December 2018
  Research highlight

As we are on the verge of a new year it is traditional to pause and look back. 

Amid all the encouraging advances highlighted in this newsletter in 2018, there has been one that needs little in the way of scientific advance and has the potential to improve treatment and prognosis of people with aspergillosis far and wide without further delay. Antifungal stewardship is our weapon to help reduce the spread of resistance to antifungal drugs. Its scope is wide in relation to who good stewardship applies, it seems almost all medical centres that use antifungal drugs can benefit from implementing an antifungal stewardship program. The benefits are not just in reducing resistant infections, but also in reducing costs and improving patients quality of life.

This month we highlight two antifungal stewardship papers. Antifungal Stewardship: developments in the field by Urbancic et. al. provides the tools to set up a program, monitoring the benefits from the start. Whitney et.al.'s Effectiveness of an antifungal stewardship programme at a London teaching hospital 2010-16 shows us the benefits of a stewardship program put in place in 2010 at a London hospital.

The time is right to initiate an antifungal stewardship program anywhere where antifungal drugs are used extensively, make it your New Year resolution for 2019.

Antifungal Stewardship, Aspergillus Website

 
  News and notices
 
Manchester University NHS Foundation Trust and The National Aspergillosis Centre is advertising for a new Consultant and a new Clinical Fellow.
 
Remember 1st February 2019 is World Aspergillosis Day and help us use this event to raise awareness in your part of the world. The Aspergillosis Trust, a patient charity in the UK is launching a range of activities in the UK based on campaigns on public transport in London and at major sporting events throughout England and Wales. If you can help support World Aspergillosis Day please send us images of your activities at admin@aspergillus.org.uk. We will be updating the World Aspergillosis website early in 2019 (www.aspergillosisday.org)
 
A Medical Mycology course will run at the Pasteur Institute in 2019, March 18th - April 12th. This four-week course is intended for microbiologists (MDs, PharmDs, PhDs & veterinarians) willing to catch up with the most recent advances in diagnosis and identification procedures and principles of therapy for fungal infections. It will be run in English with French support.
 
Make a note in your diaries: the 9th Advances Against Aspergillosis meeting will take place on the 27-29th February 2020 in Lugano, Switzerland.
 
Don't forget the 14th Fungal Update Meeting on the 16th March 2019, London.
 
 
  Research articles
 
Role of FDG PET/CT in monitoring treatment response in patients with invasive fungal infections (Ankrah 2018). 
Twenty-eight patients with in total 98 FDG-PET/CT scans were included in this study. FDG-PET/CT altered management in 14 out of the 28 patients (50%). At the final FDG-PET/CT scan, 19 (68%) had a complete metabolic response (CMR), seven a partial response and two patients were defined as having progressive disease. The authors concluded that FDG-PET/CT is useful in the monitoring of Invasive fungal infections resulting in management therapy change in half of the patients. Baseline global total lesion glycolysis (TLG) and metabolic volume (MV) were found to be able to predict the metabolic response to antifungal treatment.
 
Fungal contamination in smokeless tobacco products traditionally consumed in Pakistan (Saleem 2018).
Samples of smokeless tobacco products such as Mainpuri, Tambako, Khiwam, Gutkha, Naswar and Mawa etc. were collected from different cities of Pakistan. The samples were tested for fungal contamination by the spread plate method. 
also revealed resistance against many commonly-used antifungals such as Amphotericin B and Itraconazole. The authors concluded that there was a high prevalence of opportunistic fungi in study samples, posing a threat Aspergillus. The isolated strains of Trichophyton and Sepedonium Mucor,, Penicillium were predominantly isolated followed by AspergillusDifferent species of for human health which requires prompt notice and management.
Correlation between fungal sensitisation in childhood persistent asthma and disease severity (Gupta 2018).
clinical significance of fungal sensitisation Fungal sensitisation in adults is associated with severe asthma but the prevalence and remain unclear in a paediatric population. The aim of this study was to study the association of fungal sensitisation with disease severity in children with persistent asthma.
organism in fungal sensitised patients was commonly implicated of allergic comorbidities was noted among patients with fungal sensitisation (47.1% vs 21.7%, P value .03). The most  A significant increase in the family history  second >50% of expected were enrolled.One hundred children with persistent asthma in the age group 7-15 years, symptom duration >2 years and forced expiratory volume in the firstAspergillus 
flavus  (47.1%). The results of this study, a first among Indian children with asthma, suggest that children with fungal sensitisation have more severe asthma as compared to children without fungal sensitisation.
 
Posaconazole-induced hypertension and hypokalemia due to inhibition of the 11β-hydroxylase enzyme (Barton 2018).
Posaconazole is an antifungal therapy reported to cause hypertension. Hypokalemia is also a known side effect. The combination of hypertension and hypokalemia suggests mineralocorticoid excess. Here the authors present the case of a 15-year-old adolescent male with hypertensive urgency while on prophylactic posaconazole therapy for a combined immunodeficiency. They identify the mechanism of posaconazole-induced hypertension to be inhibition of the 11β-hydroxylase enzyme, resulting in elevated levels of the mineralocorticoid receptor activator deoxycorticosterone. Loss of function of the 11β-hydroxylase enzyme is responsible for a rare form of congenital adrenal hyperplasia and can be associated with the life-threatening adrenal crisis.
Editorial note: Itraconazole may also cause hypertension and hypokalaemia and it is possible the same mechanism is responsible given the similarities in chemical structure.
 
 
 Veterinary articles
 
Fungal infections are one important source of reproductive failures (mycotic abortion) of cattle in Australia & New Zealand and Aspergillus fumigatus is the most important of these. Effective disease control strategies require rapid diagnoses at diagnostic laboratories. To facilitate this process, this review discusses the infectious causes of reproductive losses present in both countries, their clinical presentation and an effective pathway to diagnosis.
Review of Diagnostic Procedures and Approaches to Infectious Causes of Reproductive Failures of Cattle in Australia and New Zealand (Reichel 2018)
 
 
  Reviews
 
Bacterial super-infection of critically ill influenza patients is well known, but in recent years, more and more reports describe invasive aspergillosis as a frequent complication as well. This review summarizes the available literature on the association of invasive pulmonary aspergillosis (IPA) with severe influenza [influenza-associated aspergillosis (IAA)], including epidemiology, diagnostic approaches and treatment options.
The authors conclude that further studies are needed to evaluate the incidence of IAA in a prospective multicentric manner, to elucidate contributing host-derived factors to the pathogenesis of this super-infection, to further delineate the population at risk, and to identify the preferred diagnostic and management strategy, and also the role of prophylaxis.
 
The authors screened 12,426 references and identified 189 studies for full-text review. Nineteen studies were included in the final meta-analysis. There was moderate heterogeneity between studies. Nine studies had a high risk of bias, which significantly elevated the overall specificity estimate. Restricting to only low-bias studies, the sensitivity and specificity were 80% and 63%, respectively.
CONCLUSIONS:
The overall sensitivity and specificity of Fungitell as a diagnostic test for IFI is moderate, and there is substantial heterogeneity between studies. Limiting studies to only low-bias risk reduced heterogeneity but also lowered the overall specificity estimate.
 
The zebrafish has become a widely accepted model host for studies of infectious disease, including fungal infections. The species is genetically tractable, and the larvae are transparent and amenable to prolonged in vivo imaging and small molecule screening.
The aim of this review is to provide a thorough introduction into the published studies of fungal infection in the zebrafish and the specific ways in which this model has benefited the field. In doing so, we hope to provide potential new zebrafish researchers with a snapshot of the current toolbox and prior results, while illustrating how the model has been used well and where the unfulfilled potential of this model can be found.
 
  Patients and carers
 
Medical Alert cards (see left) for aspergillosis patients are now available in clinic or by emailing us at admin@aspergillus.org.uk
 
NOTE we did not hold a Community meeting in December as our usual room was taken over by hospital officials for an important meeting related to the merger of Wythenshawe Hospital with other in Manchester to form Manchester University Foundation Trust (mft.nhs.uk). We will be back on the 4th January with the Christmas Quiz.
 
To receive a text reminder when each meeting is approaching send us your mobile phone number (NB this doesn't operate in the US) to admin@aspergillus.org.uk.

(Facebook Broadcast) Our meetings for the Aspergillosis Community occur on the first Friday of each month at the Altounyan Suite, North West Lung Centre, Manchester at 12.30pm BST/GMT. If you can't make it in person, you are welcome to listen in to our UK only).
 
We host a weekly video phone call with around 4-8 patients and a member of NAC staff each week. You can use a computer/laptop or phone/tablet to join the video call by downloading the Zoom software by following this link: https://zoom.us/j/243782379. This meeting runs from 11:00-12:00 GMT every Thursday (UHT+1 in the summer). 
 
 
Join our Facebook Groups
  • Our Aspergillosis Support Facebook Group has over 2000 members and is a safe place to meet and talk to other people with aspergillosis. We have a public group and a private group.
  • We also have a Facebook group for carers, friends and family of someone who is affected by the disease - join here. 
  • To find our regional and international groups, search the following terms within Facebook: 'aspergillosis'; 'aspergillus'; 'ABPA'
 
Jobs
Clinical networks
Conferences
 
ID Consultant and Clinical Fellow posts are available at MFT/NAC, Manchester.
Drug Interactions Database - consultancy available
The Fungal Infection Trust are seeking an experienced healthcare professional with considerable workplace experience to update these databases on a continuing basis, focussing on new published data, updated SPCs and new medicines launches.
 
Consultancy rate negotiable.
 
 
 
 
 
6th International Conference on Mycetoma (15 - 17 February 2019, Sudan)
 
 
30th Fungal Genetics Conference (12-17 March 2019 Asilomar Conference Grounds Pacific Grove, CA)
 
14th Annual Fungal Update (15 - 16 March 2019 QE2 Conference Centre, London.
See more groups and societies
 
 
Visit our sites
 
(MFIG)
(MRCM)
(free online microscopy course)
(fungal education for clinicians)
 
 
     
Fungal Infection Trust, PO Box 482, Macclesfield, Cheshire SK10 9AR
 
 
 
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