Fungal Infection Trust
February 2017
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Highlights of this month...

New MRC Centre for Medical Mycology

The UK Medical Research Council have awarded Centre status for Medical Mycology to the Fungal Group at the University of Aberdeen, Scotland and it will be one of only 22 MRC Centres in the UK.
 
This represents a £6.5 million investment into the study of medical mycology and is recognition of the importance of investing more money into medical mycology. Serious fungal infections cause 1.5 million deaths every year worldwide!
 
This new funding strengthens the Aberdeen Fungal Group as a world leader in medical mycology research and will lead to a further increase in numbers of world class staff in Aberdeen engaged in multidisciplinary research at the centre. 
 
In addition to research the funding will also support improved awareness of serious fungal infections throughout the world using a variety of attention grabbing events and activities to engage the public. From awareness comes greater recognition and consequently increased pressure on funding bodies. More funding will lead to improved diagnosis and treatments across the globe.
 
News
Rare Disease Day 2017 - 28th February. Rare Diseases are defined as those that afflict less than 5 in 10,000 people in the general population. Rare diseases all suffer from poor awareness and poor research funding. Aspergillosis is a rare disease. Read about the work of Rare Diseases UK here
 
Further publications on the serious fungal disease burden in 14 countries of the world were published this month in the European Journal of Clinical Microbiology & Infectious Diseases. Prof David Denning presents the collection in his callout paper 'Calling upon all public health mycologists', summarising the main objectives as two-fold: to generate approximations of the disease burden in each country and to lay out what is known about the burden in each country - and what is not known!
 
This last month has been one of the first in operation for the newly re-hosted Aspergillus Website and it has also been one of its busiest ever with over 100,000 individual users visiting the website. This is the first time we have reached such a high figure - in the late part of 2016 70,000 visitors was the average. This may be due to the enhanced speed that the new servers bring with the notable absence of what had become a regular afternoon slowdown.
Featured Website Section
Marijuana is currently being prescribed for medical use in some parts of the world. Marijuana has a long history of use by rolling into a cigarette and deeply inhaling the smoke. The practice is still mostly illegal but nevertheless widespread.
 
Illicit marijuana is not generally prepared under conditions that would minimise the growth of Aspergillus while drying or in storage and several research papers have detected notable quantities of the fungus in this dried material - Aspergillus spores that will be inhaled deeply into the lungs of the user. Consequently we highlight the potential for harm to respiratory health caused by the practice in a small new section written for the website by Helen Le Sueur.
 
As recently as this month an article was written that suggests that doctors prescribing this drug should be aware of the potential hazards for particular patient groups if they inhale the drug - AIDS patients, cancer patients, transplant patients who will all have an impaired immune system.
Articles
Clinical outcomes of critically ill patients who have IFT are unclear and are not limited to immunocompromised patients. This paper carries out an observational study of cases in order to identify underlying factors.
The authors found diabetes was the most prevalent factor with chronic lung disease next. Infection with Aspergillus spp. and Mucorales was also prominent. Biopsy was the key diagnostic strategy.
 
The authors studied the pharmocokinetics of caspofungin in 12 patients who were receiving continuous venovenous hemodiafiltration. In 4 of those patients they had difficulty reaching recommended trough levels and suggest that the licensed regimen of caspofungin was insufficient in some cases, though more work is necessary to confirm this.
 
A set of 34 Aspergillus clinical isolates (mostly from the respiratory tract) were identified to species level and screened for antifungal susceptibility against 8 antifungal drugs. Interestingly the most common species were A. westerdijkiae (29.4%), A. pseudosclerotiorum (23.5%), A. sclerotiorum (17.6%), A. ochraceus (8.8%), A. subramanianii (8.8%), and A. insulicola and A. ochraceopetaliformis with two isolates (5.9%).
The most potent antifungals were caspofungin, micafungin, and terbinafine, while amphotericin B showed the least activity.
Reviews
This article is the editorial and introduces a series of 5 review articles on antifungal drug discovery including:
This editorial reviews the rising need for new treatments for serious fungal infection with over 300 million people afflicted, in danger of dying or losing their sight. Invasive aspergillosis alone accounts for  450 000 deaths per year, Severe fungal asthma (SAFS) for another 100 000 deaths.
It goes on to review the current status of availability, effectiveness, limitations of and rising resistance to existing antifungal drugs. Consequently the need for new antifungal drugs is highlighted.
New Horizons in Antifungal Therapy looks at the the research underpinning the search for new antifungal drug targets, the new antifungal drugs currently in development and the re-use of existing drugs for use as antifungal drugs.
 
Calling upon all public health mycologists : To accompany the country burden papers from 14 countries.
David Denning questions why epidemiological studies in fungal disease are largely ignored when public health is discussed? He reasons that public health teaching is dominated for historical reasons by diseases where interventions at the public level can have some impact e.g. helping prevent person to person transmission. However even fungal diseases that are passed by contact such as cutaneous fungal infections (e.g. Tinea capitis) are ignored.
 
Fungal infection afflicts nearly a billion people worldwide and this month Prof Denning has co-authored 14 epidemiology papers describing fungal disease in 14 countries. There are now a total of 43 countries for which this information is available and the intention is that this will encourage national public health agenda's worldwide to take notice and include fungal infection in their work. 
 
Countries covered in separate papers on fungal burden just published are Philippines, Algeria, Egypt, Guatemala, Pakistan, Canada, Ecuador, Bangladesh, Thailand, Korea, Chile, Portugal & Peru.
Maps of all of the countries for which fungal burden has now been estimated are provided on the Gaffi website
Courses
We have modified our listing of courses so that you can now see them as a list as well as on a calendar.
 
There are still spaces available for the Masters in Medical Mycology course at the University of Manchester starting later in 2017. The course consists of a full year of teaching in Manchester. Students will spend much of their time in the laboratory learning to be a Medical Mycologist as well as undertaking work experience. They will learn from the world-leading scientists, microbiologists and clinicians based in Manchester.
 
Course in Diagnostic Medical Mycology 2017University of Leeds, UK April 3-7th 2017
 
 
Specialization Course in Medical Mycology, KU Leuven Campus Gasthuisberg, Belgium Sept 11-21 2017 (Registration deadline 1st May).
 
Attention!
Contribute to clinical data on rare infections:

Patients & Carers
Our trials with Skype have been successful so we are expanding the principle and will be attempting to hold an hour long weekly meeting on Skype at 11am GMT every Thursday. Instructions will change over the next few weeks so go to http://www.nacpatients.org.uk/content/skype-group for the latest information.
 
We have simplified the blogging facility on the Patients website (www.nacpatients.org.uk) to try to encourage more people to add their own content - writing about event that tell us more about living with aspergillosis or any other relevant material. Write your own blog by registering with the website and then after logging in go to the blogging page at www.nacpatients.org.uk/blog and click on 'Create new blog entry' at the top of the page. Then just start typing, upload pictures, add other media. The only limit is your imagination!
 
In February our patients meeting greeted four medical mycology students currently studying at the University of Manchester. The students introduced themselves and their countries and illustrated why medical mycology was important to them and their countries. It was a very enjoyable hour spent with people from Romania, Iran, USA, China and Kuwait.
 
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.

On March 3rd we will be listening to members of a local charity who are working with us to provide the oppertunity for patients and carers to explore the many potential health benefits of singing for people with a chronic respiratory illness. Singing is thought to improve the strength and control of the muscles that enable us to breathe so exercising them is definitely a good thing! Come along and see?

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