Fungal Infection Trust
August 2017

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We have modified our listing of courses (many of which have no fixed starting date) so that you can now see them as a list as well as on a calendar.
Highlights of this month...

'Predatory' Journals, Be Aware

Many researchers will receive regular (almost daily in some cases) emails asking for us to contribute work to or help edit a particular journal. Other than the frequency of arrival of these requests this does not seem unusual request until we start to read the detail of the request. Some may be requests from journals completely unrelated to our subject, all will be for journals we are not familiar with.
All are likely to be completely legitimate online journals with free access. Submitted papers are often dealt with speedily and accepted for publication with minimal delay. The snag is that the journal often has extremely low quality controls for accepted papers, some none at all and of course little or no peer review.
This article published in explains in some detail that some scientists have been so irritated by the constant arrival of these emails they have submitted false 'papers' consisting entirely of nonsense text and they have still been accepted for publication. Named 'Predatory Journal's' there was originally a list maintained by concerned librarian Jeff Beall but that has since been closed down and a new listing is being built by Cabell's International though no longer free access.
It is worth mentioning that there are also low value conferences referred to as 'Predatory conferences' that many will already be aware of as they also send out indiscriminate emails asking for guest speakers & delegates. Wikipedia host a description and history of these meetings (much work also credited to Jeff Beall) and refer to ongoing legal action intended to provide much better regulation of scientific meeting organisation.   
We have published an article this month entitled 'Drivers and Impact of Antifungal Therapy in Critically Ill Patients with Aspergillus-Positive Respiratory Tract Cultures.' (see below) which concludes that outcomes for patients diagnosed with invasive pulmonary aspergillosis could be vastly improved if we could speed up diagnosis. Currently, antifungal therapy is all too often ineffective and it is used too late.
How do we speed diagnosis up? Culture techniques are very slow but are still the most widespread tools available (IDSA Guidelines 2016). Nucleic acid testing needs careful use ( interpretation but CT scan, galactomannan and glucan testing are more strongly recommended for use in highly immunocompromised populations. Bronchoscopy with bronchoalveolar lavage is very useful for some patients.
European Respiratory Society calls for greater investment europe-wide in the prevention of respiratory health problems.
Fungal Awareness Week
The US Center for Disease Control and Development (CDC) hosted a week long awareness event from 14-18th August which is planned to be an annual event. The main message was intended to promote awareness that the early recognition of a serious fungal infection was vitally important to improve outcomes. Clinicians were encouraged to #ThinkFungus when an infection failed to respond to treatment for the commoner infections.
8th Advances Against Aspergillosis
Plans are well under way for the next AAA in Lisbon, Portugal on 1-3 February 2018.  Having run bi-annually since 2004 AAA is established as the biggest and best forum for detailed and dedicated discussion of Aspergillus diagnosis, treatment, and research.

In addition, AAA led the way in involving patients in a medical mycology conference. In 2010 in Rome an entire session preceding the conference was devoted to a series of speakers who spoke to an audience of patient's and carers on a range of subjects relevant to the audience.
During the 2016 AAA in Manchester the organisers held a full parallel session for patients with six speakers, four from the main conference who participated in a half day session where patients were able to listen and ask questions of speakers from the UK, USA and India on Sinusitis & ABPA research & treatment, allergic aspergillosis & Cystic Fibrosis, the potential for vaccines for aspergillosis and preparations for the running of a specialist aspergillosis clinic in London as a satellite of the National Aspergillosis Centre in Manchester. The European Lung Foundation and British Lung Foundation also participated in an active afternoon.
Next year in 2018 AAA hopes to hold another event for patients, this time providing translations to the host language for local participants, Portuguese.
Some of the highlights are:
Predominantly a disease of an immunocompromised patient including those with poorly controlled diabetes, Invasive Fungal Rhinosinusitis (IFRS) is an aggressive infection with high mortality. In this study, the average age was 9.7 years, 9 females and 8 males. There were 10 different infecting organisms isolated, mostly Fusarium(6 cases), Zygomycetes(4) and Curvularia(4) but also Aspergillus(2) and Candida(2).
17 patients underwent serial surgical debridement via an endoscope, 1 open surgery. 13(76%) of patients were successfully treated for their sinonasal disease, 4 died with IFRS. Overall 7(41%) survived at 6 months.
Use of echinocandins did not seem to improve outcomes but those who underwent more surgeries tended to do better.
Little is known about how doctors in acute care react to an Aspergillus-positive respiratory sample and about the efficacy of antifungals. The authors set out to identify what drives the decisions of doctors under these conditions and when & why they prescribe antifungal therapy (AFT) (and how they use those drugs) and diagnostic workup in patients with Aspergillus isolation in respiratory specimens. The authors also set out to assess the impact of AFT in these patients.
Conclusions: Treatment decisions appear to be based on diagnostic criteria and underlying disease severity at the time of Aspergillus isolation. Invasive Pulmonary Aspergillosis in this population has a dire prognosis and AFT is not associated with reduced mortality. This may be explained by delayed diagnosis and an often inevitable death due to advanced multi organ failure. 
This study investigates the clinical characteristics of severe asthma with fungal sensitisation. It enrolled 124 patients with severe asthma and detected sensitisation in 36(29%) of those. A range of fungal sensitivities was detected with Candida the most common (16%), then Aspergillus and Trichophyton (11%).
Early onset asthma was detected at a higher rate in patients (<16years) that were sensitive to fungi (45% compared with 25%), Interleukin-33 levels were higher and asthma control test scores higher in sensitive patients.
Conclusions: Severe asthma with fungal sensitization is characterized by early onset of disease and high serum levels of interleukin-33. Multiple fungal sensitizations are associated with poor asthma control.
Diagnosis during early stages of invasive aspergillosis (IA) and targeted antifungal treatment has the potential to improve survival significantly. Despite advances in the diagnostic arsenal, invasive mold infections remain difficult to diagnose-especially at early stages before typical radiological signs develop. Varying availability and time-to-results are important limitations of currently approved biomarkers and molecular assays for diagnosis of IA. Here, the authors give an update on the Aspergillus-specific lateral-flow device (LFD) test. We further review promising findings on the feasibility of point-of-care (POC) detection of urinary excreted fungal galactomannan-like antigens.
Valtonen describes a newly reported group of illnesses associated with damp buildings as Dampness and Mold Hypersensitivity Syndrome (DMHS). There are five stages with criteria that enable the clinician to place the patient according to severity of illness. Those with relatively mild exposure have reversible mould allergies but if exposure continues it progresses to 'Sick Building Syndrome' (where a patient is ill if they remain inside a damp building, but recover after 1-2 day once leaving). Worse still is 'Multiple Chemical Sensitivity' (MCS) and finally acute sensitivity to odours. The last two are much more difficult to recover from.
The only way to recover is by reducing exposure and this may not help once MCS has developed.
There are no accepted diagnostic tests that would help with the diagnosis of this syndrome, nor is there any way to assess the vulnerability of people to this syndrome. It is therefore imperative that we reduce the exposure of all our citizens to damp homes! 
Voriconazole was released from the PLGA-PEG-PLGA thermogel for more than 21 days in all groups. The release followed first-order kinetics. Voriconazole diffused through the cornea and sclera in all groups. Permeation was greater through the sclerae than corneas. Voriconazole released from the 1.5% voriconazole-thermogel showed antifungal activity in vitro. Voriconazole-thermogel was easily able to be injected into the dorsal SCS where it formed a discrete gel deposit. Voriconazole-thermogel was easily injected in vivo and did not induce any adverse reactions.
Conclusions: Voriconazole-containing thermogels have potential application in the treatment of keratomycosis. Further research is required to evaluate their performance in vivo.
Contribute to clinical data on rare infections:

Patients & Carers
In August National Aspergillosis Centre Clinical Trials Manager Azad Aziz talked about a trial that will be recruiting shortly that will test a new drug specifically designed to reduce the allergic symptoms that cause a lot of problems for ABPA patients.
Azad told us that NAC would be one of the main centres for this trial and that suitable patients would be automatically assessed in clinic and approached, though anyone interested in being involved could also approach him directly
Azad was also asking for patients & carers to volunteer to help out with the running of the trial itself. Our funding requires that several of our drug trials involve patients & carers in giving their thoughts and comments on their design and progress, documentation and reporting back to patients - in fact anyway that we can improve patient input into trials so that the trials are improved and more understandable by patients. There are lots of ways patients & carers can contribute so please get in tough with Azad to volunteer.
We are also running a successful Skype meeting every week! We are a chatty group of 8 - 12 most weeks but we can accommodate up to 24. If you have a computer or phone that has APP's you will be able to join in - just click on andyou will be asked to register, then taken to the group. Skype at 11am BST every Thursday
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 Facebook broadcast.

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