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

O'Neill Report includes antifungal resistance

Lord O'Neill's report on the prevention of drug resistant infections has outlined four priority areas for antifungal drugs:
  1. Agriculture: Use on most food crops is important and is difficult to limit in the short term but where the crop is a luxury item e.g. flowers or wine then limits or bans on the use of triazole antifungal drugs are recommended. New classes of antifungal drugs should not be used in farming.
  2. Environment: There is a problem with factories dumping large amounts of active antifungal chemicals into the environment. This needs to stop.
  3. Diagnostics: Often fungal infections are misdiagnosed as TB or other illnesses leading to unnecessary antibiotic use. Widespread use of better diagnostics would cut inappropriate use of antibiotics and increase appropriate use of antifungals. Surveillance of antifungal drug resistance needs to be expanded, consequently diagnostic reference capability needs to be enhanced and subsidised.
  4. New drugs:  The quantity of recently developing new antifungal drugs is encouraging but these efforts need to be sustained if these new drugs fail to progress to use in clinics.
News
A new consensus document for chronic and acute rhinosinusitis has been released. Focus is placed on the appropriate medical therapy at the minimum effective treatment level needed by patients. Contributing factors included anatomic variants, allergy, septal deviation, viruses, bacterial infection, biofilm, osteitis, reflux, vitamin deficiency, fungus, superantigens, innate immunity, microbiome and epithelial barrier disturbance, ciliary derangements, immunodeficiency, and aspirin-exacerbated respiratory disease.
Featured Website Section
Resources section. The section that used to be called 'Links' has been reorganised, updated and can now be found listed under 'Library'.
This section has been broadened out to include awareness, resources (not just websites) of interest to patients, researchers and clinicians.
 
There are now 15 listed sections ranging from 'General Interest' to 'Funding' and 'Awareness'.
New resources include links to collections of free, open access books (many of which are recent technical or clinical works), collections of images and information for patients, and ISHAM case reports.
 
As we link from anywhere in the Aspergillus Wesbite we will add links to the resources mentioned into this section, so if you are looking for a resource that you read about on the website or in a newsletter you should find it in this section - and of course the section is searchable too.
 
Search engine: Every item of information on the website is indexed by our dedicated search engine. You can refine search results by title, date, author, section (i.e. content type) so you should always be able to find what you need. 
Articles
Fungal Sensitisation in Severe Asthma is Associated with the Identification of Aspergillus fumigatus in Sputum.
Aspergillus fumigatus was recovered from sputum far more commonly in patients with severe asthma with fungal sensitisation (SAFS) or allergic bronchopulmonary aspergillosis (ABPA: 70 & 50% respectively) compared with controls (9%). This result supports the hypothesis that the high degree of sensitivity to this fungus found in these patients is associated with the presence of Aspergillus fumigatus in their airways. 
Furthermore treatment of SAFS patients with antifungal medication reduced the frequency of isolation of A. fumigatus from 70% to 23%, suggesting that the presence of the fungus in airways is associated with growing fungus.
HorA Aspergillus mutants exhibit impaired response to oxidative and reductive stress such as might be found during infection in inflammatory or nectrotic tissue. Virulence as measured in mouse infection models is also dramatically reduced, suggesting that the loss of HorA function is critical for infection.
The authors suggest that HorA represents a good, novel target for future antifungal drug research
Association of CYP2C19 *17/*17 Genotype With the Risk of Voriconazole-Associated Squamous Cell Carcinoma.
Patients taking voriconazole have a 75% increased risk of developing squamous cell carcinoma (SCC). The authors speculate that a metabolic breakdown product of voriconazole (voriconazole-N-oxide VNO) is likely to increase the frequency of UVB mediated DNA damage leading to SCC.One specific variant of the cytochrome P450 metabolic system (commonly found in Europeans and Africans) could cause much higher levels of VNO and thus possibly SCC.
Volatile Compounds Emitted by Pseudomonas aeruginosa Stimulate Growth of the Fungal Pathogen Aspergillus fumigatus .
The way we think of infection is changing. From perceiving a single pathogenic organism growing in isolation we are now starting to think of pathogens growing alongside many other microbes in a complex microbiome. P. aeruginosa is known to grow alongside and inhibit growth of A. fumigatus.
This study shows that direct contact between these two pathogens is not necessary for them to communicate with each other, and that they can pass messages using volatile chemical messengers (mVOC). Growth of A. fumigatus is stimulated by mVOC emitted by P. aeruginosa.
The study of microbial communities is in its infancy, and this observation serves to add to the complexity that we need to understand in order to complete our understanding of how microbes grow and how pathogens infect.
Reviews
Numerous studies have summarized the adverse health effects of mycotoxins and described severe intoxications of humans and animals. The major health concerns are caused via the alimentary route which unambiguously is the main source for human internal exposure; however, the relevance of other pathways under environmental and occupational conditions should also be considered. Thus firstly, this review aims in summarizing literature data on potentially inhalable mycotoxins occurring in dusts or air in residences and in working environments. Secondly, it gives an overview of the overall internal body burden of mycotoxins in humans in an attempt to characterize total human exposure. These data are also discussed in relation to the current toxicologically based values used for risk assessment.
 
Combined Allergic Bronchopulmonary Aspergillosis (ABPA) and Eosinophilic Granulomatosis with Polyangiitis (EGPA): Three Cases and a Review of the Literature.
Out of 59 cases of ABPA or EGPA seen at a specialist respiratory centre in Japan, 3 patients had both. 2 of these were diagnosed with EGPA first, the third showed signs that ABPA was already present when EGPA was diagnosed. There are six other cases reported in the literature of cases where these two illnesses are combined and of these ABPM came first in 4, EGPA in 2.
The authors suggest that careful attention be paid during diagnosis of either to the possibility that these two diseases may coexist.
Veterinary
Impact of fungal species cultured on outcome in horses with fungal keratitis.
Equine keratomycosis from Fusarium spp. compared to keratomycosis from Aspergillus spp. is not associated with a different clinical outcome.
"Haysickness" in Icelandic horses: precipitin tests and other studies.
Blood samples were taken from 18 healthy horses (Group A), 15 horses clinically diagnosed to have "haysickness" ("farmer's lung") (Group B), 10 closely related horses (Group C) and 14 inbred horses (Group D). Precipitins in sera were measured by double gel diffusion test against Micropolyspora faeni, Thermoactinomyces vulgaris, Aspergillus fumigatus, Alternaria, Penicillium and Rhizopus species. In Group A, all the horses were precipitin negative except one with a faint reaction to Rhizopus species. In Group B all had precipitin against M faeni. One horse also had precipitins against Rhizopus species and another against A fumigatus. In Group C, seven of the 10 horses had precipitins against M faeni. Of these, five had a history of respiratory signs, but two horses with a faint reaction had no such history. In Group D, four out of 14 horses had positive precipitin tests against M faeni. Of these four horses, three also had a faint reaction to A fumigatus and one a faint reaction to Alternaria species. All were asymptomatic. These results indicate that "farmer's lung" in man and "haysickness" in horses are of the same origin.
Courses
We have modified our listing of courses so that you can now see them as a list as well as on a calendar.
 
Medical Mycology taught MSc, University of Manchester. One year course beginning in September every year
 
Individualized Medicine in Infectious Diseases: a Practical Approach, Tubingen, Germany ESCMID Postgraduate Education Course June 3, 2016
 
 
15th ESCMID Summer School Seville, Spain July 2-9 2016
 
 
Azole Resistance in Aspergillus Fumigatus - from Fungicide to Bedside Radboud University, The Netherlands August 8-12 2016
Attention!
Contribute to clinical data on rare infections:

Patients & carers
Patient & Carers meeting in May welcomed Jenny Ratner from Leeds Mycology Centre to talk about her studies in the involvement of patients in research. 
Several more new people attended the meeting and we were pretty full with over 15 people plus members of staff. You can listen to the meeting here
 
Our meeting in June will be led by Chris Harris with guest speaker Prof Denning.
 
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.

If you want a text reminder when each meeting is approaching (UK only) then send us an email at admin@aspergillus.org.uk.
 
Fungal Infection Trust, PO Box 482, Macclesfield, Cheshire SK10 9AR