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Major review of fungal infections after stem cell transplant
This review looks at the recent developments in diagnostic tests and in the use of antifungal prophylaxis to prevent fungal infection. The impact of newer antifungals (voriconazole) as primary therapy with higher efficacy (fewer side effects compared with amphotericin though still a problem for patients with liver dysfunction) are also discussed, with itraconazole, posaconazole and caspofungin mentioned as an appropriate second line therapy and are shown to have achieved 40-50% responses. Combination therapy utilising two antifungals that have different targets of activity at the same time is also assessed, particularly for invasive aspergillosis. There may be a synergistic (i.e. greater effect than either on their own would suggest) advantage to using an echinocandin antifungal or a polyene (e.g. amphotericin) alongside voriconazole (but not itraconazole), and there may be fewer side effects as a result. Results show lower mortality in both cases. Further improvement in mortality figures is suggested to be possible by:
This Month
Latest News and ArticlesArticles: There have been a 153 additions to the Articles section, of which 14 are reviews. NOTE we have rearranged the Articles index page to make it easier to look at recent articles as well as those that were added recently but were written some time ago. We have picked out a few of the highlights here: The microbiological quality of air improves when using air conditioning systems in cars Regular use of well maintained (regularly changing air filtration material) air conditioning systems in a car causes an 80% drop in mould content of the air within the car, demonstrating that the air filtration is quite efficient for particles the size of a mould spore. However leaving the air conditioning airflow switched off (which some might do to save fuel) was shown to have potential for allowing the growth of mould within the filter material. Three new compounds (bisabolane-type sesquiterpenoids) are isolated from a marine Aspergillus species isolated from a Sea Whip growing in the South China Sea. Secreted Aspergillus fumigatus protease Alp1 degrades human complement proteins C3, C4 and C5 The human complement system is an important part of its immune response to infection. It is shown in this paper that Aspergillus fumigatus can directly attack the human complement system by secreting the Alp1, an enzyme capable of 'chopping up' proteins such as complement proteins into inactive pieces. A. fumigatus mutants that contain inactive Alp1 cannot attack the complement system. This is an example of one way that A. fumigatus can evade the human immune system during an infection. A public resource for metabolic pathway mapping of Aspergillus fumigatus Af293 The next step after defining all of the genes in an organism is to start to piece together how all these genes interact to synthesis the final metabolic products needed to construct and maintain a cell. Metabolic pathways are starting to become available (MetaCyc) as researchers undertake the long painstaking process of piecing each part of each metabolic pathway together. The Aspergillus Website is playing its part in this process by making putative metabolic pathways generated from Aspergillus genome sequence data availalble to enable active collaboration for any number of groups to work together on this project. ReviewsPrimary Invasive Oral Aspergillosis: An Updated Literature Review Primary oral aspergillosis is a very rare infection of immunocompromised patients. 26 cases are presented in this review along with details of differential diagnosis, histopathology and treatment options. 12 studies analysed to determine if measurement of galactomannan in fluid taken directly from the lungs is a sensitive method to detect invasive aspergillosis. The conclusion was that it is a very sensitive and accurate method, suitable for diagnosing invasive aspergillosis. Treatment (Registration required)Extensive, fully updated article on Aspergillus tracheobronchitis written by Sahlawati Mustakim has been uploaded Medical Images (Registration required)
Images from a patient with pseudomembranous aspergillus tracheobronchitis, including CT scans, Xrays, histology and bronchoscopy can be viewed in the image library in the airways section. Conference AbstractsThe conference abstracts of the 20th European Congress of Clinical Microbiology and Infectious Disease (ECCMID) are now available here PatientsA new monthly patient meeting began in June 2010 based in Manchester, UK. This is intended for UK patients but we are trialing access via Skype for overseas patients. For more details email admin@aspergillus.org.uk Our first Patient's meeting outside of Manchester will take place in Edinburgh on Sunday morning 3rd October as part of the 'From Another Kingdom' exhibition - more details soon! A patient volunteer is making & selling handmade cards for birthdays in aid of the Fungal Research Trust. 6 cards for £6 and 75% of that goes to the FRT. Order here. There is a newly designed Patients website now entitled 'Aspergillosis Patient Support'. Much more comprehensive than before and easier to navigate but with the same successful support group and Q & A board Jobs1 new job currently being advertised: View PhD Studentship: Identification, characterisation and validation of antifungal gene targets in pathogenic moulds. Closing date 28th June 2010. Advertise your vacancy free of charge on the Aspergillus Website here. Optional donation to the Fungal Research Trust to cover costs incurred in providing this newsletter. Courses and WorkshopsWe keep a listing of courses and workshops including 'one off' events and courses that repeat regularly. Course subjects are wide ranging and include medical mycology, lab ID, young scientists symposia and much more. Those coming up next are:
If you know of a course that should be added to this list please add it by contacting us here. VeterinaryEfficacy of voriconazole in Japanese quail (Coturnix japonica) experimentally infected with Aspergillus fumigatus Repeated rhinoscopic and serologic assessment of the effectiveness of intranasally administered clotrimazole for the treatment of nasal aspergillosis in dogs Blog
DonationsSpecialist Aspergillosis Nurse Georgina Powell (National Aspergillosis Centre) has successfully completed the BUPA Great Manchester 10K Run in aid of the Fungal Research Trust. She raised a fantastic total of £250. The Steph Smith Appeal (walking 100 miles along the West Highland Way in Scotland, UK) successfully completed their walk in 4 days on the 10th of June 2010 and has raised over £1650 so far with more to come. Chris Schroeter successfully completed the gruelling Strongman event in Germany in aid of the Fungal Research Trust. Not only that he cycled to the event from the UK too! The Strongman Appeal has raised £50 so far with more promised. The combined total of these events should eventually exceed £2300 so many If you donated please check our list of donators for yourname. Technical TipsOur discussion group (email and/or website) designed to promote discussion on technical issues for laboratory workers. Searching for Aspergillus Information
RSSDownload our updates and articles automatically every time we add to those pages- no need to wait for the next newsletter. 40 000 pages accesses per month. Use RSS. You can now receive notification of updates to the Aspergillus Website on your mobile phone via SMS texting free of charge. Go to http://twitter.com/AspergillusWeb and open a Twitter account. Follow AspergillusWeb. Join the Aspergillus & Aspergillosis group to get in touch and keep in touch with your professional colleagues working in this field. All free of charge. Thanks for reading!Visit our website again soon. The Aspergillus Team. |
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The NCG
Fungal infection after haematopoietic stem cell transplantation (HSCT) has long been a major contributor to mortality. The rate of patients that don't survive has been high, largely due to the difficulty diagnosing infection quickly and accurately. Quickly so that treatment can begin as soon as possible, and accurately so that we can have more confidence in applying aggressive treatment with more confidence in the knowledge that the treatment is absolutely necessary. 
Some histology and pathology of |
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