Aspergillus Newsletter
August 2014

New Diagnostic Tool for Active Aspergillosis

A new lateral flow device has been invented by Prof Chris Thornton of Exeter University, UK,  to accurately diagnose invasive pulmonary aspergillosis (IPA). The affordable device uses a highly specific monoclonal antibody (mAb) which detects a diagnostic biomarker in either blood or lung fluids - which indicates Aspergillus infection.
Advantages of the test include:
  1. Very rapid - a drop of blood takes 15 mins to analyse 
  2. Very convenient - the test can be carried out 'at point of care' 
  3. Very affordable @ £10 per test 
  4. Highly specific to Aspergillus (so other fungi will not confuse the result)
  5. It detects active Aspergillus infection
  6. The device is compatible with with hospital procedures
  7. Does not rely on the response of the patient's immune system
 
Dr Thornton generated the Aspergillus specific monoclonal antibody to a mannoprotein that is only expressed when the fungus is actively growing. The device has been evaluated in European hospitals and is currently undergoing a trial on leukaemic patients at the Royal Devon and Exeter Hospital.
The device will be used in  hospitals around the world from August onwards.
 
News
This month we see the description of a new form of aspergillosis: Fibrosing mediastinitis.
Fibrosing mediastinitis (FM) is a rare condition characterized by extensive proliferation of fibrous tissue in the mediastinum resulting in mass like lesion. Histoplasma and Mycobacterium tuberculosis are the common infective causes of fibrosing mediastinitis, but Aspergillus infection is an extremely rare cause. Fibrosing mediastinitis due to Aspergillus usually occurs following Aspergillus bronchopneumonia. See review article below for more information.
 
GP's should note the report on finding azole resistant isolates in the environment in UK and Holland. Evidence is emerging that some antifungal resistance encountered in the clinic may come from inhaled spores that are already resistant due to exposure to agricultural azoles.
 
Longitude Prize 2014: Antibiotic Action call for contributors! The winners of a £10 million fund to help prevent the rise in antibiotic resistance within 5 years by finding a way to create a cheap, accurate, rapid and easy-to-use point of care test kit for bacterial infections are asking for the widest possible range of comments to help spend the prize as effectively as possible. Send your comment by clicking here.
 
Poetry and Medicine: Open the Windows. This awareness/public contact event at the Manchester Literature Festival took place in October 2013. It was a great success and the recording can now be viewed
Articles
NOTE access to all articles now requires registration
 
The aim of this study was to survey environmental isolates of Aspergillus resistant to azoles in azole-treated and naïve areas to determine whether resistance could be related to azole treatment history. These results support the hypothesis that agricultural azole use may lead to resistance in environmental fungi of clinical importance.
 
We evaluated established and novel diagnostic methods for IPA and found that the Aspergillus PCR, LFD, and GM tests were the most useful methods for diagnosing the disease by using BAL fluid samples. In particular, the combination of the GM test and PCR or, if PCR is not available, the LFD test, allows for sensitive and specific diagnosis of IPA.
 
Invasive aspergillosis is a significant cause of morbidity and mortality for at risk groups. Directed antifungal chemotherapy, guided by effective screening algorithms which incorporate reliable and validated molecular assays, reduces the morbidity associated with empirical administration and allows earlier diagnosis. The efficient extraction of nucleic acid from Aspergillus fumigatus is the main limiting factor for successful Aspergillus PCR from clinical specimens. Four extraction robots (ABI MagMax, bioMerieux easyMAG, Qiagen EZ1 and Roche MagNA Pure LC) were evaluated for their ability to extract clinically significant levels of Aspergillus fumigatus from blood. All platforms could detect 101cfu/ml from EDTA whole blood although only the easyMAG, EZ1 and MagNA Pure had 100% reproducibility at this level. Despite good analytical sensitivity, contamination associated with the easyMAG excluded its use for diagnostic Aspergillus PCR. The EZ1 and MagNA Pure demonstrated equivalent high sensitivity and NPV (97.5-100%), essential for screening assays.
 
Aflatoxins were detected in 32·6% of the food-grain workers and 9·1% of non food grain workers (P<0·01). A significant difference was also found in BAL culture for Aspergillus (P<0·01) between the two groups. About 47·8% of the food-grain workers and 11·4% of non-food-grain workers had chronic respiratory symptoms. Conclusion: Occupational exposure to aflatoxins in food-grain workers was found to be associated with the increased presence of respiratory symptoms.
 
High plasma fluoride levels coupled with skeletal pain among patients who are on long-term voriconazole therapy is highly suggestive of periostitis. Initial measurement of fluoride may be considered when bone scan is not readily available. Early detection should be sought as discontinuation of voriconazole is effective at reversing the disease.
Reviews/Overviews
Here, we report two cases of Aspergillus FM with dominant cardiac involvement in immune-competent patients. Both cases presented with large mediastinal mass and large vegetation in the left atrium. Autopsy findings showed the granulomatous Aspergillus mediastinitis and extension into the heart with associated fibrosis. One case was proven to be due to Aspergillus flavus by fungal genomic sequencing. To the best of our knowledge, this is the first report of Aspergillus FM with pancarditis.
 
Invasive fungal infections constitute a serious threat to an ever-growing population of immunocompromised individuals and other individuals at risk.
The purpose of this review is to highlight the different diagnostic approaches that are currently utilized or under development for invasive fungal infections and to identify their performance characteristics and the challenges associated with their use.
Conference Deadlines
ICAR 2015 (International Conference on Antimicrobal Research) Deadline for registration: 26 August 2014.
 
IDWeek 2014 Discounted rate for registration 25th July 2014; General 29th August 2014.
 
ICAAC 2014 Discounted registration deadline 26th July 2014
 
IMC 2014 Late registration deadline 25th August 2014
 
BSI - Inflammation and disease Registration deadline 31st August 2014; Abstract submission deadline 31st July 2014
 
Infocus 2014 Early registration deadline 31st August 2014
Courses
Latin American Medical Mycology Conference (Infocus 2014) will take place in Curitiba - Paraná, Brazil on the 16th - 18th October 2014.
 
The next CBS Course in Medical Mycology will take place in Utrecht, The Netherlands, 17-28 November, 2014.
 
Mechanisms in Fungal Infections: From the Science to the Clinical Setting Online course, Start approximately July 2014. Mechanisms in Fungal Infections is a blended, e-learning resource with CME content developed by an expert, multidisciplinary group of specialists.
 
Medical Mycology CPD courses Four (three-week) units of the University of Manchester Medical Mycology MSc programme are now available as Continuing Professional Development courses.
 
Veterinary Mycology in Practice ISHAM_VMWG-ESCVP Postgraduate Technical Workshop October 3rd 2014, Milan, Italy.
 
Allergy Academy, King's College, London. Online resources for allergy education. Intended for all audiences including doctors & patients.
Veterinary
Feline upper respiratory tract aspergillosis (URTA) occurs as two distinct anatomical forms, namely, sino-nasal aspergillosis (SNA) and sino-orbital aspergillosis (SOA). An emerging pathogen, Aspergillus felis, is frequently involved.
 
Veterinary Mycology in Practice ISHAM_VMWG-ESCVP Postgraduate Technical Workshop October 3rd 2014, Milan, Italy.
Attention Clinicians & Scientists
Nominate genomes for sequencing at the Joint Genome Institute (JGI) here
 
Contribute to clinical data on rare infections:
 
 
 
Patients
Patients and carers newsletter - please click here to access
 
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Also of interest...
News blog:
Jobs:
 
Clinical Fellow (ID) - UHSM, Manchester, UK
 
 
Clinical Research Fellow, National Aspergillosis Centre, Manchester, UK
Antifungal drug interactions
 
Antifungal drugs can interact strongly with other medications. Check your medications using our free APP
 
 
Look out for our App in iTunes and Android (search for 'antifungal interactions).
 
Interactions with 529 prescription drugs are searchable, 1991 interactions listed, 381 severe.
Conferences:
 
Theses:
 
 
The Pharmacodynamics of Antifungal Agents Against Aspergillus by Jeans, Adam Rupert. University of Manchester. Free download.
 
Anàlisi i avaluació de l'exposició a les aflatoxines i a l'ocratoxina A, a partir de compost by Cuadrench Tripiana, Anna, Universitat Ramon Llull. Free download.
Clinical Trials (38 open):
 
 
 
Click map to browse
Case reports:
There are 243 aspergillosis cases reported here
Research & Supportive Grants:
 
Gilead UK and Ireland Fellowship Programme (cycle closes end of May 2014)
 
 
Lab protocols:
 
Networking:
 
Fungal Infection Trust, PO Box 482, Macclesfield, Cheshire SK10 9AR, UK,www.fungalinfectiontrust.org.uk