Aspergillus Newsletter
May 2014

ECCMID 2014ECCMID 2014

12500 people attended this large event in Barcelona, Spain, the focus being the diagnosis & management of all types of infections including a section on fungal infection and aspergillosis.
 
Highlight for aspergillosis include Prof Emanuelle Roilides summing up the current state of the efficacy of several types of treatment in his talk 'Fighting against fungal infections: cells on the front lines'. Beneficial results were reported for the use of cytokines as an addition to antifungal treatment.
 
We also heard talks on the efficacy and improvements in adverse side effects of the new antifungal isavuconazole versus voriconazole - the former performing well with fewer side effects.
 
Galactomannan ELISA has been a useful diagnostic tool for some years now and a speaker outlined the improvements that have been made more recently - specifically the use of lower cut off points and the greater sensitivity offered by carrying out two consecutive tests. A new lateral flow device based on galactomannan detection was mentioned as having similar accuracy as ELISA for those cases where a single ELISA sufficed, with a result available in 15 mins.
 
Full searchable listing of abstracts will be available shortly
News
The Fungal Infection Trust hosted a booth at 24th ECCMID in order to promote awareness of the huge effect fungal infections have on human health around the world. One aspect of this was to promote education of medical mycologists, especially in developing countries that lack such expertise and it was pleasing to note interest from several applicants in countries across Africa in the University of Manchester Medical Mycology degree course and CPD units.
 
Treatment section: Aspergillus website treatment protocol on laryngeal and epiglottis aspergillosis has been updated, as has the treatment article on Aspergillus empyema - both by Gemma Hayes.
 
 
It is perhaps not widely appreciated that fungi have a profound effect on global warming. They are a major recycler of organic debris and thus a major source of returning CO2 to the atmosphere. One of our blogs goes into detail on how mycologists are trying to understand this process better - a recent study looks at the dispersal of different species across Northern America and through several depths of soil. One surprise result was the amount of recycling that is done by fungi lying deeper in the soil and which have an intimate relationship with many plant root systems. There are more implications for our planet if we disturb plant life that we thought!
Articles
NOTE access to all articles now requires registration
 
Characteristics of Invasive Aspergillosis in Neutropenic Haematology Patients (Sousse, Tunisia)
 Available data suggests epidemiology of invasive aspergillosis (IA) in North Africa differs from northern countries, where more than 80 % is caused by Aspergillus fumigatus. This study aimed at describing the epidemiology of IA in the region of Sousse, Tunisia, and at assessing the usefulness of the available diagnostic tools.

 Galactomannan (GM) detection in bronchoalveolar-lavage (BAL) fluid is currently considered the gold standard test for diagnosis of invasive pulmonary aspergillosis (IPA). The authors here compared the performance of GM with that of conventional culture, Aspergillus Lateral-Flow-Device (LFD) test, Beta-D-Glucan (BDG) and an Aspergillus polymerase chain reaction (PCR) assay by using BAL samples from immunocompromised patients.

 In the widely accepted ion channel model for its mechanism of cytocidal action, amphotericin forms aggregates inside lipid bilayers that permeabilize and kill cells. In contrast, we report that amphotericin exists primarily in the form of large, extramembranous aggregates that kill yeast by extracting ergosterol from lipid bilayers. These findings reveal that extraction of a polyfunctional lipid underlies the resistance-refractory antimicrobial action of amphotericin and suggests a roadmap for separating its cytocidal and membrane-permeabilizing activities. This new mechanistic understanding is also guiding development of what are to our knowledge the first derivatives of amphotericin that kill yeast but not human cells.

An increasing trend in incidence of IA was observed during the latter half of study period. Early empiric therapy led to modest aspergillus-free survival. Clinical and financial implications of IA mandate review of institutional antifungal prophylaxis policy especially in selected ALL patients during induction.

Forming a biofilm provides the microbes protection from environmental stresses due to contaminants, nutritional depletion, or imbalances, but is dangerous to human health due to their inherent robustness and elevated resistance. In this protocol, we describe a clinically relevant rabbit model of C. albicans biofilm-associated catheter infection to evaluate the morphology, topography, and architecture of fungal biofilms. We also describe a murine model of contact lens-associated Fusarium keratitis. Evaluation of the formation of fungal biofilms on catheters in vivo, their analysis using scanning electron microscopy (SEM) and quantitative catheter culture (QCC), and treatment of biofilms using antimicrobial lock therapy can be completed in ~20-25 days using the described methods.

The use of extracorporeal membrane oxygenation (ECMO) for reversible pulmonary failure in critically ill patients has increased over the last few decades. Nosocomial infections are a major complication of ECMO and fungi have been found to be a common cause. Herein, we describe a case of invasive pulmonary aspergillosis following ECMO, which was successfully treated with combination antifungal therapy and interferon-gamma.

Reviews/Overviews
Efficacy of combination therapy of triazole and echinocandin in treatment of invasive aspergillosis: a systematic review of animal and human studies.
The effectiveness of the combination therapy of triazole and echinocandin in treatment of invasive aspergillosis (IA) remains controversial. The objective of this systematic review was to assess the efficacy of combination therapy of triazole and echinocandin in treatment of IA.
Highlights in pathogenic fungal biofilms
There is a current interest in describing the particular characteristics of biofilm formation by fungi including Aspergillus fumigatus. A major concern is the control of biofilms, requiring knowledge of the biofilm mechanisms. However, our knowledge of these microbial communities is limited, due to the complexity of these systems and metabolic interactions that remain unknown. This mini-review aims to highlight recently discovered fungal biofilms and to compare them with the current knowledge on biofilms.
Modern taxonomy of biotechnologically important Aspergillus and penicillium species.
Taxonomy is a dynamic discipline and name changes of fungi with biotechnological, industrial, or medical importance are often difficult to understand for researchers in the applied field.
New insights in the taxonomy of Aspergillus, Penicillium, and related genera will help to interpret the results generated with comparative genomics studies or other studies dealing with evolution of, for example, enzymes, mating-type loci, virulence genes, and secondary metabolite biosynthetic gene clusters.
Damp & Health
Indoor Environment Professionals
Join our LinkedIn discussion 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? and read our new website pages
 
Conference Deadlines
16th Biennial Meeting of the European Society for Immunodeficiencies (Prague, Czech Republic) Abstract submissions deadline 25th May.
 
10th International Mycological Congress (Bankok, Thailand August 3 - 8). Early registration will be open at July 1, 2013. Abstract submission will begin July 2013
Courses
The next CBS Course in Medical Mycology will take place in Utrecht, The Netherlands, 17-28 November, 2014.
 
Bringing PK and PD in Fungal Infections into the Clinic July 4-6 2014, Nijmegen, The Netherlands. For more information check website in January 2014.
 
Mechanisms in Fungal Infections: From the Science to the Clinical Setting Online course, Start approximately July 2014. Mechanisms in Fungal Infections is a blended, e-learning resource with CME content developed by an expert, multidisciplinary group of specialists.
 
Medical Mycology CPD courses (3rd March 2013 - February 2015) Four (three-week) units of the University of Manchester Medical Mycology MSc programme are now available as Continuing Professional Development courses.
 
Veterinary Mycology in Practice ISHAM_VMWG-ESCVP Postgraduate Technical Workshop October 3rd 2014, Milan, Italy.
 
Allergy Academy, King's College, London. Online resources for allergy education. Intended for all audiences including doctors & patients.
Veterinary
Azole resistance in the fungal pathogen Aspergillus fumigatus is an emerging problem and may develop during azole therapy in humans and animals or exposure to azole fungicides in the environment. To assess the potential risk of azole-resistance emergence in avian farms where azole compounds are used for the control of avian mycoses, we conducted a drug susceptibility study including A. fumigatus isolates from birds and avian farms in France and Southern China.
Veterinary Mycology in Practice ISHAM_VMWG-ESCVP Postgraduate Technical Workshop October 3rd 2014, Milan, Italy.
Attention Clinicians & Scientists
Case Histories Database 243 aspergillosis cases already recorded and you can add yours too.
 
 
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.
Patients
 
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Also of interest...
News blog:
Jobs:
 
 
 
 
Antifungal drug interactions
 
Antifungal drugs can interact strongly with other medications. Check your medications using our APP
 
 
Look out for our App in iTunes and Android (search for 'antifungal interactions).
 
Interactions with 529 prescription drugs are searchable, 1991 interactions listed, 381 severe.
Conferences:
 
Books:
Asthma: Comorbidities, Coexisting Conditions, and Differential Diagnosis by WAO, Richard F. Lockey MD and Dennis K. Ledford MD (May 2014)
 
Aminopeptidase From Marine Aspergillus flavus by N. Sriram, M. Priyadharshini and S. Sivasakthi (24 Apr 2014)
 
Advances in Applied Microbiology: 88 by Geoffrey Gadd and Sima Sariaslani (28 Apr 2014)
Theses:
 
Aspergillosis: interactions of Aspergillus fumigatus and Human Airway Cells by Safari, Maryam, Westminster University, 2013.
 
Characterisation of the C-type lectin-like receptor 1 (CLEC-1) by Clark, Alexandra Elsie, University of Aberdeen, 2013.
 
Clinical Trials (38 Recruiting):
 
Case reports:
There are 243 aspergillosis cases reported here
 
 
 
Research Grants:
 
Gilead UK and Ireland Fellowship Programme (cycle closes end of May 2014)
Lab protocols:
 
Networking:
 
Fungal Infection Trust, PO Box 482, Macclesfield, Cheshire SK10 9AR, UK,www.fungalinfectiontrust.org.uk