Fungal Infection Trust
March 2017

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Funds & Awareness


Highlights of this month...

Dampness in the Home

It has long been suspected that damp in the home is bad for our respiratory health. Gathering sufficiently robust evidence to support that assumption has been slow but is now gradually accumulating. Dampness is thought to be causal in asthma and in asthma exacerbation, airway infections and rhinitis (RCP Report 2016, Norback et. al. 2013)).
It is also often assumed that the presence of increased levels of moulds in a damp home plays a part in the impact on respiratory health though for the most part this is unproven. 
This month the German Society of Hygiene, Environmental Medicine and Preventative Health together with other scientific medical societies have published a review intended to act as guidelines for doctors entitled 'Medical diagnostics for indoor mold exposure'. 
Moulds are treated throughout as equivalent to damp for the purposes of this document. It reviews all of the impacts on health whether suspected or proven and all of the suspected causal agents. Predisposing factors are examined and assessed and include environmental and well as genetic and anxiety abnormalities.

The guidelines contain details of when the indoor environment might be suspected as influencing a patients health and how to proceed with diagnosis. In short the aim of these guidelines is that they "shall close the existing gap for rational and efficient medical diagnostics of indoor air exposure".
Analysis of the numbers of primary diagnoses of aspergillosis in the UK over the last 15 years shows a near four fold increase between 1999 and 2015. Cases rose in all age groups >15 years of age.
Ten more Aspergillus species sequenced by de Vries et. al. to add to the collection of eight already done, the aim being to sequence a spread of species that represent the wide range of variability in the Aspergillus genus. The medically significant species A. fumigatus and A. terreus had already been done and this study adds A. luchuensis, A. aculeatus, A. brasiliensis, A. carbonarius, A. glaucus, A. sydowii, A. tubingensis, A. versicolor, A. wentii, and A. zonatus. Three of these species (A. versicolor, A. sydowii &  A. glaucus) are noted to have medical importance.
The study compares genomes and concludes that much has been learned about the influence of genetic changes on phenotypic differences seen across this diverse genus. Many of the genomic featured discovered may improve prospects for future new medical and biotechnological applications.
Featured Website Section
The Patients website now has an addition to its 'Keeping Well' section. Breathlessness impacts the health of many patients with aspergillosis and there is some suggestion that some groups of patients feel the need for more support in this area. 
Consequently we have added a page outlining the causes and diagnosis of breathlessness for patients along with advice on how to recognise an attack that needs rapid referral to medical support.
Management of breathlessness is of primary importance and there are often ways that patients can contribute such as by taking regular exercise, ensuring that they take medication in the right way and avoiding or better managing anxiety.
A simple tip that was recently investigated in a research paper is to use a handheld fan to blow air across the face of a patient, often self administered. Our patient groups were very supportive of this as a great way to lower anxiety and improve breathing.
We have learned much about the range of sensitivities to moulds in the general world population but this information is mostly about only three fungal species including Aspergillus fumigatus, presumably because A. fumigatus  is the main airborne pathogenic Aspergillus species.
This paper looks at sensitization to ten other fungal species in a healthy general population and discovered that one in three were sensitized and the strongest reactions were to A. niger and Alternaria alternata. 25% of the major reactivities were against moulds that are common indoors.
Of the 9 cases of proven invasive aspergillosis (IA) the Aspergillus lateral flow device detected only 1 with a further 1 detected when the sample was pretreated (pretreatment includes heating samples for 3min in a boiling water bath, centrifuge for 5 min at 14,000 rpm and using 100ul to load the device - Thornton 2012). Sensitivity of this tool thus seems low even after pretreatment but there were no false positives and numbers of IA patients in the study were low. Galactomannan successfully detected 92% IA in the same samples though only after pretreatment (32% prior to pretreatment). More work is needed to optimise the use of the lateral flow device for use at point-of-care and the preparation of samples beforehand.
These patients are rare but increasing in number, thought to be due to aggressive medication with steroids or other immunosuppressant and antibiotics. 10 Patients were treated over 2 years using surgical resection following by voriconazole therapy. All nine patients responded well to treatment with only 2 out of 9 developing intolerance to voriconazole.
A better understanding of the global epidemiology of Aspergillus fumigatus is important if we are to understand how to control this important pathogen and to understand how antifungal resistant strains spread for example. The authors sampled isolates from 13 countries in four continents and detected genetic relationships between them.
Azole resistant populations exhibited significantly different population structures reflecting differing selective pressures on the two. These results suggest that global populations of A. fumigatus are shaped by historical differentiation, contemporary gene flow, sexual reproduction, and the localized antifungal drug selection that is driving clonal expansion of genotypes resistant to multiple triazole drugs.
This study is by far the largest of its type and the authors hope that it may play its part in limiting azole resistant gene flow.
The author reviews (PhD thesis) the emergence of azole and echinocandin resistance in clinical samples of Aspergillus and Candida respectively that present unforseen challenges to the clinician. For Aspergillus fumigatus a leading concern for management of this change is the environmental origin of resistance. The author urges better surveillance and awareness.
The authors review the evidence supporting the use of galactomannan (GM) for diagnosis and as a biomarker to measure response to antifungal therapy.
They conclude that although much progress has been made, more work is required to define ways to use GM in the early stages of treament in the best way to influence therapeutic decisions for each individual patient.
We have modified our listing of courses so that you can now see them as a list as well as on a calendar.
Specialization Course in Medical Mycology, KU Leuven Campus Gasthuisberg, Belgium Sept 11-21 2017 (Registration deadline 1st May).
Contribute to clinical data on rare infections:

Patients & Carers
A group of us were treated to a singing session at this months meeting at the National Aspergillosis Centre. Intended as a taster session two professional musicians (Nigel and Pam) led 30 mins of preparation and then singing culminating in a 3 part harmony! None of us had had any prior experience and by the end a very respecable sound was created! 
The point of doing this is to provide an opportunity for our patient community to explore the health giving aspects that singing gives to people with respiratory illness - these are described well in a recent article. There are many benefits (social, exercise, improved control over breathing) though many of us were quite unsure at the start Nigel was very persuasive and comforting - the main outcome was FUN! Listen to the recording here.
This event was so enjoyable we will attempt to set up a regular monthly singing opportunity - possibly by SKYPE as well as in the more traditional setting.
Remember our Skype meeting every week! We are a chatty group of 8 - 12 most weeks but we can accomodate up to 24. If you have a computer or phone that has APP's you will be able to install Skype and join in - instructions at the link below. Skype at 11am GMT every Thursday. Instructions will change over the next few weeks so go to for the latest information.
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 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