Aspergillus Newsletter
December 2014

Drying Laundry Indoors:  The Impact on our Health

This month the media picked up on a recent paper by Porteus et. al. which looks at problems with indoor air quality caused by excessive moisture generation within the home combined with national government sponsored programs to reduce heat loss and thus enhance energy provision. Measures to reduce heat loss often result in reduced ventilation. In particular much moisture is generated by passive indoor drying of laundry.
 
100 homes were assessed. Multiple confounding factors were taken in for account (e.g. number of occupants, heating, type of floor coverings, house plants) and multiple indoor environmental parameters were assessed or measured eg duplicate air samples in several rooms of each home were taken to estimate airborne mould levels, relative humidity, absolute vapour pressure, CO2 and temperature were measured.
 
The authors concluded:
 
 The combination of inadequate indoor and outdoor drying provision, coupled with prevalent poor control of ventilation and moisture migration within dwellings, means that the occupants’ ad hoc use of PID in various rooms and circulation spaces has two identified and potentially undesirable environmental consequences:
 
a. Moisture contributes to excess dust mite growth,with a known causal association with asthma.

b. Association with higher concentration of airborne mould spores (CFU/m3> 1000), and greater prevalence of hydrophilic/tertiary isolates; attributable to slow release of moisture and possibly partly to low-temperature washes and potentially adding to health risk for atopic occupants.
News
A new fungal education tool has been released: an iPad app: search the Apple app store for 'CARE Fungal KnowledgeBank'. It’s free! This has been developed jointly by the University of Manchester and Gilead Sciences.
 
If you are interested in education and training in the biomedical sector there is now a resource dedicated to publicising courses throughout the EU:on-course® is an industry and academia led course portal that is the most comprehensive and insightful biomedical postgraduate education and training resource in Europe.

Masters in Medical Mycology, University of Manchester, UK 2015 - 2016

Applications for this one-year taught Masters programme in Medical Mycology, 2015 entry, are now open. Following its launch in 2013 this unrivalled degree has attracted scientists and clinicians from all over the globe who have acquired practical and clinical science skills which will help them succeed in becoming mycology ambassadors and practitioners in their home countries. The University of Manchester is one of the world’s leading universities. The Faculty for the Manchester Medical Mycology programme is world-renowned with a number of leading scientists, clinician scientists and medical mycologists. Learn more about this unique Masters in Medical Mycology and apply here Medical Mycology FT MSc
 
 
The End for Aspergillus? Poll results.
 
The options put before our audience last month were:

1. Use Aspergillus for most species (Samson et. al. 2014) or
2. Use perfect state (teleomorph) for most Aspergillus species, use the name Aspergillus only for section Circumdati (Pitt & Taylor 2014).
 
We can now announce that 39 people voted and 100% supported option 1: Use Aspergillus for most species.

For more details of the poll go here.
 
Articles
NOTE access to all articles now requires registration (free of charge)
 
The total Indian population in 2011 was 1.2 billion. The asthma prevalence in adults was estimated at about 27.6 (range, 17–30) million. The burden of ABPA ranged from 0.12–6.09 million with different assumptions (best estimate, 1.38 [range, 0.86–1.52] million). The prevalence of SAFS was approximated at about 0.52–1.21 million (best estimate, 0.96 [range, 0.6–1.06] million). The incident TB cases were about 2.1 million while the annual incidence of CPA varied 27,000-0.17 million cases, with different estimates. If the mortality of CPA is estimated as 15% annually, the 5-year prevalence of CPA was placed at 290,147 cases with 5-year prevalence rate being 24 per 100,000.
 
Of 207 patients, 139 (67%) had pneumonia, 12 had noninfectious lung disease, and 56 had no remarkable chest computed tomography (CT) (20 with extrathoracic fever focus and 36 with no specific disease). Mean radiation expose dose of ULDCT was 0.60±0.15 mSv. Each observer regarded low-dose CT scans as unacceptable in only four (1.9%), one (0.5%), and three (1.5%) cases of ULDCTs. Sensitivity and area under the ROC curve in making a specific pneumonia diagnosis were 63.0%, 0.65 for reader 1; 63.0%, 0.61 for reader 2; and 65.0%, 0.62 for reader 3; respectively. CONCLUSION: ULDCT, with a sub-mSv radiation dose and acceptable image quality, provides ready and reasonably acceptable diagnostic information for pulmonary infection in febrile neutropenic patients with hematologic malignancy.
 
In total, 4,192 patients receiving 4,889 chemotherapy courses were enrolled [mean age 40.7 years, 58.4 % male, 16.9 % children (<18 years)]. The most common hematological diseases were acute myeloid leukemia (AML, 28.5 %), non-Hodgkin lymphoma (NHL, 26.3 %), and acute lymphoblastic leukemia (ALL, 20.2 %).
In summary, IFI was more common in MDS, AHL, AML, or induction chemotherapy, and substantially increased mortality. Neutropenic patients receiving induction chemotherapy for AML or MDS and those with previous IFI were at particular risk. Antifungal prophylaxis showed an independent protective effect but was not commonly used, even in high-risk patients. By contrast, empiric antifungals were widely used.
Reviews/Overviews
Sarcoidosis is an inflammatory disease marked by a paradoxical immune status. The anergic state, which results from various immune defects, contrasts with the inflammatory formation of granulomas. Sarcoidosis patients may be at risk for opportunistic infections (OIs) and a substantial number of cases have been reported, even in untreated sarcoidosis. It is not clear how OIs in patients with sarcoidosis are different from other groups at risk. In this review, we discuss the most common OIs: mycobacterial infection (including tuberculosis), cryptococcosis, progressive multifocal leukoencephalopathy, and aspergillosis.
 
Evolution of the transplant procedures was followed by an important change in the epidemiology and clinical risk of IFD after allogeneic HSCT. A new stratification of subpopulations according to different clinical infectious risk and genetic susceptibility may be considered to predict those patients most vulnerable to IFD and update tailored antifungal strategies.
 
The antifungal treatment failures and the emergence of resistant fungal strains have stimulated the need for reproducible and clinically relevant antifungal susceptibility testing (AFST). While the standard reference methods are not intended for routine use, commercial methods are widely used for performing AFST. However, to accelerate AFST and to improve the detection of antifungal resistance, which is the most challenging goal of AFST, novel assays have been developed. Following brief drug exposures of fungal cells, the new antifungal susceptibility end points seem to provide a reliable means of identifying fungal isolates, which harbor mutations that have been associated with antifungal resistance. This article summarizes the recent progress in AFST that is destined to enhance its clinical utility in the near future.
Deadlines
 
 
 
 
Courses
Registration deadline is 27 February 2015.
 
Medical Mycology CPD courses Four (three-week) units of the University of Manchester Medical Mycology MSc programme are now available as Continuing Professional Development courses.
 
The first workshop on antifungal susceptibility testing in the routine laboratory will be held in the Turkish language in Ankara, Turkey, on 28 February, 2015.
Veterinary
Emerging fungal pathogens pose a greater threat to biodiversity than any other parasitic group, causing declines of many taxa, including bats, corals, bees, snakes and amphibians. Currently, there is little evidence that wild animals can acquire resistance to these pathogens. Batrachochytrium dendrobatidis is a pathogenic fungus implicated in the recent global decline of amphibians. Here we demonstrate that three species of amphibians can acquire behavioural or immunological resistance to B. dendrobatidis. These results suggest that amphibians can acquire immunity to B. dendrobatidis that overcomes pathogen-induced immunosuppression and increases their survival. Importantly, exposure to dead fungus induced a similar magnitude of acquired resistance as exposure to live fungus. 
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