Fungal Infection Trust
December 2016
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Highlights of this month...

First ECMM Excellence Centre

The European Confederation for Medical Mycology (ECMM) is to promote worldwide collaboration in Medical Mycology, strengthening the information, resources and training available to every country in line with its organisational aims. To achieve this ECMM is initiating a global network of Centres of Excellence of Medical Mycology, each institute leading the way in its area of specialism.
 
The first Excellence Centre is to be the Manchester ECMM Excellence Centre based at the Mycology Reference Centre Manchester (MRCM) in partnership with the National Aspergillosis Centre (NAC), both sited at the University Hospital of South Manchester (UHSM) in Wythenshawe, UK.
 
There will be a launch ceremony held at UHSM along with a series of talks by leading Medical Mycologists and clinicians of the new Centre who will summarise the expertise at the new Centre and ECMM officials who will make it clear why Excellence Centres are needed and what they set out to achieve.
 
Everyone on the Medical Mycology community and patients & carers are invited to attend the event on 11th January 2017 at the Education and Research Centre, University Hospital of South Manchester, Wythenshawe, Manchester, UK. Talks will begin at 9am and the meeting closes after lunch at 1pm. Register for your place here, free of charge.
News
Environmental Aspergillus isolate is source of life threatening infection in immunocompromised patient. Lavergne et.al. (see articles below) have just published the first paper that demonstrates the isolation of an antifungal resistant strain of Aspergillus fumigatus from the home of a deceased patient that is identical to the strain isolated from the patient.
 
The free smartphone & tablet APP that allows patients and medical professionals to search for adverse drug:drug interactions between systemic antifungal drugs and other prescription drugs has just been updated and is available for iOS and Android or on the Aspergillus Website.
 
Experts in Manchester have recently launched the first e-learning course in direct microscopy for identifying fungal infection, also teaching histological staining methods and interpretation of fungal elements. The course is accredited by the University of Manchester & will teach not only how to rapidly and accurately diagnose life-threatening fungal infections, but also how to set up direct microscopy in a diagnostic laboratory. It is available at www.microfungi.net. The first 50 students to complete this course will be offered free ESCMID membership for one year.
 
The LIFE-Worldwide website has just published its latest newsletter - read it here.
Featured Website Section
The treatment section has a new article on the link between smoking marijuana and aspergillosis. Written by Helen Le Suaur this short sub-section reviews 13 published papers and discusses the implications of using marijuana for medicinal purposes to treat AIDS and cancer patients for the alleviation of pain.
 
Several papers find that samples of marijuana can be heavily contaminated by Aspergillus spores, presumably due to poor control over the drying and storing of the plant material, sometimes stored for extended periods of time.
 
Cases of aspergillosis have been recorded in patients with cancer, leukemia, transplant and AIDS, though evidence is too weak to demonstrate cause there does seems to be an association between smoking marijuana and aspergillosis under some circumstances and it certainly should be given a lot of thought before marijuana is given to patients with impaired immune systems.
Articles
Home environment as a source of life-threatening azole-resistant Aspergillus fumigatus in immunocompromised patients.
A case of fatal aspergillosis due to a TR46/Y121F/T289A azole-resistant Aspergillus fumigatus is reported. Environmental investigations at the patient's residence led to the recovery of TR46/Y121F/T289A isolates, genotypically indistinguishable from the clinical isolate, supporting for the first time the direct role of household as potential source of azole-resistant invasive aspergillosis.
 
Susceptible strains of Aspergillus fumigatus stop growing when treated with moderate levels of echinocandin antifungal drug but start to grow again if the concentration of drug is increased. This paper finds that overexpression of glucan synthase renders A. fumigatus more susceptible and deletion of glucan synthase removes the ability to grow at high concentrations of echinocandin, suggesting that this paradoxical growth behaviour is dependant on glucan synthesis and glucan synthesis recovers at high levels of echinocandin.
 
Blood serum levels of some antifungal drugs tend to be very unpredictable so the need to be able to monitor drugs levels quickly and reliably is high. This paper describes a simple and rapid UPLC-MS/MS method for monitoring multiple triazole antifungals that has been developed with a focus on the needs of hospital laboratories. The assay is suitable for clinical utilization and management of patients on these medications. Also see the next article below:
 
A rapid and accurate method to determine levels of several antifungal drugs in blood serum and urine for the purpose of assisting clinical drug management of patients on these medications (Also see article above and similar articles)
 
In critically ill patients, drug exposure may be influenced by altered drug distribution and clearance. Earlier studies showed that the variability in caspofungin exposure was high in Intensive Care Unit (ICU) patients, and this study takes those observations further by demonstrating that drug exposure of patients in this cohort on a standard dose is low compared to healthy patients. The authors suggest that a weight-based dose regimen is probably more suitable for patients such as these with substantially altered drug distribution.
Reviews
Methods in Molecular Biology Reviews: currently only available for paid subscribers:

Ploidy dynamics and evolvability in fungi

The authors propose that the ability of pathogenic fungi to vary their chromosome number contributes to rapid generation of genetic diversity which enables their ability to adapt to new living conditions and evolutionary niches as well as their rapid generation of resistance to antifungal drugs. 
 
Medical mycology and fungal immunology: new research perspectives addressing a major world health challenge
This review is part of a themed issue of Philosophical Transactions of the Royal Society entitled ‘Tackling emerging fungal threats to animal health, food security and ecosystem resilience’. Fungal infections kill more people than malaria or breast cancer and yet awareness remains poor. The authors highlight some recent advances in basic research that are beginning to inform clinical decisions and options for personalised medicine, vaccine and immunotherapies.
 
Veterinary
A 5-Year Retrospective Review of Avian Diseases Diagnosed at the Department of Pathology, University of Georgia.
827 cases reviewed. Overall, bacterial infection was the most frequently diagnosed cause of death in captive birds, most commonly in Psittaciformes, followed by Passeriformes and Galliformes. Neoplasia was most common in Psittaciformes, which generally are longer lived than other taxa studied. Some disease entities (e.g. atherosclerosis and aspergillosis) may be associated with captive conditions, and some may involve a genetic predisposition (e.g. atherosclerosis, amyloidosis and haemosiderosis).
Courses
We have modified our listing of courses so that you can now see them as a list as well as on a calendar.
 
CBS Course Fungal Biodiversity 2017, Utrecht, Uppsalalaan 8, The Netherlands Feb 6-17 2017
 
 
Specialization Course in Medical Mycology, KU Leuven Campus Gasthuisberg, Belgium Sept 11-21 2017 (Registration deadline 1st May).
 
 
Attention!
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Patients & Carers
We have simplified the blogging facility on the Patients website (www.nacpatients.org.uk) to try to encourage more people to add their own content - writing about event that tell us more about living with aspergillosis or any other relevant material. Write your own blog by registering with the website and then after logging in go to the blogging page at www.nacpatients.org.uk/blog and click on 'Create new blog entry' at the top of the page. Then just start typing, upload pictures, add other media. The only limit is your imagination!
 
December is Christmas Quiz month and this year it was won by Malcolm Birrell with a three way tie for second place. Malcom wins the David MacIntyre Memorial Trophy and get to keep it for a year. Well done to everyone who entered and did so well.
 
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 broadcast. On January 6th we will be listening to a talk on the Mediterrenean Diet and why it is good for us - a very suitable subject for many of us after the Christmas excesses!
 
Our SKYPE trial meeting after the end of this months meeting went very well, to such an extent that I think we can broadcast the entire meeting on SKYPE on January 6th. If you have SKYPE join in on drgraham.atherton - better still contact us first to add your contact details to our SKYPE list and we will contact you after the main meeting.

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