Aspergillus Newsletter
July 2013
Voriconazole Resistance in Aspergillus
Dutch researchers are identifying clinical isolates of A. fumigatus that are resistant to voriconazole from many homes and hospital environments across The Netherlands. They have found a new strain with a different mechanism of resistance (TR46/Y121F/T289A), not previously seen. Interestingly these isolates are highly resistant to voriconazole, but not necessarily resistant to itraconazole or posaconazole, whereas the more common resistant strain (TR34/L98H) is always itraconazole and voriconazole resistant and variably susceptible to posaconazole.
 
Dr van der Linden and colleagues believe >90% of their resistant isolates come from exposure of A. fumigatus to agricultural fungicides.
 
Concern is voiced that the continued use of certain triazole agricultural fungicides throughout the EU will exacerbate the difficulties faced by hundreds of thousands of people suffering from aspergillosis every year.
 
An accompanying commentary discusses this situation with regard to treatment as voriconazole is usually first line therapy. Vigilance must be enhanced in order to detect triazole resistance as outcomes are poor if the strain is resistant. However, Certainly the implicated fungicide triazoles should not be introduced into countries where they are not already on the market, given the seriousness of the medical implications.
News
Ice-pops trigger false positive tests for aspergillosis. Tests show that many brands contain glucans that can interfere with diagnostic testing for aspergillosis. Use of these cooling drinks in ICU should be limited.
 
A new type of microarray has now been developed that allows 1200 tiny (30nl) cultures to be used to test for antifungal activity, 28 antifungal drugs at a time. The reduction in size of each culture is 2000 fold thus processing time can be much faster and throughput can be hugely increased.
 
Adaptation to different types of environmental stress is a common part of life for today’s fungi. A deeper understanding of the organization, regulation and evolution of fungal stress response systems may lead to the development of novel antifungal drugs and technologies or the engineering of industrial strains with elevated stress tolerance. Here we present the Fungal Stress Response Database aimed to stimulate further research on stress biology of fungi.
Articles
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Aspergillus flavus is the second most important Aspergillus species associated with aspergillosis and the incidence of infections caused by it are increasing in the immunocompromised population. This species is of major epidemiological importance in regions with a dry and hot climate. This study was aimed at examining whether isolates from distinct genotypes were involved in distinct clinical forms of aspergillosis.
 
Patients with hematologic malignancies are increasingly admitted to the intensive care unit (ICU) when life-threatening events occur. The authors sought to report outcomes and prognostic factors in these patients.
 
GM quantification in BAL fluid at an OD index cutoff value of 1.5 has excellent sensitivity and specificity to assist clinical decision-making in confirming or excluding a diagnosis of IA when results are interpreted with clinical findings. Additional research investigating the effects of antifungal agents, optimal timing and processing of BAL sampling are needed to improve the diagnostic accuracy of BAL-GM testing.
 
 
Reviews
Fungal infections continue to produce morbidity and mortality in lung transplant recipients despite the widespread use of antifungal prophylaxis. There has been a decline in Candida infections but Aspergillus species predominate. Other mold pathogens including Fusarium, Scedosporium, and Zygomycetes also cause infections in lung transplant recipients. Furthermore, the widespread use of antifungal prophylaxis has prompted a delay in onset of Aspergillus infection in lung transplant recipients.
 
The overall mortality of patients with acute invasive fungal sinusitis (AIFS) remains high, with only half of the patients surviving. Diabetic patients appear to have a better overall survival than patients with other comorbidities. Patients who have intracranial involvement, or who do not receive surgery as part of their therapy, have a poor prognosis.
 
Evidence has increasingly shown that the lungs are a major site of immune regulation. A robust and highly regulated immune response in the lung protects the host from pathogen infection, whereas an inefficient or deleterious response can lead to various pulmonary diseases. Many cell types, such as epithelial cells, dendritic cells, macrophages, neutrophils, eosinophils, and B and T lymphocytes, contribute to lung immunity. This review focuses on the recent advances in understanding how T lymphocytes mediate pulmonary host defenses against bacterial, viral, and fungal pathogens
Damp & Health
Indoor Environment Professionals
Please join our LinkedIn group on Damp Building and Human Health.
 
Living in a damp home?
Please check out our LinkedIn group: Is my damp home making me ill?
Courses
New Masters Degree in Medical Mycology at the University of Manchester starting in September 2013. This Masters programme has been specifically designed for graduates who wish to develop their skills as medical mycologists. The programme aims to combine a significant level of theoretical understanding and practical skills.
 
 
CBS Course Medical Mycology The course is a joint effort of the Mycological of China, Dermatology Society of Chinese Medical Association and the CBS Fungal Biodiversity Centre. Lectures will be in English and Chinese language. Lectures and microscopic work will follow the style of the CBS Mycology course, and the Atlas of Clinical Fungi will be used as lab manual. For this book a recent CD-ROM version (2011) will be included in the course fee.
Veterinary
Aspergillosis is a sporadic mycosis that occurs worldwide in mammals and birds and leads to a usually chronic, and only rarely acute, disease that mainly affects the nasal cavity and sinuses. Infection: Aspergillus species infections are commonly associated with predisposing local or systemic factors. Local disease can spread and involve the central nervous system or the lungs. Some Aspergillus species can also disseminate, causing systemic infections. In contrast to dogs, in which (nasal) aspergillosis is relatively common, aspergillosis is rare in cats, but considered an emerging infection. Clinical signs: There are two clinical forms of aspergillosis in cats, the sinonasal form (characterised by signs of chronic nasal infection) and the newly emerging, more invasive sino-orbital form (characterised by signs of orbital and surrounding tissue invasion). Sino-orbital involvement has been described now in approximately half of the reported cases. Disease management: Treatment should consist of local and systemic antifungal therapy.
 
Aspergillosis is frequently reported in parrots, falcons and other birds held in captivity. Inhalation is the main route of infection for Aspergillus fumigatus, resulting in both acute and chronic disease conditions. Itraconazole (ITRA) is an antifungal commonly used in birds, but administration requires repeated oral dosing and the safety margin is narrow. We describe lung tissue and serum pharmacokinetics of a nanoparticulate ITRA suspension administered to Japanese quail by aerosol exposure.
Attention Clinicians & Scientists
The Joint Genome Institute (JGI) welcomes nominations of genomes to be sequences in its Community Sequencing Program. For procedures how to submit a proposal, see here. The current fungal program can be found here.
 
You may like to contribute to the following collaborative groups who are collecting clinical data on these rare infections:
 
Fungiscope is a global rare fungal infection registry, a working group of ISHAM.
 
International Pediatric Fungal Network (PFN) collating information on treatment of pediatric patients
AspICU2 is a web-based multicentre observational survey to assess the burden of aspergillosis and other fungi in critically ill patients.
 
Public Health and Tropical Medicine Fellowships. It has come to our attention that there are a series of Fellowships funded by the Wellcome Trust available to applicants for low and middle income countries. We would like to encourage medical mycology applicants and would be happy to provide facilities and expertise for training at the National Aspergillosis Centre for applicants. We would like to identify applicants for these Fellowships and help facilitate application - please contact us atadmin@aspergillus.org.uk
 
Request for assistance from clinics in all five continents of the world with a study entitled “Pulmonary aspergillosis in kidney transplant recipients” supported by REIPI and GESITRA This study has two targets. The first target is to define some risk factors that allow the identification of a subgroup of kidney transplant recipients that would be candidates for antifungal prophylaxis active against Aspergillus The second target is to find factors implicated in the outcome that were amenable to intervention.
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Antifungal Metabolites from Plants by Mehdi Razzaghi-Abyaneh and Mahendra Rai (30 Jun 2013)
 
 
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Fungal Infection Trust, PO Box 482, Macclesfield, Cheshire SK10 9AR, UK,www.fungalinfectiontrust.org.uk