Aspergillus Newsletter
March 2014

New Educational Module on Aspergillosis

The European Respiratory Society have produced a new educational module on aspergillosis, particularly those forms that infect the non-immunocompromised patient who is taking steroids.
Presented by Professor David Denning, the Director of the National Aspergillosis Centre in Manchester, UK, 
Objectives: After the completion of this module, the participant will be able to:
1- Be able to suspect and request appropriate investigations for and treat invasive pulmonary aspergillosis in non-neutropenic, atypical patients.
2- Recognise the clues to the diagnosis of pneumocystis pneumonia in AIDS and non-AIDS patients, and be able to diagnose and treat appropriately.
3- Be able to diagnose and appropriately refer patients for long term ( sometimes life-long) antifungal therapy with chronic pulmonary aspergillosis.
Access is free of charge and it culminates in a CME test for 1 credit.
The 6th Advances Against Aspergillosis was held last week with great success. This AAA saw an explosion of work on the virulence of fumigatus mediated by the surface carbohydrate galactosaminogalactan (GAG) – first reported by Don Sheppard 4 years ago at the AAA meeting in Rome. The Aspergillus Website will be collating and presenting the abstracts and posters over the next month.
British Society for Medical Mycology 50th Anniversary Scientific Meeting will be held on 27-29th April 2014 in Manchester, UK and has a prominent section on aspergillosis.
6th AAA poster highlights from a personal perspective include; the investigation of the use of inhaled itraconazole in an attempt to target low-susceptible A. fumigatus; Diagnosis of invasive aspergillosis in HIV infected patients; Zinc transporter required for A. fumigatus virulence in limiting growth conditions; Deciphering the role of chitin synthase gene families by gene deletion; Modification of exopolysaccharide composition can increase the virulence of A.fumigatus; The temporal sequence of the transition from asthma through ABPA to chronic pulmonary aspergillosis; Detection of Aspergillus antibodies by a new indirect haemagglutination assay. More to come next month...
Patient ambassadors The European Patient Ambassador Programme is an online educational programme for patients and carers on how to help patients be a representative for their illness and give us all the benefit of their unique experience. The modules are: Being better informed; Improving public awareness, Improving treatment and care, Supporting reseach & development, Influencing policy across the EU and Working with the media. More in the patients newsletter linked below.
LIFE highlights this month: THE NEW EUROPEAN UNION RESEARCH BUDGET HAS HAD ITS OFFICIAL UK LAUNCH. Known as Horizon 2020, it offers UK businesses and researchers important opportunities to find finance, networks and partnerships for innovation. The programme is worth nearly £67bn over the next seven years.
NOTE access to all articles now requires registration
Multiple causes for tree-in-bud (TIB) opacities have been reported. However, to our knowledge the relative frequencies of the causes have not been evaluated. The purpose of this study was to determine the relative frequency of causes of TIB opacities and identify patterns of disease associated with TIB opacities.
Functional genomic analysis of the mould pathogen Aspergillus fumigatus has identified multiple secondary metabolism genes upregulated in the host niche. Intriguingly, transcriptomic analyses of infectious germlings, germinating spores and mutants lacking the LaeA methyltransferase reveal differential expression of transposable elements (TEs), which often flank secondary metabolite gene clusters. In this study, the authors investigated, in clinical and environmental isolates, the structure and distribution of a specific class of A. fumigatus long interspersed nuclear element (LINE)-like retrotransposons occupying subtelomeric loci in the A. fumigatus genome, and probe their stability in response to laboratory- and host-imposed stresses.
Invasive aspergillosis is a major cause of morbidity and mortality in immunocompromised patients, particularly those with neutropenia and those undergoing bone marrow or stem cell transplants. This review summarises the current evidence base surrounding the clinical use of micafungin in the treatment of invasive aspergillosis to consider the potential role of micafungin in these patients. There are currently no randomised studies comparing micafungin with standard antifungal therapy. Prospective non-randomised clinical studies, predominantly performed in Japan, involving 492 patients with aspergillosis and 455 febrile patients with chemotherapy-induced neutropenia suggest that micafungin may be as effective as comparator antifungal agents. Other clinical evidence is limited to case reports. Further experience in the form of randomised controlled trials is required to establish the exact role of micafungin in the context of currently available broad-spectrum antifungal agents.
Aspergillus fumigatus is an opportunistic fungal pathogen that causes fatal invasive aspergillosis among immunocompromised patients. The cell wall β-1,3-glucan is mainly elongated by β-1,3-glucanosyltransferase Gel family, which is vital for growth and virulence of A. fumigatus. Although seven members of Gels have been annotated, only Gel1, Gel2 and Gel4 were characterized.
The results suggested that the A. fumigatus β-1,3-glucanosyltransferase Gel7 was involved in conidiation and was compensated for the cell wall β-1,3-glucan defects when Gel1 and Gel2 lost their functions, especially at an elevated temperature.
Hematopoietic stem transplant recipients are subject to increased risk for invasive fungal infections. This meta-analysis was undertaken to explore the comparative effectiveness of systemic antifungal prophylaxis in hematopoietic stem cell transplant recipients. There is evidence for the comparable effectiveness of different antifungal drugs used for prophylaxis. Fluconazole is the most widely studied agent, but micafungin might prove to be more effective. There is a relative paucity of studies for the newer azoles, although both voriconazole and posaconazole give proof of their comparative or higher effectiveness to fluconazole in single randomized studies.
This review gives an update on the epidemiology, diagnosis, and management of IPA in the ICU. It concludes that a high level of suspicion in critically ill patients presenting with Aspergillus-positive respiratory tract cultures or nonresolving pulmonary infection may lead to earlier IPA diagnosis. Dosage individualization may decrease treatment discontinuation and improve clinical efficacy.
Damp & Health
Indoor Environment Professionals
Join our LinkedIn discussion group on Damp Building and Human Health.
Living in a damp home?
Please check out our LinkedIn group: Is my damp home making me ill? and read our new website pages
Conference Deadlines
UKIEG 2014 - Low Carbon Buildings: What About Health and Wellbeing? (June 18th). The deadline for submission of abstracts is Wednesday 14 March 2014
Indoor Air 2014 (July 07 - 12). Early bird registration ends 15 March 2014. Final paper submission is 1 April 2014.
11th International Conference on Innate Immunity (June 01-06 2014). Deadline for abstracts, discounted registration and hotel reservations is 15 March 2014.
XII Spanish National Congress on Mycology / XII Congreso Nacional de Micología (June 18th - 20th). Abstracts should be submitted by April 28, 2014.
The next CBS Course in Medical Mycology will take place in Utrecht, The Netherlands, 17-28 November, 2014.
Bringing PK and PD in Fungal Infections into the Clinic July 4-6 2014, Nijmegen, The Netherlands. For more information check website in January 2014.
Mechanisms in Fungal Infections: From the Science to the Clinical Setting Online course, Start approximately July 2014. Mechanisms in Fungal Infections is a blended, e-learning resource with CME content developed by an expert, multidisciplinary group of specialists.
Allergy Academy, King's College, London. Online resources for allergy education. Intended for all audiences including doctors & patients.
The distribution of Aspergillus spp. opportunistic parasites in hives and their pathogenicity to honey bees. In this study, an apiary was screened to determine the prevalence and diversity of Aspergillus spp. fungi. A series of dose-response tests were then conducted using laboratory reared larvae to determine the pathogenicity and virulence of frequently occurring isolates. The susceptibility of adult worker bees to Aspergillus flavus was also tested. Three isolates (A. flavus, Aspergillus nomius and Aspergillus phoenicis) of the ten species identified were pathogenic to honey bee larvae. Moreover, adult honey bees were also confirmed to be highly susceptible to A. flavus infection when they ingested conidia. Neither of the two Aspergillus fumigatus strains used in dose-response tests induced mortality in larvae and were the least pathogenic of the isolates tested.
These results confirm the ubiquity of Aspergillus spp. in the apiary environment and highlight their potential to infect both larvae and adult bees.
Fungal/mycotic diseases cause significant economic losses to the poultry industry either due to their direct infectious nature or due to production of mycotoxins, the secondary fungal metabolites produced in grains or poultry feed. The present review describes the fungal pathogens causing diseases in poultry/birds, especially focusing to their diagnosis, prevention and control measures, which would help in formulating appropriate strategies to have a check and control on these unwanted troubles to the poultry producers/farmers.
Attention Clinicians & Scientists
An international clinical guideline on the diagnosis and management of fungal asthma is being developed. It is expected that ISHAM will be one society contributing to this effort. The WG Allergic Bronchopulmonary Aspergillosis in Asthmatics is seeking members with considerable depth of knowledge and clinical experience in this topic to contribute from outside N. America, Europe and India. Please let one of the co-ordinators know if you are interested in contributing. Contact David DenningRitesh Agarwal or Arunaloke Chakrabarti
Case Histories Database 230 aspergillosis cases already recorded and you can add yours too.
Information on mycetoma on the WHO List of Neglected Tropical Diseases can be found here, and see also the media briefing of the Mycetoma Consortium here.
The Joint Genome Institute (JGI) welcomes nominations of genomes to be sequences in its Community Sequencing Program. For procedures how to submit a proposal, see here. The current fungal program can be found here.
You may like to contribute to the following collaborative groups who are collecting clinical data on these rare infections:
Fungiscope is a global rare fungal infection registry, a working group of ISHAM.
International Pediatric Fungal Network (PFN) collating information on treatment of pediatric patients
AspICU2 is a web-based multicentre observational survey to assess the burden of aspergillosis and other fungi in critically ill patients.
Patients and carers newsletter - please click here to access
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Also of interest...
PhD position TV-L E13 at Maximillian University of Munich
International Research Scholars at University of Aberdeen
Clinical Research Fellow at the National Aspergillosis Centre, Manchester, UK
Clinical Microbiologist at Changi General Hospital, Singapore
Molecular Pathologist at Changi General Hospital, Singapore
Research Technician for Pulmocide Ltd, Imperial College Incubator, London
Antifungal drug interactions
Antifungal drugs can interact strongly with other medications. Check your medications using our APP
Look out for our App in iTunes and Android (search for 'antifungal interactions).
Interactions with 739 prescription drugs are searchable, 2216 interactions listed, 443 severe.
CBS Spring Symposium Week 2014 (April 22) Includes a masterclass on Methods in Fungal Diversity and Barcoding.
Medical Mycology CPD courses (3rd March 2013 - February 2015) Four (three-week) units of the University of Manchester Medical Mycology MSc programme are now available as Continuing Professional Development courses.

Febrile Neutropenia by Jean A. Klastersky (28 Feb 2014)
Mycotoxins in Foodstuffsby Martin Weidenbörne (4 Feb 2014)
Morphogenesis and Pathogenicity in Fungi (Topics in Current Genetics) by José Pérez Martín and Antonio Di Pietro (11 Aug 2014)
Fungal Infections in Asia - The Eastern Frontier of Mycology,  by Arunaloke Chakrabarti. Suited to both mycology students and clinical care teams. ISBN:978-81-312-3556-0.
Adaptive resistance mechanisms of Aspergillus fumigatus biofilms Author: Rajendran, Ranjith Awarding Body: University of Glasgow 
Clinical Trials (34 Recruiting):
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Case reports:
There are 230 aspergillosis cases reported here
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Help assess the public need for better training for damp home surveyors in the Uk by reading & signing this online petition.
Fungal Infection Trust, PO Box 482, Macclesfield, Cheshire SK10 9AR, UK,