Highlights of this month...
The importance of our Mycobiome
Mahmoud Ghannoum The Director of the Center for Medical Mycology at Case Western Reserve University, Ohio highlighted the importance of the role fungi play
in maintaining the healthy balance of the microbe communities that grow on and in our bodies i.e. the fungal element of our microbiome, known as myco
While exciting research forges ahead demonstrating aspects of the impact on our health of disrupting the balance in our bacterial communities (e.g. overused of antibiotics can result in overgrowth of Candida & cases of thrush) there appears to be very little or no research being carried out on the mycobiome (e.g. abundance of Candida and Saccharomyces correlates to increased susceptibility to hepatitis B infection, overabundance of Candida in the gut aggravates inflammatory bowel disease.) - in fact out of 6000 research papers published only 55 cover the mycobiome and only six of those include Aspergillus.
Fine-needle aspiration (FNA) is an important tool for the diagnosis of infectious disease. FNA material should be appropriately submitted for cultures when indicated by preliminary findings. Correlation of cytologic diagnoses with culture results are important quality assurance tools. This study reviews 14 years of FNA-culture correlation.
AUTHORS CONCLUSIONS: FNA cytology-culture correlation is a valuable tool with which to assess the efficacy and limitations of the direct diagnosis of infectious agents, and to identify types of infections that may be negative on culture but positive on cytology diagnosis.
The mAb-based newly developed PET tracer [64Cu]DOTA-JF5 distinguished IPA from bacterial lung infections and, in contrast to [18F]FDG-PET, discriminated IPA from a general increase in metabolic activity associated with lung inflammation. To our knowledge, this is the first time that antibody-guided in vivo imaging has been used for noninvasive diagnosis of a fungal lung disease (IPA) of humans, an approach with enormous potential for diagnosis of infectious diseases and with potential for clinical translation.
Immunosuppression is frequently part of the treatment regimen of rheumatoid arthritis patients, making them vulnerable to fungal infection. Galactomannan detection is useful to help diagnose fungal infection in other groups of immunosuppressed patients however this study shows that galactomannan detection is less useful for this group of patients as it was elevated in 18.2% of arthritis patients, none of whom had any known aspergillosis. Thus nonspecific elevation is common.
Pulmonary complications affect up to 40% of patients with severe neutropenia lasting for more than 10 d. As they are frequently associated with fever and elevation of C-reactive protein or other signs of inflammation, they are mostly handled as pneumonia. However, the differential diagnosis is broad, and a causative microbial agent remains undetected in the majority of cases.
This detailed review goes into some detail as to how best to manage antimicrobial treatment in these difficult cases
If the authors used the test at a cut-off value of 0.5 ODI in a population of 100 patients with a disease prevalence of 9% (overall median prevalence), two patients who have invasive aspergillosis would be missed (sensitivity 82%, 18% false negatives), and 17 patients would be treated unnecessarily or referred unnecessarily for further testing (specificity 81%, 19% false negatives). If they used the test at a cut-off value of 1.5 in the same population, that would mean that four invasive aspergillosis patients would be missed (sensitivity 61%, 39% false negatives), and six patients would be treated or referred for further testing unnecessarily (specificity 93%, 7% false negatives). These numbers should, however, be interpreted with caution because the results were very heterogeneous.
Proton Transport and pH Control in Fungi.
Recent studies indicate that cellular pH plays a genuine signaling role that connects nutrient availability and growth rate through a number of mechanisms. Many of the pH control mechanisms found in S. cerevisiae are shared with other fungi, with adaptations for their individual physiological contexts. Fungi deploy certain proton transport and pH control mechanisms not shared with other eukaryotes; these regulators of cellular pH are potential antifungal targets. This review describes current and emerging knowledge proton transport and pH control mechanisms in S. cerevisiae
and briefly discusses how these mechanisms vary among fungi.
Antifungals: Mechanism of Action and Drug Resistance.
There are currently few antifungals in use which show efficacy against fungal diseases. These antifungals mostly target specific components of fungal plasma membrane or its biosynthetic pathways. However, more recent class of antifungals in use is echinocandins which target the fungal cell wall components.
Here, we briefly present an overview of the current understanding of the antifungal drugs in use, their mechanism of action and the emerging possible novel antifungal drugs with great promise.
|Aspergillus otitis in small animals - a retrospective study of 17 cases.
are saprophytic opportunistic fungal organisms and are a common cause of otomycosis in humans. Although there have been case reports of Aspergillus
otitis externa in dogs, to the best of the authors' knowledge, this is the first retrospective case series describing Aspergillus
otitis in dogs and cats.
Aspergillus otitis is uncommon, typically seen as unilateral otitis externa in cats and larger breed dogs with possible risk factors that include immunosuppression and otic foreign bodies; previous antibiotic usage was common.
This month we hold a special meeting for patients & carers at the 7th Advances Against Aspergillosis (7th AAA) which is the principle conference in the world for this illness. Our meeting will be held in parallel at the same venue in Manchester, UK on 3rd March 2016. We will have several speakers who will talk to us about the work they are doing - this is only possible because they are already 'in town' for the main meeting and speaking at the main meeting too.
If you are a patient or carer and want to attend you can find full details here
- let us know as we need to know numbers for catering.
Aspergillosis Community (National Aspergillosis Centre) normall 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 firstname.lastname@example.org.