Decline in autopsy rate leads to underdiagnosis of fungal disease?
 Autopsy rates in many European, Asian and American countries have declined steadily - down to 3% in Germany by 1999 compared with 10% as recently as 1980. Overall rates are much higher in the United States but there has still been a major decline from 67% to 26% between 1989 and 2003.
Reasons for this decline are given as a dislike amongst the public for them to be carried out, the introduction of requirement for consent by next of kin and the cost of performing an autopsy.
Statistics show that 20-30% of patients who die in hospital have lesions or infections that are only detected via autopsy - many of which are fungal infections. The rates of fungal infection causing death are therefore underestimated in the collection of national statistics unless autopsies are performed.
National health provision, medical education and training in many countries is driven in part by 'cause of death' statistics, so underrepresentation of fungal infections in these figures leads to inadequacies in many areas, not least that of ensuring a clinician has accurate statistics on which to base clinical judgement.
Read more on this subject here.
This Month
There is a lot of activity going on behind the scenes here to generate a lot of new content based around information for patients. The Aspergillus for Patients webpages are being expanded and completely redesigned as part of the merging of the Aspergillus Trust website with the Aspergillus Website. Much of this will be released in May 2009 but a small part of this effort has gone live this month.
 The Aspergillus Support patients group is an outstanding success with over 700 members and continues to grow steadily. Our aim is to reach as many people as possible so we can offer support and since Aspergillus Support was formed some 10 years ago there have been several changes in how the internet is used to provide social contact. One of the most popular and successful ways to reach a large number of people is now the social utility website at Facebook (180 million members).
The aim of our efforts is to support as many people as possible who suffer from Aspergillus diseases so we have created a new Aspergillus Support community in Facebook which we hope will promote more interest and spread the word further afield. We would hope that both groups will exist side by side.
Latest News and Articles
There have been 44 additions (13 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:
Autophagy in the filamentous fungus Aspergillus fumigatus
A book chapter on this emerging field. Autophagy is the rapid turnover of internal organelles - useful when slowing growth down or shutting it off altogether during conidiation (spore formation) for example. Theoretically manipulation of the autophagy mechanism should be able to slow down growth of Aspergillus - useful when trying to eradicate infection.
Complement and fungal pathogens: an update
A review of the current understanding of the interplay between part of the hosts immune system (complement) and the fungal pathogen attacking the host: a potential source of new targets for antifungal drugs/strategies.
Increasing the efficiency of complement is one aim so that fungal infection can be fought more aggressively, however this could also increase fungally-induced allergic reaction - there is a difficult compromise to be found.
Effects of oral posaconazole on the pharmacokinetics of sirolimus
Antifungals and immunosuppressants are often coadministered to transplant recipients as antifungal prophylaxis is an excellent precaution against infection. Both drugs interact with cytochrome P450 isoenzyme CYP3A4 and may do so in a way that conflicts so this study was set out to test that possibility.
Sirolumus concentration and kinetics were tested before and after administration of posaconazole. The results were consistent with posaconazole inhibiting the activity of P450 isoenzyme, increasing the concentration of sirolimus in the blood of volunteers.
Coadministration of sirolimus and posaconazole is NOT considered appropriate.
Standards of care for patients with invasive fungal infections within the United Kingdom: a national audit.
Improvement in microbiology and histopathology specimen processing aswell as rapid
interventions such as initiation of anti-fungal therapy or CVC line removal could improve diagnostic
rates and clinical outcomes of invasive fungal infections.
Reviews
Aspergillus flavus: an emerging non-fumigatus Aspergillus species of significance
Aspergillus flavus (15-20%) is the second most frequent pathogen involved in invasive aspergillosis after A. fumigatus (80%). It is also important worldwide in sinusitis and keratitis. This article review the literature.
Protective Interventions to Prevent Aflatoxin-Induced Carcinogenesis in Developing Countries
A review of the adverse health effects of aflatoxins in the diet of those in developing countries. Acute and chronic effects as well as less well known new risks e.g. hepatitis B virus infected individuals exposed to low doses of aflatoxin increase their susceptibility to liver cancer..
Diagnosis
Don’t throw your blood clot’s away: Use of Blood Clot may improve sensitivity of PCR Diagnosis in Invasive Aspergillosis
PCR template preparation using blood clots rather than blood or serum improves the quality of the DNA and therefore the sensitivity of the reaction.
Jobs
There are two vacant positions currently advertised in the website:
- Consultant in Infectious Diseases, National Aspergillosis Centre, Manchester, UK
Closing date for applications 20th March 2009
- Principle Investigator, International Center for Biomedical Science, Fenhu, China
Please note advertisments of vacant positions on the Aspergillus Website are free of charge and available to everyone here. We will mention any new positions in this newsletter.
Genomes
Aspergillus terreus has been added to the list of species we have searchable genome information for.
Species Database
We have the original papers of 184 asexual forms, 36 sexual forms and 27 previous names located in the Species Database. You can see them all listed if you tick the box entitled 'Species for which the original paper is available' and then click 'Search' (NOT 'List all species').
Images
 New images of a fungal ball removed from a sinus - crushed and viewed under a microscope. Kindly provided by Dr Serda Kantarcioglu, Cerrahpasa Medical Faculty, Istanbul, Turkey.
Blog
Running at roughly 4000 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.
This month it has covered the intimate relationship between house dust mites and Aspergillus (and asthma), novel efforts to find new antifungal drug targets (hsp90) , allergic aspergillosis in people with cystic fibrosis and the protection of vulnerable patients from aspergillosis not to mention the development of oral amphotericin B..
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
Download 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.
What is RSS and how do I use it? Get help here.
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The Aspergillus Team.
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