Talks given for patients of aspergillosis and aspergilloma on a variety of health related subjects. Includes a talk on implications for CGD and CF patients http://www.aspergillus.org.uk/newpatients/podcasts.xml Aspergillus Website http://blogs.law.harvard.edu/tech/rss en-gb Wed, 5 May 2010 14:56:18 +0100 gtatherton@googlemail.com Wed, 5 May 2010 11:51:08 +0100 admin@aspergillus.org.uk FeedForAll v2.0 (2.0.3.1) unlicensed version http://www.feedforall.com Talks given at the Aspergillosis for patients meeting in Rome 2010 Sufferers of the wide range of health problems caused by the fungus aspergillus come from several different health groups; ABPA, CPA, asthmatics, CGD, CF and more. We present here a series of talks aimed at those patients and given by world experts in each field Aspergillus Website Graham Atherton gtatherton@googlemail.com aspergillosis, aspergillus, aspergilloma, ABPA, Cystic Fibrosis, Chronic Granulomatous Disorder, Sick Buildings, CF, CGD no no Dr Segal makes the case for prevention of aspergillosis in CGD, including prophylactic use of antifungals and avoidance of exposure to mould. http://130.88.242.202/Medicine/Aspergillus/newpatients/segal01.m4v Science & Medicine 605480A5-2BE6-432F-ABAA-C8A0B1CAD9F1 Wed, 5 May 2010 11:51:08 +0100 Invasive mould infection is the most significant cause of mortality in CGD, and Aspergillus is the most common cause of pneumonia for people with this condition. Chronic granulomatous disorder (CGD) is the result of a genetic mutation and causes excessive inflammation. Invasive mould infection is the most significant cause of mortality in CGD, and Aspergillus is the most common cause of pneumonia for people with this condition, so the need to destroy the Aspergillus but minimise inflammation calls for treatment with a combination of antifungal agents and steroids. However, there are often few signs that people are infected. 00:30:35 CGD, aspergillus, antifungal treatment no no The usefulness and problems associated with steroid treatment of aspergillus infections, in combination with antifungal drugs. http://130.88.242.202/Medicine/Aspergillus/newpatients/lewis01.mp4 Science & Medicine 4E83B76B-1F34-4204-AC70-3A52057F1F28 Wed, 5 May 2010 10:35:41 +0100 Effectiveness of steroids and antifungals in the treatment of aspergillus infections. Steroids are used to control inflammation in ABPA, but giving people cortisone suppresses their own production of cortisol (important for coping with stress and providing a feedback mechanism for the immune system) and can produce side effects including muscle weakness, diabetes mellitus, cardiovascular complications, glaucoma, depression and osteoporosis. Steroids affect natural immunity, suppressing cell-mediated immunity and masking the symptoms of infection. The risk of negative effects of steroid use can be minimised by direct administration of the medication to the lungs, and by using the minimum necessary dose. Many drugs need to be modified by the liver before excretion. Azole antifungals (e.g. Itraconazole, Voriconazole and Posaconazole) work by inhibiting an enzyme found in fungi, but can also inhibit liver function. 00:24:03 steroids, antifungals, aspergillus no no Dr Stanzani explains that fungal cells are very similar to human cells, and that drugs which are toxic to fungals cells may have the same effect on human cells. Mortality in invasive aspergillosis depends largely on the timing of the intervention, timely diagnosis and the state of the patient’s defences – treatment is much more effective when people have an intact immune system. http://130.88.242.202/Medicine/Aspergillus/newpatients/stanzani01.m4v Science & Medicine F0D322C9-DC8B-4949-B76A-EC3DFA3E1555 Tue, 4 May 2010 13:38:26 +0100 Fungi are opportunistic and can become a problem when human defence systems break down and fungal infection results. Because of the similarity of fungal and human cells, drugs which are effective against fungi can also be toxic. Mortality in invasive aspergillosis depends largely on the timing of the intervention, timely diagnosis and the state of the patient’s defences, treatment is much more effective when people have an intact immune system. Effective intervention depends on knowledge of the condition, high awareness of the possibility of its occurrence, early recognition and early treatment. Early diagnosis requires continuous and specific screening. 00:20:18 Marta Stanzani invasive aspergillosis, immunosuppression, no no Cystic fibrosis (CF) occurs in 1 in 4,000 births, and there are approximately 70,000 people worldwide who have CF. Aspergillus lung infection is often found in people with CF, is more common in adults and becomes increasingly common as lung function declines. http://130.88.242.202/Medicine/Aspergillus/newpatients/Mossnew01.m4v Science & Medicine 5D8E3665-1D19-4D85-9F41-F1CEE603DCF9 Wed, 21 Apr 2010 14:51:35 +0100 Cystic fibrosis (CF) occurs in 1 in 4,000 births, and there are approximately 70,000 people worldwide who have CF. Aspergillus lung infection is often found in people with CF. CF often has some of the features of allergic bronchopulmonary aspergillosis (ABPA), and ABPA may be diagnosed in people with CF when there is evidence of clinical deterioration, a high IgE level, an allergic reaction to Aspergillus on skin or blood testing, presence of IgG antibodies and new abnormalities on chest X-ray. As ABPA hastens the loss of lung function in CF, there is an argument for screening for ABPA in people with CF from school age, and treating the condition with corticosteroids and antifungals. 00:43:42 Rick Moss cystic fibrosis, aspergillus, ABPA no no Prof. Denning describes chronic pulmonary aspergillosis (CPA) as a long-term invasive disease, generally episodic in nature. Common symptoms are cough, shortness of breath, weight loss, tiredness, coughing up blood and aching or discomfort of the chest. http://130.88.242.202/Medicine/Aspergillus/newpatients/Denningnew01.m4v D24AC3D6-C7DD-4B5C-8B83-5BDAFF764C5C Wed, 21 Apr 2010 13:37:08 +0100 Chronic pulmonary aspergillosis - symptoms, outcome and treatment. The prognosis is good for people with CPA once treatment has been established, although there is evidence that long-term treatment is necessary to prevent relapse. As there is an increasing problem with azole resistance, the use of azoles needs to be well monitored. 00:25:57 David Denning Chronic, pulmonary, aspergillosis, no no Antifungal drugs (e.g. Itraconazole, Voriconazole and Posaconazole) have a variable and unpredictable dose–concentration relationship, and therefore need careful concentration management. Problems may occur whether the concentration is either too low or too high, and it is difficult to maintain a concentration that falls within the therapeutic window. http://130.88.242.202/Medicine/Aspergillus/newpatients/Andes02.m4v 2406402B-23C0-495B-A46A-E9A0214C3D24 Tue, 20 Apr 2010 13:28:04 +0100 Antifungal drugs (e.g. Itraconazole, Voricaonazole and Posaconazole) have a variable and unpredictable dose–concentration relationship, and therefore need careful concentration management. Antifungal drugs (e.g. Itraconazole, Voricaonazole and Posaconazole) have a variable and unpredictable dose–concentration relationship, and therefore need careful concentration management. Problems may occur whether the concentration is either too low or too high, and it is difficult to maintain a concentration that falls within the therapeutic window. 28:24 David Andes MD Antifungal, levels no no Dr Massard discusses the options for surgery in aspergilloma and invasive aspergillosis. http://www.aspergillus.org.uk/newpatients/Massard%2001.m4v BD102C4E-C728-4E00-8DEB-4E6012980FD1 Tue, 20 Apr 2010 13:11:36 +0100 Dr Massard discusses the options for surgery in aspergilloma and invasive aspergillosis. Surgical resection should be considered for only the most dangerous of lesions. Factors predicting a low rate of operative complication are youth, lack of underlying lung disease and limited resection; operative death rate for this procedure is about 10%. 43:29 Gilbert Massard Aspergilloma, surgery, aspergillosis no no There is evidence that occupants of damp or mouldy buildings are at increased risk of respiratory symptoms, that remediation of dampness can reduce adverse health outcomes, that exposure to mould increases the risk of various conditions and that allergic people are particularly susceptible. http://130.88.242.202/Medicine/Aspergillus/newpatients/Richardson01b.m4v Science & Medicine 64453CAC-8A00-4AE4-8B76-BD4BEF6ED16F Tue, 27 Apr 2010 15:25:25 +0100 The monitoring of the local environment, remedies for dealing with dampness and why some individuals are susceptible is discussed. There is evidence that occupants of damp or mouldy buildings are at increased risk of respiratory symptoms, that remediation of dampness can reduce adverse health outcomes, that exposure to mould increases the risk of various conditions and that allergic people are particularly susceptible. 00:57:15 J Bartholomew Environment, monitoring ,damp,mouldy no no