Aspergillus Newsletter
June 2014

The rise of antimicrobial drug resistance

The World Health Organisation has published a detailed document showing the rise of resistance of microbes to the current range of antimicrobial drugs. Use of antibiotic and antifungal drugs need careful regulation in order to extend their use as far into the future as possible. 

A subsequent article published in Nature goes further and states that if we don't coordinate the use of antimicrobials on a global level we will shortly be entering a post-antibiotic era where common infections cannot be treated as they are now. So far there is no such substantial global effort.
Our News blog points out that part of the cause of rising resistance to antifungal drugs is the widespread use of similar antifungal chemicals to fight fungal infection of crops. Resistance to an agricultural azole seems to also give resistance to a clinical azole and once present in the environment these resistant strains of fungi are routinely breathed in - there is some evidence that people can have resistant infections as a result of this even though they have yet to be treated with an antifungal drug!
A significant paper associating patients attending hospital with asthma exacerbations and the concentration of Aspergillus spores in the air of their homes has been published. Fungi other than Aspergillus were identified but Aspergillus was the most strongly correlated with asthma exacerbation.
This is probably the first time Aspergillus fungal spores have been correlated with asthma in this way. There have been earlier studies (1, 2, 3) correlating Aspergillus with asthma  but these were done by identifying the fungi present using a DNA analysis of settled fungi (ERMI), or by identifying sensitivity to moulds via skin prick testing rather than directly from the air.
8 slide presentations from the 24th ECCMID are now available for viewing and include Raoul Herbrecht's talk on 'First line therapy with combined antifungal for aspergillosis' and Johan Maertens presentation on 'Designing new diagnostic-driven concepts'. Note that these slides are now viewed using a built in slide viewer on the web page rather than having to download and open them in Powerpoint.
Also highlighted this month in several places on the website is the incident of a young boy being treated for leukemia and who received a stem cell transplant but subsequently contracted aspergillosis. It has since been learned that there were failures to recognise the potential danger to immunocompromised patients caused by building works close to the hospital. The hospital and its staff were judged to have acted neglectfully in this instance. The tragic consequences of lack of awareness of the threat caused by fungal infection and potential potential sources of that risk are a lesson to be learned.
You can listen & read about several more stories from carers & patients on the LIFE website, including one from Nicola Horlick who's daughter Georgie also passed away from an aspergillosis infection after receiving successful treatment for leukemia. 

NOTE access to all articles now requires registration
Distinct and complementary roles for Aspergillus fumigatus-specific Tr1 and Foxp3þ regulatory T cells in humans and mice
Our data show that antifungal IL-10-producing LAPþ Tr1 cells exist in the peripheral blood of healthy humans and can be induced in mice via cooperative activation of c-Maf via IL-27 and AhR. Direct comparison of p41þ Tr1 cells with Foxp3þ iTreg of the same specificity showed that these Treg-cell subsets differ in their mode of induction and, in part, in their suppressive function. Given the ability of the p41-peptide to induce protective antifungal Tr1 cells as well as Th1/Foxp3þ iTreg cells,30 we suggest that this peptide provides a versatile tool to restore protective A. fumigatus-specific immunity in clinical settings of invasive aspergillosis and ABPA.

The utility of bronchoalveolar lavage beta-D-glucan testing for the diagnosis of invasive fungal infections.

Beta-D-Glucan (BDG) testing exhibits poor specificity and reproducibility in  bronchoalveolar lavage (BAL). Identification of the BAL-specific factors that may interfere with the performance of the assay could improve the clinical usefulness of BAL BDG testing.
This study highlights the potential impact of microbial volatiles in an ecological arena. Many of the compounds are likely aiding in niche securement and colony establishment through tempering of
normal physiological behavior of other microorganisms. The
spatial and temporal range of these compounds greatly increases
the potential interaction radius of the producing microbe, thus contributing to the dynamic nature of the soil microbiome. While the complexities of microbial volatile communication between two microbes can be difficult to grapple with, continued research in this field will surely expose that the interplay of volatiles from a variety of soil microbes plays an important role in shaping soil microbial ecology.

A better understanding of antifungal immunity and human susceptibility to IA has led to the identification of potential immune correlates of protection. Although incorporation of these biomarkers into clinical algorithms may potentially guide clinical decision making and lead to better outcomes, their clinical value remains to be defined. Clinical trials designed to evaluate the role of immune biomarkers in risk stratification strategies that facilitate individualized antifungal therapy/prophylaxis are urgently needed.
Antifungal interventions in ABPA improved patient and disease outcomes in both asthma and cystic fibrosis. However, the recommendation for their use is weak and clinicians should therefore weigh up desirable and undesirable effects on a case-by-case basis. More studies with a better methodology are needed, especially in cystic fibrosis, to increase confidence in the effects of antifungal treatments in ABPA.
Although Aspergillus infections among surgical patients have been associated historically with solid-organ transplantation, our data suggest that other patients may also be susceptible to such infections, especially those in an ICU who are deemed to be critically ill. This supports the idea that critically ill surgical patients exist in an immunocompromised state. Surgical intensivists should be familiar with the diagnosis and treatment of Aspergillus infections even in the absence of an active transplant program. Although Aspergillus infections among surgical patients have been associated historically withsolid-organ transplantation, our data suggest that other patients may also be susceptible to such infections,especially those in an ICU who are deemed to be critically ill. This supports the idea that critically ill surgicalpatients exist in an immunocompromised state. Surgical intensivists should be familiar with the diagnosis andtreatment of Aspergillus infections even in the absence of an active transplant program.
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
10th International Mycological Congress (Bankok, Thailand August 3 - 8).Early registration will be open at July 1, 2013. Abstract submission will begin July 2013
Indoor Air 2014 Deadline June 15th to pay registration fees
IUMS 2014 Deadline for accomodation June 16th
TEMPH 2014 Deadline for abstract submission and registration
Latin American Medical Mycology Conference (Infocus 2014) will take place in Curitiba - Paraná, Brazil on the 16th - 18th October 2014.
The next CBS Course in Medical Mycology will take place in Utrecht, The Netherlands, 17-28 November, 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.
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.
Veterinary Mycology in Practice ISHAM_VMWG-ESCVP Postgraduate Technical Workshop October 3rd 2014, Milan, Italy.<
Allergy Academy, King's College, London. Online resources for allergy education. Intended for all audiences including doctors & patients.
Computed tomographic features of feline sino-nasal and sino-orbital aspergillosis. These findings support the hypothesis that the nasal cavity is the portal of entry for fungal spores in feline URTA and that the route of extension to involve the orbit is via direct naso-orbital communication from bone lysis. Additionally, a pathogenic role for A. wyomingensis and a sinolith in a cat with A. udagawae infection are reported for the first time.
Trends in diagnosis and control of bovine mastitis: a review.This mini review gives an overview of all different aspects that act as trend setters as far as the diagnosis and control of bovine mastitis is concerned to help the diagnosticians; helping epidemiologists and researchers not to remain ignorant about this grave condition.
Veterinary Mycology in Practice ISHAM_VMWG-ESCVP Postgraduate Technical Workshop October 3rd 2014, Milan, Italy.
Attention Clinicians & Scientists
Case Histories Database 243 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.
Patients and carers newsletter - please click here to access
NOTE: support for patient organisations in the UK is available from Pfizer
Visit our Website
Donate to help upkeep of the Aspergillus Website
Also of interest...
News blog:

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 529 prescription drugs are searchable, 1991 interactions listed, 381 severe.

Aspergillus and Cosyus Indian (Series Researches) by Jasim Neeran and Azziz Zahra (30 Apr 2014)
New Approaches for Antifungal Drugs by Fernandes and Prabhavathi (10 Nov 2013)
Μελέτη των συστηματικών μυκητιάσεων
Study of systemic fungal infections by Παπαπέτρου, Ευαγγελία, University of Ioannina, 2013
NanoClusters Enhance Drug Delivery in Mechanical Ventilation by Pornputtapitak, Warangkana, University of Kansas, 2014.
Clinical Trials (39 Recruiting):
Case reports:
There are 243 aspergillosis cases reported here
Research & Supportive Grants:
Gilead UK and Ireland Fellowship Programme (cycle closes end of May 2014)
Lab protocols:
Fungal Infection Trust, PO Box 482, Macclesfield, Cheshire SK10 9AR, UK,