June 2019
  Research highlight
Antifungal resistant isolates of Aspergillus fumigatus found in flower beds close to city centre hospitals.
Researchers from Imperial College London report this week that elevated levels of azole resistant Aspergillus fumigatus isolates are present in urban environments, particularly in flower beds close to hospitals.
The team from Imperial sampled soil from several environments, from remote forests to hospital flower beds, in order to determine the prevalence of azole resistant isolates in the south of the UK.
Resistance was detected in 6.7% of the soil samples, with urban areas showing a higher prevalence (13.8%) than rural sites (1.1%).  This contradicts the hypothesis that resistance is driven by the environmental application of azoles in arable agriculture. In fact in this study, of the 53 samples collected directly on or surrounding agricultural land, zero azole-tolerant isolates were identified.
A particularly concerning discovery was the repeat isolation of resistant isolates from flower beds surrounding city centre hospitals. Concerns over the use of azole treated flower bulbs has been raised before and is of concern because of the ability of A. fumigatus to cause serious, life threatening infections in immunocompromised patients.
Elevated prevalence of azole resistant Aspergillus fumigatus in urban versus rural environments in the United Kingdom. (Sewell et al., 2019)
  News and notices
Don't miss the next AIDS-related Mycoses meeting, which will be held in Cape Town, South Africa from the 10th to the 12th of July. Register now!
Also approaching are the Annual Meeting on Infectious Diseases in Amsterdam, Netherlands from the 29th to the 30th July, and the 5th conference on Emerging Infectious Diseases and Biosecurity in Nigeria from the 7th to the 9th August.
Did you apply for MoMy this year? Congratulations if you were accepted and enjoy! Molecular Mycology (MoMy): Current Approaches to Fungal Pathogenesis, Marine Biological Laboratory, MA USA from the 17th July to the 2nd August.
The Fungal Infection Trust are asking for feedback on their antifungal interactions app. If you use the app or database as a clinician or researcher please complete this survey and let FIT know of any improvements you’d like to see.
  Research articles
Burden of fungal asthma in Africa: A systematic review and meta-analysis. (Kwizera et al., 2019)
This systematic review and meta-analysis estimates the incidence of asthma in Africa and the prevalence of ABPA and SAFS within this group. Using data from the Institute of Health Metrics and Evaluation from between 1990 and 2017, plus all studies of any design focussing on fungal asthma in any African country, the authors estimate that approximately 4 million adult asthmatics have fungal sensitisation in Africa.
Recreation of in-host acquired single nucleotide polymorphisms by CRISPR-Cas9 reveals an uncharacterised gene playing a role in Aspergillus fumigatus azole resistance via a non-cyp51A mediated resistance mechanism. (Ballard et al., 2019)
This paper describes a clinically relevant novel azole resistance mechanism in A.fumigatus that is not cyp51A mediated. The isolates investigated were obtained from a patient suffering from persistent and recurrent invasive aspergillosis. The specific SNP was identified as 167* in AFUA_7G01960 and was acquired in-host during infection.
Chronic Pulmonary Aspergillosis (CPA) in a Tertiary Care Centre in Spain: A Retrospective, Observational Study. (Aguilar-Company et al., 2019)
This is the first study providing an overview of the features of CPA in patients from Spain. Chronic cavitary pulmonary aspergillosis (CCPA) was the most frequent form of CPA and A. fumigatus the most frequently isolated species. Patients with cancer history and subacute invasive aspergillosis (SAIA) had a worse prognosis.
Serial monitoring of isavuconazole blood levels during prolonged antifungal therapy. (Furfaro et al., 2019)
This paper characterises the assessment of the blood levels of isavuconazole and their association with efficacy and toxicity using therapeutic drug monitoring in patients with invasive aspergillosis. The authors found that isavuconazole was efficacious and well tolerated. Side effects, mainly gastrointestinal, were associated with prolonged administration and high serum levels.
Culture-Documented Invasive Mold Infections at MD Anderson Cancer Center in Houston, Texas, Pre– and Post–Hurricane Harvey (Dimitrios et al., 2019)
Following hurricane Harvey immunocompromised patients raised concerns about mold infections caused by flooded damp homes. This study sought to evaluate the impact of hurricane Harvey on the incidence of culture-positive invasive mold infections in patients treated at MD Anderson Cancer Center in Houston, Texas. No emergence of unusual mold infections was seen.
Invasive Aspergillosis in solidā€organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice (Husain and Camargo, 2019)
This paper describes updated AST-ISCOP guidelines which provide information on epidemiology, diagnosis, and management of Aspergillus after solid organ transplantation. Risk factors for invasive aspergillosis in organ transplant recipients are given, as well as clinical manifestations, and strategies for diagnosis, treatment and prevention. Finally, this paper outlines the areas where further work is required for example, the development of ECVs/breakpoints for isavuconazole against Aspergillus to aid in the interpretation of isavuconazole MICs.
  Veterinary articles
Equine ulcerative keratitis with furrow: A review of the outcomes of 72 cases from 1987 to 2015. (Berkowski et al., 2019)
Ulcerative keratitis with peripheral furrow formation is a poorly-described condition in horses which has been associated with a grave prognosis due to rapid necrosis of the cornea. This paper uses 72 retrospective case histories to describe the infectious aetiologies associated with furrow-forming ulcerative keratitis, its overall clinical course and the efficacy of medical and surgical intervention in horses.
Innate and adaptive immune responses to fungi in the airway. (Bartemes and Kita, 2018)
This review discusses our current understanding of the complex biology of fungi and gives a detailed description of the mechanisms by which they activate the immune responses that can protect against, or contribute to, disease in humans. There is specific emphasis on airway allergic immune responses. The gaps in our knowledge and desirable future directions are also discussed.
  Patients and carers
The Fungal Infection Trust are asking for feedback on their antifungal interactions app. If you use the app or database as a patient or carer please complete this survey and let FIT know of any improvements you’d like to see.
The European Respiratory Journal published an article recently about living with allergic bronchopulmonary aspergillosis from a patient’s perspective. This is a poignant account of the everyday trials that living with aspergillosis brings.
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 call by downloading the Zoom software by following this link: https://zoom.us/j/243782379. This meeting runs from 11:00-12:00 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. 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. (Facebook Broadcast
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 have a public group and a private group.
  • 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 the following terms within Facebook: 'aspergillosis'; 'aspergillus'; 'ABPA'
Clinical networks
3rd Aids-Related Mycoses Meeting (10-12 July 2019 Cape Town, South Africa)
Annual Meeting on Infectious Diseases (29-30 July 2019 Amsterdam, Netherlands)
(5-7 September, Mannheim, Germany)
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