Aspergillus Newsletter
April 2014

Injectable form of Posaconazole Approved

The FDA has announced approval of Merck's intravenous form of posaconazole. Marketed as NOXAFIL, intravenous use is indicated only for patients over 18 years. With this approval, Merck now provides an IV formulation and 2 additional oral forms—delayed release and oral suspension—of NOXAFIL for prophylaxis against
Aspergillus and Candida infections in high risk patients. View Blog
Dr. Nicholas Kartsonis, executive director, Infectious Disease, Merck Research Laboratories said: "The availability of a NOXAFIL formulation for intravenous administration is particularly important for those patients who may benefit from or require intravenous therapy, or who, for a variety of reasons, might not be able to take an oral formulation.” 
GAFFI presented a 'raising awareness' event for fungal infections on April 1st (April fools day!). Reporting that the genome of the garden gnome had now been sequenced. 
It is feared gnomes are in danger of extinction because it's traditional habitat (close to compost heaps, & sitting on toadstools) had left them vulnerable to infection by Aspergillus. A video accompanied the spoof story and was viewed by several thousand people. The story pointed to the serious topic of fungal infections and achieved its objective of raising awareness.
6th AAA slide presentations are being presented in the educational materials section with more being added as they come in.
The Aspergillus Website upgrade continues as we can now present replacements for the following sections:
Most sections have improved searching (particularly images which have been extensively catalogued and categorised) and presentation - for example slide presentations and other documents will now open automatically within the webpage without the need for the file to be downloaded.
Treatment section article on osteomyelitis has been updated by Jamie Fey, Thomas Walsh & team.
NOTE access to all articles now requires registration
Invasive aspergillosis is a well-known complication in severely immunosuppressed patients, including heart transplant recipients, and associated mortality is high. Despite the severity of the disease in this population, few recent series with secular trends have addressed the problem. This study performed a descriptive study of 479 consecutive heart transplant recipients from 1988 to 2011, and found that both incidence and mortality associated with invasive aspergillosis in heart transplant recipients showed a decrease in recent years. Careful environmental management and targeted anti-fungal prophylaxis may minimize the incidence of invasive aspergillosis in this setting.

Aspergillus spp. colonization in exhaled breath condensate of lung cancer patients from Puglia Region of Italy.

Airways of lung cancer patients are often colonized by fungi. Some of these colonizing fungi, under particular conditions, produce cancerogenic mycotoxins. Given the recent interest in the infective origin of lung cancer, with this preliminary study the author's aim to give a contribution to this field of research by analysing the fungal microbiome of the exhaled breath condensate of lung cancer patients from Puglia, a region of Italy.

An improved number of anti-fungal drugs are currently available for the treatment of invasive aspergillosis (IA). While serial galactomannan index (GMI) measurement can be used to monitor response to treatment, the extent to which different anti-fungal regimens can affect galactomannan levels is unknown. In 147 IA patients receiving either voriconazole (VCZ) or conventional amphotericin B (CAB) in a multicentre clinical trial, we performed post-hoc analyses of GMI trends in relation to outcomes.

These authors retrospectively evaluated, in a logistic-regression-model, the role of proven/probable invasive fungal diseases (PP-IFD), occurring during first induction chemotherapy, on the achievement of complete remission (CR) and overall survival (OS) in 198 acute myeloid leukemia (AML) patients. A PP-IFD was documented in 34 (17.2%) patients. Younger age, good performance status at AML diagnosis and no development of a PP-IFD (OR 4.09, 95% CI 1.71-9.81, p<0.0001) were independent factors associated to CR achievement. Younger age, good performance status, favorable genetic risk and no development of PP-IFD (HR 1.86, 95% CI 1.20-2.88, p=0.005) were independent factors associated to OS at 3 years.
Vacuolar proton-translocating ATPase (V-ATPase) is a membrane-bound, multi-subunit enzyme that uses the energy of ATP hydrolysis to pump protons across membranes. Recent studies in mammals have identified significant alterations from fungi; these differences could be exploited for selectivity between fungi and humans and highlight the potential for V-ATPase as an anti-fungal drug target. Candida albicans is a major human fungal pathogen and causes fatality in 35% of systemic infections, even with anti-fungal treatment. The pathogenicity of C. albicans correlates with environmental, vacuolar, and cytoplasmic pH regulation, and V-ATPase appears to play a fundamental role in each of these processes. This overview will discuss these studies as well as hypothetical ways to target V-ATPase and novel high-throughput methods for use in future drug discovery screens.
Untreated invasive aspergillosis (IA) is lethal, yet diagnosis is often delayed. Recognising the risk factors can lead to earlier diagnosis. We present a case of an invasive pulmonary aspergillosis in a patient with cirrhosis, who had been treated with corticosteroids for 2.5 weeks for alcoholic hepatitis. He was successfully treated with liposomal amphotericin B and caspofungin (first in combination, then caspofungin monotherapy).
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
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.
On the basis of phenotypic identification methods, Aspergillus fumigatus is reported as the most commonly identified aetiological agent of canine sino-nasal aspergillosis (SNA). However, definitive identification of Aspergillus spp. using phenotypic features alone is unreliable. The aim of this study was to determine the molecular identities of fungal species causing SNA in dogs. Genomic DNA was extracted from 91 fungal isolates from 90 dogs diagnosed with SNA in Australia, the USA and Belgium, and the ITS1-5.8S-ITS2 ribosomal DNA and partial β-tubulin regions were sequenced. Eighty-eight of 91 (96.7%) isolates were identified as A. fumigatus and 3/91 (3.3%) belonged to Aspergillus section Nigri spp. (Aspergillus tubingensis: 2/91; Aspergillus uvarum: 1/91). These findings confirm that A. fumigatus is the most common aetiological agent of canine SNA. This is the first report to document a pathogenic role for A. tubingensis and A. uvarum in dogs.
Attention Clinicians & Scientists
Case Histories Database 230 aspergillosis cases already recorded and you can add yours too.
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.
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Also of interest...
News blog:
PhD position TV-L E13 at Maximillian University of Munich
Postdoctoral researchers at the 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.
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.
Microbial Production: From Genome Design to Cell Engineering by Anazawa, Hideharu and Shimizu, Sakayu (20 Feb 2014)
Clinical Trials (34 Recruiting):
Click map to browse
Case reports:
There are 230 aspergillosis cases reported here
Research Grants:
Lab protocols:
Fungal Infection Trust, PO Box 482, Macclesfield, Cheshire SK10 9AR, UK,