk with your mobile phone number.
 
Fungal Infection Trust, PO Box 482, Macclesfield, Cheshire SK10 9AR