May 2019
  Research highlight
 
Severe asthma – a population study perspective
This large, population based study estimates the prevalence of severe asthma according to the three internationally well-known criteria: the ATS workshop definition from 2000 used in the US Severe Asthma Research Program (SARP), the 2014 ATS/ERS Task force definition and GINA 2017 (Global Initiative for Asthma).
 
It reports on the incidence of severe asthma in an adult population based cohort (1006 participants) who were diagnosed between 1986 and 2001. The cohort was derived from the general population of the northernmost county of Sweden, Norrbotten.
 
The prevalence of severe asthma among all patients with current asthma was 3.6%, 4.8% and 6.1%, according to the SARP-, ERS/ATS- and GINA-definitions, respectively. Interestingly, two distinct types of asthma were detected, one of which was severe asthma with sensitization to moulds, particularly Aspergillus.
 
The prevalence of sensitization to Aspergillus in individuals with severe asthma was 10%, 12.8% and 17.2%, according to the SARP, ERS/ATS and GINA definitions, respectively, compared to 2.1% in individuals with ‘other’ i.e. non-severe asthma.
 
Severe asthma – A population study perspective (Backman et al., 2019)
 
  News and notices
 
Don't forget ASM Microbe is taking place in June from the 20th to the 24th in San Francisco, USA. Register now!
 
Also approaching is the 2019 Chest Regional Congress in Athens, Greece from the 27th to the 29th June.
 
Did you apply for Molecular Mycology (MoMy) this year? Congratulations if you were accepted and enjoy! MoMy: Current Approaches to Fungal Pathogenesis, Marine Biological Laboratory, MA USA from the 17th July to the 2nd August.
 
Antifungal stewardship: a new Massive Open Online Course (MOOC). Dr Riina Richardson (Consultant Clinical Mycologist, Department of Infectious Diseases and NHS Mycology Reference Centre Manchester, MFT and Senior Lecturer in Infectious Diseases, DIIRM) and Dr Stephen Hopping (Clinical Educational Fellow, Department of Infectious Diseases, MFT), both based at Wythenshawe Hospital have been commissioned by the British Society for Antimicrobial Chemotherapy (BSAC) to develop a MOOC consisting of interactive cases covering the key topics essential for a greater understanding of the importance and challenges of antifungal stewardship. The MOOC will launch in May 2019. More details available on the Future Learn platform.
 
 
  Research articles
 
Burden of fungal asthma in Africa: A systematic review and meta-analysis. (Kwizera et al., 2019)
This systematic review and meta-analysis estimates the incidence of asthma in Africa and the prevalence of ABPA and SAF within this group. Using data from the Institute of Health Metrics and Evaluation from between 1990 and 2017, plus all studies of any design focussing on fungal asthma in any African country, the authors estimate that approximately 4 million adult asthmatics have fungal sensitisation in Africa.
 
Allergic bronchopulmonary aspergillosis (ABPA) sans asthma: A distinct subset of ABPA with a lesser risk of exacerbation. (Muthu et al., 2019)
It is relatively rare for ABPA to present without underlying asthma. In this study, the authors describe the outcomes of ABPA with and without asthma. Of the 530 subjects, 37 (7%) were ABPA without asthma. Bronchiectasis was more frequent (97.3% vs. 83.2%), and the lung function was significantly better in ABPA sans asthma. The incidence-rate of ABPA exacerbation was higher in those with asthma than without. The authors conclude that ABPA without asthma appears to be a distinct subset of ABPA, with a better lung function and fewer exacerbations.
 
Prevalence of sensitization to Aspergillus flavus in patients with allergic bronchopulmonary aspergillosis. (Sehgal et al., 2019)
Aspergillus fumigatus is the most common Aspergillus species worldwide; however, A. flavus has also been shown to be prevalent in North India. This paper reports on the prevalence of sensitization to A. flavus in subjects with allergic bronchopulmonary aspergillosis (ABPA). It also reports on the occurrence of allergic bronchopulmonary mycosis (ABPM) due to A. flavus. The authors report a high occurrence of sensitization to A. flavus in subjects with ABPA. Subjects with A. flavus-related ABPM had a higher likelihood of high-attenuation mucus and probability of sinusitis. More studies are required to confirm this observation.
 
Serum IgE and IgG reactivity to aspergillus recombinant antigens in patients with cystic fibrosis. (Alghamdi et al., 2019)
The diagnosis of aspergillosis in cystic fibrosis (CF) patients remains a challenge due to overlapping features of both diseases. This is further complicated by inconsistent antibody reactivity to the currently used crude antigen, which has led a more focused evaluation of the efficacy of IgE response to a number of pure Aspergillus fumigatus recombinant proteins in patients with CF and asthma.
In this study, the authors dissected the IgE and IgG responses to multiple A. fumigatus recombinant antigens in CF patients with different Aspergillus diseases and conclude that the use of multiple recombinant antigens may improve the diagnostic accuracy in CF complicated with ABPA or Aspergillus bronchitis.
 
How to: EUCAST recommendations on the screening procedure E.def 10.1 for the detection of azole resistance in Aspergillus fumigatus isolates using four-well azole containing agar plates. (Guinea et al., 2019)
This paper describes new methodology for the detection of azole resistant A. fumigatus isolates and reports on the release of updated QC tables for antifungal susceptibility testing with associated QC endpoints. These changes are in response to the high prevalence of azole resistance in hospitalised patients in the Netherlands and the subsequent changes to treatment guidelines which now recommend initial therapy with combination therapy until the specific susceptibility pattern is known.
 
 
  Veterinary articles
 
Fatal Aspergillus flavus rhinitis with gastrointestinal gaseous distension in a Cape porcupine. (Jalenques et al., 2019).
This paper reports on the presentation of an adult female Cape porcupine (Hystrix africaeaustralis) due to marked abdominal distension, acute dyspnea, and lethargy. The paper describes the physical examination and standard radiographs which revealed marked and diffuse gaseous dilation of the stomach and intestines of undetermined origin. The porcupine died despite medical therapy and surgical intervention. Postmortem examination revealed chronic fungal (Aspergillus flavus) rhinitis. Given that rodents are obligate nasal breathers, the authors conclude that the rhinitis likely resulted in substantial upper airway obstruction leading to aerophagia.
 
  Reviews
 
Intensive Care management of influenza-associated pulmonary aspergillosis. (Koehler et al., 2019)
Severe pulmonary infections are among the most common reasons for admission to ICU. Within the last decade increasing reports of severe influenza pneumonia resulting in acute respiratory distress syndrome (ARDS) complicated by Aspergillus infection were published. This review provides a comprehensive review of management of influenza-associated pulmonary aspergillosis in patients with ARDS.
 
The role of Aspergillus fumigatus polysaccharides in host-pathogen interactions. (Zacharias and Sheppard, 2019)
Aspergillus fumigatus is a saprophytic mold that can cause infection in patients with impaired immunity or chronic lung diseases. The polysaccharide-rich cell wall of this fungus is a key point of contact with the host immune system. The availability of purified cell wall polysaccharides and mutant strains deficient in the production of these glycans has revealed that these glycans play an important role in the pathogenesis of A. fumigatus infections. This review describes our current understanding of the key polysaccharides present within the A. fumigatus cell wall, and their interactions with host cells and secreted factors during infection.
 
  Patients and carers
 
Medical Alert Cards
Medical alert cards (see left) for aspergillosis patients are now available in clinic or by emailing us at admin@aspergillus.org.uk
 
Thank you to all of those who completed our survey on how you use your medial alert cards.
 
We’ve collated your responses and have sent a reply to Rare Disease UK. Rare Disease UK will pass this on to NHS England along with information from various other organisations who represent patients with rare diseases.
 
The aim is to influence policy and planning as NHS England roll out their plan to implement the UK government’s strategy for rare diseases which has three main objectives:
  • Facilitating earlier diagnosis
  • Improving care coordination
  • Promoting research
We'll keep you informed as the process progresses.
 
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'
 
Jobs
Clinical networks
Conferences
 
 
 
ASM Microbe (20-24 June 2019 San Francisco, California, USA)
 
 
Chest Regional Congress 2019 (27-29 June 2019 Athens, Greece)
 
3rd Aids-Related Mycoses Meeting (10-12 July 2019 Cape Town, South Africa)
 
Annual Meeting on Infectious Diseases (29-30 July 2019 Amsterdam, Netherlands)
 
See more groups and societies
 
 
Visit our sites
 
(MFIG)
(MRCM)
(free online microscopy course)
(fungal education for clinicians)
 
 
     
Fungal Infection Trust, PO Box 482, Macclesfield, Cheshire SK10 9AR
 
 
 
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