February 2020
  Research highlight
What are the risk factors for Chronic Pulmonary Aspergillosis returning once antifungal therapy has been stopped? (Bongomin et al., 2020)
This retrospective study aimed to identify the frequency and risk factors for disease relapse following cessation of antifungal therapy in CPA. Outcomes for patients with CPA who had received antifungal treatment and for whom therapy was discontinued for at least one month between August 2009 and May 2017 were assessed. Relapse was defined as a deterioration in two of the following parameters: clinical, radiological, serological or sputum microbiological markers of CPA activity.
In 102 patients aged 63.7 ±11.5 years who discontinued antifungal therapy, 43% had to restart therapy and 50% these had objective criteria of relapse, the others had only symptomatic deterioration. Relapse was more common in those with bilateral disease. 
The authors conclude that bilateral CPA is a risk factor for relapse after treatment discontinuation. A longer duration of treatment may be associated with a lower rate of relapse in extensive CPA, whereas more limited disease may respond to shorter courses.
  News and notices
February 27th was World Aspergillosis Day (WAD) and coincided with the 9th Advances Against Aspergillosis and Mucormycosis conference in Lugano, Switzerland which ran from 27 – 29 February. This conference is the premier forum for detailed and dedicated discussion of all aspects of Aspergillus infection and research and a collection of talks and slides from the conference is available on the Aspergillus website.
Impact statements from people living with aspergillosis were displayed at the conference on World Aspergillosis Day to bring the patient voice to the event and a number of the poster abstracts were summarised for the patients by the National Aspergillosis Centre. There was lots of engagement from conference attendees on Twitter too about WAD, so a huge thank you to the organisers and delegates for supporting the event and helping to raise awareness of aspergillosis.
Meetings coming up soon
Mycology 2020, 13-14 March 2020. Registration is now open.
Applications for the annual Molecular Mycology: Current Approaches to Fungal Pathogenesis course are now open. The course runs from 17 July to 2 August 2020 at the Marine Biological Laboratory in Woods Hole, Massachusetts, USA and applications close on 30 March 2020.
  Research articles
Clinical characteristics of allergic bronchopulmonary aspergillosis (Zhang et al., 2020)
Due to the diversity of ABPA manifestations and physicians' incomplete knowledge of the condition, patients with ABPA are often misdiagnosed and given poor prognosis. This study retrospectively analysed 75 patients diagnosed as ABPA in Zhongshan Hospital, Fudan University between October 2008 and June 2018. Nearly half of patients did not meet the diagnostic criteria of ABPA and all the patients who overlapped with invasive pulmonary aspergillosis (IPA) did not meet the diagnostic criteria of standard ABPA. Patients who did not fully meet the diagnostic criteria were more likely treated with inhaled corticosteroids (ICS) and antibiotics. This study demonstrates an unsatisfactory situation of diagnosis, treatment and prognosis of ABPA.
An atypical acute exacerbation of COPD due to Aspergillus fumigatus (Teikkurt et al., 2020)
This case study of a A 64-year-old male with a history of stabile chronic obstructive pulmonary disease (COPD) describes an acute COPD exacerbation due to Aspergillus fumigatus that lead to an aberrant clinical profile unresponsive to conventional treatment. Clinicians should consider A.fumigatus as an etiologic agent in an atypical and severe COPD exacerbation.
Positive Aspergillus PCR as a marker of azole resistance or sub-therapeutic antifungal therapy in patients with chronic pulmonary aspergillosis (Moazam et al., 2020)
This study looked at CPA patients with a positive Aspergillus PCR, to determine whether a positive Aspergillus PCR is a marker of resistance in CPA patients on azole therapy. In treated patients, concurrent azole-resistant A. fumigatus was found in 75% of A fumigatus-positive cultures (6/8). Positive sputum, Aspergillus-specific PCR can be associated with azole resistance in CPA patients on therapy.
A comparative genomics study of 23 Aspergillus species from section Flavi (Kjærbølling et al., 2020)
Section Flavi encompasses both harmful and beneficial Aspergillus species, such as Aspergillus oryzae, used in food fermentation and enzyme production, and Aspergillus flavus, food spoiler and mycotoxin producer. This paper reports the sequence of 19 genomes spanning section Flavi and compare 31 fungal genomes including 23 Flavi species. The paper includes genomic analyses, phenotypic assays, and identification of secondary metabolites, highlights the genetic and metabolic diversity within section Flavi.
Respiratory mycobiome and suggestion of inter-kingdom network during acute pulmonary exacerbation in cystic fibrosis (Soret et al., 2020)
Lung infections play a critical role in cystic fibrosis (CF) pathogenesis. This paper characterises the microbiota and mycobiota of the CF respiratory tracts during CF pulmonary exacerbation (CFPE). The authors report finding three main clusters organized around Aspergillus, Candida, and Scedosporium genera, identifiying Aspergillus and Malassezia as relevantly associated with CFPE. They also report interactions between Aspergillus and Streptococcus and include documented mycobiome data into a version of the ecological Climax/Attack model that opens new lines of thoughts about the physiopathology of CF lung disease and future perspectives to improve its therapeutic management.
  Veterinary article
Fungal Placentitis Caused by Aspergillus terreus in a Mare: Case Report. (Orellana-Guerrero et al., 2019)
This paper describes one of the few case reports available describing fungal placentitis. Placentitis is the most important cause of equine abortions, stillbirths, and perinatal deaths in horses. Most cases are caused by bacteria and fungal causes are much less common. Aspergillus terreus has not been previously reported as a cause of placentitis.
Drug resistance and tolerance in fungi (Berman and Krysan, 2020)
This review, defines and distinguishes antifungal resistance and tolerance and discuss the current understanding of the molecular, genetic and physiological mechanisms of resistance or treatment failure. Distinguishing tolerance from resistance might provide important insights into the reasons for treatment failure in some settings. Whilst it does not cover Aspergillus in great detail it is nonetheless a useful review for understanding antifungal resistance more broadly.
Antifungal Susceptibly Testing by Concentration Gradient Strip Etest Method for Fungal Isolates: A Review. (Dannaoui and Espinel-Ingroff, 2019).
Antifungal susceptibility testing is an important tool for managing patients with invasive fungal infections, as well as for epidemiological surveillance of emerging resistance. For routine testing in clinical microbiology laboratories, ready-to-use commercial methods are more practical than homemade reference techniques. Among commercially available methods, the concentration gradient Etest strip technique is widely used. This review summarizes the available data on the performance and potential use of the gradient strip method.
  Patients and carers
NAC Comms team becomes NAC CARES team
“So, what do you do?” What a difficult question! The communications team at the National Aspergillosis Centre have been mulling this one over a lot recently and have decided that they need to make things clearer.
They have been known as ‘the comms team’ for a long time. But what does that really mean? How can they explain what they really do?
They have broken it down into five main areas and have become NAC CARES. Read their blog post to find out more.
World Aspergillosis Day
World Aspergillosis Day was on February 27th and this year there were lots of ways for people to get involved. It’s fantastic to report that there were simply too many activities going on to mention them all here. Raffles, coffee mornings, conferences, webinars, posters and social media to name but a few. Please do take a look at aspergillosisday.org to read all about it.
We’ll spend the next few weeks tracking engagement and measuring the success and reach of the events and activities so stay tuned for a full report next month.
Patient meeting
On 7th February we welcomed guest speaker Professor Kyle Pattinson to NAC for the patients meeting. Professor Pattinson is a Senior Clinical Research Fellow and Associate Professor in the Nuffield Department of Clinical Neurosciences at the University of Oxford. He will be talking about 'Breathing with your Brain', and explaining how the brain controls our feelings of being out of breath and why some people still feel out of breath, even when they have been provided with medical care.
You can watch the meeting on our Facebook support group.
Other meetings and support
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 or mobile device to join the video but you need to register in advance. This meeting runs from 10:00-11:00 BST every Thursday.
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.
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 watch on Facebook. We broadcast live (this is limited to UK patients only) and post the recording so you can watch it in your own time.
April's patient meeting will be delivered by Prof Nikolaos Papadopoulos, Professor of Allergy & Paediatric Allergy at the University of Manchester. One of Prof Papadopoulos's main research interests is the role of infections in asthma, so his talk should be extremely informative and interesting. We hope you can join us either in person or online!
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 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 for 'aspergillosis' in Facebook.
Clinical networks
Open Rank Academic positions (Lecturer to Professor - including clinically qualified candidates) in Medical Mycology (Education and Research)
See more groups and societies
Visit our sites
(free online microscopy course)
(fungal education for clinicians)

Fungal Infection Trust, PO Box 482, Macclesfield, Cheshire SK10 9AR