Antifungals for Severe Asthma
 Asthma is known to react to a series of allergens that are breathed in by the sufferer - pet dander, mites & pollens being major providers of those allergens. A minority of asthmatics react to fungal allergens, also present in the air. This group of patients are almost exclusively suffering from the more severe forms of asthma.
Denning et al. have published the results of a clinical trial in which it was demonstrated that treating severe asthma with fungal sensitisation (SAFS) with the antifungal drug itraconazole resulted in improved quality of life, reduced IgE, improved rhinitis score and morning peak flow.
Most patients were sensitised to only 1 or 2 of 7 seven fungi tested, and the improvements in quality of life occurred regardless of the fungus that tested positive, but only in ~60% of patients.
If further studies bear this conclusion out then we have a proven fungal involvement in some severe asthmas, which is a novel finding that may well enable the improvement of the management and treatment of many asthmatic people.
There is no logical reason why an antifungal medication should improve asthma symptoms if all that is contributing to the symptoms is the presence of fungal allergens. This result suggests that fungus is growing within the patients lungs, rather like it does in allergic bronchopulmonary aspergillosis (ABPA) and that the antifungal medication is preventing growth of the fungus.
This Month
Several interesting new developments have taken place over the last month.
You might notice that we have two or three sections that still require registration to view. This is because they contain articles or information that authors did not want to be indexed by search engines such as Google. We also do not want many of the more potentially distressing clinical images or videos that we feature to be copied to places where people may come across them without warning and thus be exposed to material they find distressing.
 Unfortunately these decisions mean that the material contained in these sections can be difficult to find unless a user is already browsing the Aspergillus Website. We are taking steps to allieviate this problem as much as possible by making excerpts of articles available and releasing a subset of non-offensive images to the search engine indexing 'bots'. You will find that this makes much of the content formerly hidden from Google now appears in Google with links to the original content (search for 'Aspergillosis case histories' or 'chronic pulmonary aspergillosis treatment' for example).
We now have the original descriptions of an additional 63 species of Aspergillus available in the Species database. papers can be downloaded via the specific species page using the 'Original Paper' link e.g. Aspergillus alutaceus.
Latest News and Articles
There have been 51 additions (7 reviews) to the articles section. Readers should also note that it is now possible to read the abstract of each article simply by clicking in the Abstract link appearing alongside each article. We have picked out a few of the highlights here:
A 1-year Aspergillus terreus surveillance study at the University Hospital of Innsbruck: molecular typing of environmental and clinical isolates. Aspergillus isolates from patients tended to be unique with respect to other patient infections and fungi in the local environment. There was no evidence that infection originated from a single source or from a single strain of the fungus.
Pathophysiological study of chronic necrotizing pulmonary aspergillosis
Histopathological examination revealed that the cavity wall consisted of three layers comprised of necrotic, granulation, and fibrous tissue layers. Aspergilli were found in both the fungus ball and necrotic tissue comprising the inner layer of the cavity. In addition, most of the vessels were incompletely occluded with thrombosis and were necrotic, as well as showing local invasion of Aspergilli. The authors reccomend that surgical intervention should be considered as a prior procedure for CNPA patients, because vessels at the cavity wall, whether occluded completely or incompletely, are usually necrotic and/or show local invasion of Aspergilli.
Proteomic analysis of Aspergillus nidulans cultured under hypoxic conditions.
The fungus Aspergillus nidulans reduces nitrate to ammonium and simultaneously oxidizes ethanol to acetate to generate ATP under hypoxic conditions in a mechanism called ammonia fermentation. This paper compares the proteins present under normal (normoxic) conditions of growth with those when the fungus is growing under hypoxic (low oxygen) conditions using 2 dimensional electrophoresis.
The results also showed that
proteins in the pentose phosphate pathway as well as the metabolism of both nucleotide and
thiamine were upregulated under hypoxic conditions.
Reviews
Primary prophylaxis of invasive fungal infections in patients with hematologic malignancies. Recommendations of the Infectious Diseases Working Party of the German Society for Haematology and Oncology Posaconazole 600 mg/d is recommended in patients with acute myelogenous leukemia/myelodysplastic syndrome or undergoing allogeneic stem cell recipients with graft versus host disease for the prevention of invasive fungal infections and attributable mortality (Level A I). Fluconazole 400 mg/d is recommended in allogeneic stem cell recipients until development of graft versus host disease only (Level A I). Aerosolized liposomal amphotericin B is recommended during prolonged neutropenia (Level B II).
Treatment
The article/review on 'Keratitis' by Philip Thomas has been extensively updated and rewritten. Likewise a new image of a keratitis has been added to the image library. Registration is required (no charge) to view treatment articles and images.
Genomes
A paper describing the genomes and tools available in the Genomes section has been published. In particular it looks at the integration of the medical information available on the Aspergillus Website with the genome information found on the CADRE website.
Species Database
Collecting the original descriptions of as many species as we can is a long term project - these date back to 1834. We currently have well over 100 as a new batch of 63 were uploaded this month.
Images
 Images of Aspergillus fumigatus forming biofilms on bronchial epithelial cells in vitro can be seen in the image library, plus and image of Aspergillus keratitis following transplantation of amniotic membrane (AMT).
There is also a pair of images from an Aspergillus bilateral endophthalmitis.
Registration is required (no charge) to view images.
Blog
Running at roughly 3000 accesses per month the Aspergillus Blog has been an outstanding success since its inception in March 2008, doubling in use every two to three months.
Patients
We run a highly active support group and Question & Answer bulletin boards for all patients and their relatives.
Technical Tips
Our discussion group (email and/or website) designed to promote discussion on technical issues for laboratory workers.
Searching the website
There is now a third facility to search for information on Aspergillus. Covering all the information in the Aspergillus Website and including a series of websites we feel contain useful information NOT currently available on the Aspergillus Website, the Aspergillus World search engine contains large amounts of focussed information from all over the world. If you can suggest more (particularly keen to access information on industrial applications) then let us know at admin@aspergillus.org.uk.
RSS
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The Aspergillus Team.
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