July 2019
  Research highlight
 
Fungal fighters – a new diagnostic tool paves the way for faster and earlier diagnosis of chronic pulmonary aspergillosis.
 
A new screening test kit will speed up diagnosis of chronic pulmonary aspergillosis (CPA) say researchers from the University of Manchester. The test, available commercially from LDBio diagnostics, is very simple and needs no power source or equipment and therefore is likely to be very useful in resource poor settings.
 
The team from the University of Manchester and the NHS Mycology Reference Centre, based at Wythenshawe Hospital, tested the LDBio Aspergillus ICT kit on blood samples collected from 154 CPA patients identified at the National Aspergillosis Centre in Manchester and 150 healthy volunteers. They found that the test had improved sensitivity (91.6%) and specificity (98.0%) for diagnosis of CPA in UK patients compared to existing diagnostic tests.
 
Limitations of current diagnostic procedures include high cost, long turn-around times, poor reproducibility and variations in performance. The new test is cheap, fast, reproducible and reliable. Therefore it is particularly useful in low to middle income countries where CPA diagnostics are a necessity for early recognition of CPA complicating TB, and to distinguish between these similarly presenting conditions.
 
Evaluation of LD Bio Aspergillus ICT lateral flow assay for IgG and IgM antibody detection in chronic pulmonary aspergillosis. (Stucky Hunter et al., 2019)
 
  News and notices
 
The Fungal Infection Trust are asking for feedback on their antifungal interactions app. If you use the app or database as a clinician or researcher please complete this survey and let FIT know of any improvements you’d like to see.
 
New ESCMID/ECMM guidelines are now available that provide recommendations about the diagnosis and management of aspergillosis in children.
 
It’s time to start thinking about abstract submission for future conferences.
  Research articles
 
Baseline predictors influencing the prognosis of invasive aspergillosis in adults. (Koehler et al., 2019)
Invasive aspergillosis (IA) is a serious hazard to haematological and critical care patients. Impactful risk factors for developing IA have been characterised; however, systematic analysis of baseline prognostic factors for treatment course of IA is missing. This paper provides a meta-analysis of all data from publications available from Pubmed from its inception to May 2018. It identifies predictors that may be used to identify patients at high risk for treatment failure.
 
New Insights into the Cyp51 Contribution to Azole Resistance in Aspergillus Section Nigri. (Pérez-Cantero et al., 2019)
This paper highlights the intrinsic resistance of strains from Aspergillus section Nigri to itraconazole and isavuconazole. Expression studies of cyp51A suggest that azole resistance in Aspergillus section Nigri is not clearly explained by Cyp51A protein alteration or by cyp51 gene upregulation, which indicates that other mechanisms might be involved.
 
Fungicides at environmentally relevant concentrations can promote the proliferation of toxic bloom-forming cyanobacteria by inhibiting natural fungal parasite epidemics. (Ortiz-Cañavate et al., 2019)
Cyanobacterial blooms raise serious public health concerns. This paper’s finding indicate that widely used agricultural fungicides, including itraconazole, might promote harmful algal blooms by inhibiting cyanobacterial natural antagonists such as chytrids, a group of primitive aquatic fungi.
 
Evaluation of Aspergillus IgG, IgM antibody for diagnosing in chronic pulmonary aspergillosis: A prospective study from a single center in China. (Guo et al., 2019)
This paper from China evaluates the effectiveness of Aspergillus IgG, IgM in diagnosing chronic pulmonary aspergillosis (CPA). The most common underlying disease in CPA patients was pulmonary tuberculosis and CPA patients were younger than those with other pulmonary disease. The most common clinical symptom was haemoptysis. The data presented indicates that Aspergillus-specific IgG, IgM could distinguish CPA from other pulmonary diseases effectively, and offers diagnostic value with regard to CPA.
 
Evaluation of a Novel Aspergillus Antigen Enzyme-Linked Immunosorbent Assay. (Dichtl et al., 2019)
This study compares the novel Aspergillus-specific galactomannoprotein (GP) enzyme-linked immunosorbent assay (ELISA) to the established Platelia Aspergillus galactomannan (GM) ELISA for the detection of invasive aspergillosis (IA). It finds that the sensitivity and specificity of the novel GP ELISA are similar to those of the Platelia GM ELISA. The authors note that the low sensitivities of both tests underline the need for serial testing in patients at risk for IA.
 
  Veterinary articles
 
First record of Aspergillus oryzae as an entomopathogenic fungus against the poultry red mite Dermanyssus gallinae. (Wang et al., 2019)
This paper describes the first use of Aspergillus oryzae to control the poultry red mite, Dermanyssus gallinae, a blood-feeding ectoparasite that affects egg-laying hens worldwide. Pathogencicty studies of an A. oryzae strain isolated from a dead D. gallinae showed the strain to significantly increase the mortality rate in adult mites but it had no pathogenic effect on the second nymph stage. These findings suggest that A. oryzae has promising biocontrol potential against D. gallinae.
 
  Reviews
 
Treating Allergic Bronchopulmonary Aspergillosis: A Review. (Patel et al., 2019)
This review discusses our current understanding of the complex biology of fungi and gives a detailed description of the mechanisms by which they activate the immune responses that can protect against, or contribute to, disease in humans. There is specific emphasis on airway allergic immune responses. The gaps in our knowledge and desirable future directions are also discussed.
 
Fungal Rhinosinusitis: Unravelling the Disease Spectrum. (Singh, 2019)
This review on fungal rhinosinusitis (FRS) provides insight into the reasons behind the increasing incidence of FRS and notes the rise in cases in immune-competent hosts with no predisposing factors. It provides a good description of the wide spectrum of disease ranging from the mild to life threatening forms. Diagnosis and management are also presented in this review.
 
Itraconazole in the Treatment of Nonfungal Cutaneous Diseases: A Review. (Tsai and Tsai, 2019)
This review surveys the literature on the non-antifungal use of itraconazole in dermatological practice and the possible modes of action of this agent. It highlights uses for itraconazole in cancer treatment and as an anti-angiogenesis agent. Itraconazole induces nail growth, and modulates inflammatory and immune diseases. The authors note the lack of large-scale randomized controlled studies to confirm the findings listed and call for caution in off-label use in real-world practice.
 
  Patients and carers
 
Several new blog posts and news features have been posted on the patients’ website this month so why not take a look? These include:
Great news this month as three fundraisers for the Aspergillosis Trust raised over £6500 by cycling from Land’s End to John O’Groats. The team are also supporting the Balerno High School Tanzania Project. Read all about it on the team’s Facebook page!
The Fungal Infection Trust are asking for feedback on their antifungal interactions app. If you use the app or database as a patient or carer please complete this survey and let FIT know of any improvements you’d like to see.
Meetings and support
 
We host a weekly video phone call with around 4-8 patients and a member of NAC staff each week. You can use a computer or mobile device to join the video call by downloading the Zoom software by following this link: https://zoom.us/j/243782379. This meeting runs from 11:00-12:00 BST every Thursday.
 
To receive a text reminder when each meeting is approaching send us your mobile phone number (NB this doesn't operate in the US) to admin@aspergillus.org.uk.
 
Our meetings for the aspergillosis community occur on the first Friday of each month at the Altounyan Suite, North West Lung Centre, Manchester at 12.30pm BST. If you can't make it in person you are welcome to watch on Facebook. We broadcast live (this is limited to UK patients only) and post the recording so you can watch it in your own time. (Facebook Broadcast) 
 
Join our Facebook Groups
  • Our Aspergillosis Support Facebook Group has over 2000 members and is a safe place to meet and talk to other people with aspergillosis. We have a public group and a private group.
  • We also have a Facebook group for carers, friends and family of someone who is affected by the disease - join here
  • To find our regional and international groups, search the following terms within Facebook: 'aspergillosis'; 'aspergillus'; 'ABPA'
 
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