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

New Drug Patent Structure to Aid Poorer Countries

New drugs are patented by their manufacturer in order to prevent other companies copying and marketing their work for a period up to 20 years. This allows a company that has developed a new drug exclusive selling and pricing rights. This often means the price is set high and that is a major barrier to countries that are cash-poor.
 
Antifungal drugs tend to be highly priced and thus unavailable to people in large parts of the world.
 
Our latest blog discusses a statement by UK pharmaceutical manufacturer GlaxoSmithKline that it will attempt to make drug costs less of a barrier in poorer parts of the world by restraining from filing and enforcing patents in those regions for new drugs that it has developed. This would have the effect of allowing companies that make generic copies of their new drug to market alternatives in those poorer areas, pushing down the price and increasingly widening availability.
 
'Middle income' countries will receive the new drugs with patents but with incentives for generic manufacturers to sell cheaper alternatives for a limited time under license.
 
This potentially revolutionary approach is thought to affect 85 countries contained 2 billion people. We can only hope more pharmaceutical companies will follow GSK's lead.
News
ISHAM and EUCAST have collaborated to produce a new smartphone App (FungiMICs) that provides MIC data and ECOFF values for a range of fungal organisms. It is intended for physicians working on the field of fungal infections. Access the App for android and iOS together with more information about the App here.
Aspergillus Website news: Use of the Aspergillus Website continues to climb as we change and innovate. We are currently experiencing record traffic in excess of 6 000 visits per day with strong growth in interest from China.
Featured Website Section
The video's section was once a small part of the website but the proliferation of video as a highly effective communication tool (lead by the use of high quality and easy to use smartphone camera's and the mass hosting of video by free services such as Youtube and Vimeo) has expanded this section dramatically. We now list 181 video's on the website an a range of topics - you can browse or search through them at your convenience.
We still feature unique footage of clinical procedures shot specifically for the website but it is now possible to see footage shot by many other clinicians. You will also find teaching series (Management of chronic and allergic aspergillosis), patient stories, veterinary, indoor air and TED presentations amongst much more.
We run our own Youtube channel (Aspergillus & Aspergillosis) which contains collections of 150 videos from Youtube on a wide range of subjects e.g. aspergillus & Food, Environment & Fungi, Future World - we think that there is there is something for everyone.
Articles
Review of 34 patients with orbital aspergillosis reporting clinicopathological features, radiologic findings and treatment outcomes.
Conclusions: Isolated orbital aspergillosis though rare should be considered in the differential diagnosis of a patient presenting with a gradually progressive orbital mass, especially in Asian individuals. Early recognition will help reduce the morbidity and mortality associated with this disease.
 
Tinea capitis(TC) is generally considered as the most frequent fungal infection in childhood, as it accounts for approximately 92% of all mycosis in children. It is well-known and that TC is caused by dermatophytes, which is a scientific label for a group of three genera of fungi:  Microsporum,  Epidermophyton and Trichophyton 
The authors present two rare cases in young children (4 and 9y.o.) where the infecting organism was Aspergillus niger. 
The authors suggest that clinicians in some parts of the world should consider other pathogenic moulds, particularly where a case is resistant to standard treatment.
 
Class II and V myosins are known to be important for critical cellular processes, including cytokinesis, endocytosis, exocytosis, and organelle trafficking in the model fungi Saccharomyces cerevisiae and Aspergillus nidulans. However, myosins' roles in the growth and virulence of the pathogen Aspergillus fumigatus are unknown.
This study demonstrates that deletion of myoE and myoB reduces virulence in a mouse model system for invasive aspergillosis.
 
Little is known about the A. fumigatus proteins that trigger the production of Aspergillus-specific IgG antibodies during the course of IA. In order to characterise the serological response to A. fumigatus protein antigens mycelial proteins were separated by 2-D gel electrophoresis.
The authors identified 49 different fungal proteins, which gave a positive IgG antibody signal. Most of these antigens play a role in primary metabolism and stress responses. Overall, their analysis identified 18 novel protein antigens from A. fumigatus, two of which were candidates for further analysis. One candidate (Shm2) induced a strong proimflammatory response, the other (CpcB) didn't - the authors suggest that this finding could be the basis of development of immunotherapy for IA.
 
Here the authors show that phytochrome-dependent light signalling in Aspergillus nidulans involves the stress-sensing and osmosensing signalling pathway. In a screening for 'blind’ mutants, the MAP kinase SakA (also known as HogA) was identified by whole genome sequencing. The phytochrome FphA physically interacted with the histidine-containing phosphotransfer protein YpdA and caused light-dependent phosphorylation of the MAP kinase SakA and its shuttling into nuclei. In the absence of phytochrome, SakA still responded to osmotic stress but not to light. The SakA pathway thus integrates several stress factors and can be considered to be a hub for environmental signals.
Reviews
A better understanding of how the host immune system contains fungal infection is likely to facilitate the development of much needed novel antifungal therapies. Innate cells are responsible for the rapid recognition and containment of fungal infections and have been found to play essential roles in defense against multiple fungal pathogens. In this review the authors summarize our current understanding of host-fungi interactions with a focus on mechanisms of innate cell-mediated recognition and control of pulmonary aspergillosis.
 
The aim of this document is to provide a critical review of the current knowledge on hypersensitivity pneumonitis caused by the occupational environment and to propose practical guidance for the diagnosis and management of this condition. Occupational hypersensitivity pneumonitis (OHP) is an immunologic lung disease resulting from lymphocytic and frequently granulomatous inflammation of the peripheral airways, alveoli and surrounding interstitial tissue which develops as the result of a non-IgE mediated allergic reaction to a variety of organic materials or low-molecular-weight agents that are present in the workplace. The offending agents can be classified into six broad categories that include bacteria, fungi, animal proteins, plant proteins, low-molecular-weight chemicals, and metals. The diagnosis of OHP requires a multidisciplinary approach and relies on a combination of diagnostic tests in order to ascertain the work-relatedness of the disease. Both the clinical and the occupational history are keys to the diagnosis and often will lead to the initial suspicion. Diagnostic criteria adapted to OHP are proposed. The cornerstone of treatment is early removal from exposure to the eliciting antigen, although the disease may show an adverse outcome even after avoidance of exposure to the causal agent.
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
 
Attention!
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Patients & carers
Our meeting this month covered a new piece of research carried out by our specialist physiotherapists whereby they were able to show that they could obtain important sputum samples from 97% of our patients using a combination of techniques. This has an impact on treatment as they showed that prior to this work only about two thirds of patients produced a sample and this risked significant infections not being rapidly treated
 
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