Antifungals for Paediatric Patients
 As more new antifungals are developed the weaponry available to the clinician to deploy against Aspergillosis and other fungal infections increases and becomes more effective for the adult patient.
Paediatric age groups have many important differences that have to be considered before using drugs that are established to treat adults. Host biology, predisposing conditions, epidemiology and presentation of infection can all differ in important ways that the clinician must consider prior to treatment.
Peadiatric age groups are increasingly being exposed to a high risk of invasive fungal infection as for example treatment for childhood leukemia forces the patients to undergo periods of neutropenia. During this time when the ability of the patient to fight off infection is low, invasive fungal infections regularly occur.
This new review by Groll & Tragiannidis offers an update on the safe use and dosing of all currently available antifungals drugs (including posaconazole and micafungin), and their clinical indications in paediatric patients.
Latest News and Articles
The Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) which has reached its 50th anniversary this year and has taken place in Boston, USA. We have 71 abstracts from this conference deposited in our Conference Abstracts database. These cover antifungals and aspergillosis.
New antifungals active against Aspergillus include Enfumafungin Derivative MK-3118, Novel Arylamidine T-2307, E1210, Type II Topoisomerase Inhibitor. Also progress from work on vaccines, combination therapy, prophylaxis, epidemiology & new diagnostic targets. See Conference Abstracts.
Articles: There have been 53 additions to the Articles section (50 full papers), of which 13 are reviews and 15 historical. We have picked out a few of the highlights here:
IgE sensitization to fungi mirrors fungal phylogenetic systematics
Molecular relationships between fungal species strongly resemble the patterns of IgE response to fungi in people sensitive to fungi. The suggestion is that the patterns of relationship between fungal species is reflected in patterns of IgE crossreactivity within those species, possibly revealing new areas for research into IgE crossreactivity components.
A retrospective series of gut aspergillosis in haematology patients
"Gut invasive aspergillosis is an extremely rare infection in immunocompromised patients. Gut aspergillosis is probably misdiagnosed and underestimated in haematology patients, owing to the poor specificity of symptoms and imaging. Patients with a persistently positive galactomannan antigenaemia finding that is unexplained by respiratory lesions should be suspected of having gut aspergillosis in the presence of abdominal symptoms, and be quickly investigated."
Computer tomography in pulmonary invasive aspergillosis in hematological patients with neutropenia: an useful tool for diagnosis and assessment of outcome in clinical trials
"The results of this prospective study suggest that the sequential analysis of CT scan in neutropenic patients with IPA depicts more precisely the evolution of lesion volumes than comparison to baseline images. Moreover, the systematic use of chest CT appears to be a useful tool for diagnosis and outcome evaluation of IPA in clinical trials."
Reviews
Invasive fungal infections in paediatric patients
Roilides & Walsh summarise the following four reviews on aspergillosis in this very specialised group of patients.
Epidemiology of invasive fungal infections in neonates and children
"Epidemiology is at the heart of medicine. Detailed epidemiology
allows us to understand which patients will become sick
and why, letting us determine who is at risk for developing
disease and therefore better direct our diagnostic and therapeutic
efforts as well as more accurately predict prognosis."
This review by Dr Bill Steinbach will highlight some of the available epidemiological data on paediatric invasive fungal infections.
Diagnosis of invasive fungal infections in immunocompromised children
"Early recognition and rapid initiation of effective treatment is a prerequisite for successful management of children with invasive fungal
infections. The increasing diversity of fungal pathogens in high-risk patients, the differences in the antifungal spectra of available agents
and the increasing rates of resistance call for identification of the infecting isolate at the species level and for information on drug
resistance, in order to provide state-of-the-art patient care."
Dornbusch, Groll & Walsh review the current state of the art.
Invasive fungal infections in congenital immunodeficiencies
"Congenital immunodeficiencies are hereditary disorders,
mainly single-gene abnormalities, that result in impaired
immune responses to a number of infectious stimuli. As a
consequence, patients may present with recurrent, protracted
or severe infections caused by common pathogens,
or with infections caused by opportunistic organisms,
including fungi"
This review by C. Antachopoulos systematically summarises invasive aspergillosis in immmunodeficient patients.
Update on antifungal agents for paediatric patients
See headline article.
Conference Abstracts
 50th ICAAC a few highlights
Global Prevalence of Chronic Pulmonary Aspergillosis (CPA) following Pulmonary Tuberculosis (PTB)
Frequency and Evolution of Triazole Resistance in Aspergillus fumigatus
Evaluation of Enfumafungin Derivative MK-3118 in Two Mouse Models of Disseminated Aspergillosis
Monitoring of Experimental Aspergillus Fumigatus Intracranial Infection Using Quantitative Culture and Real-Time PCR
Secreted Proteases of Aspergillus fumigatus (AF) as Targets for Diagnosis of Invasive Aspergillosis (IA)
Efficacy of a New Air Purifier against Aspergillus fumigatus
Experimental CNS Aspergillosis Therapy (Rx): Efficacy, Drug Levels, Toxicity
Effect of Different Molecular Sizes of Mannan as Vaccines against Invasive Aspergillosis
Lab Protocols - Appeal for more
We have added a large number of protocols to our listing, largely those used at the research labs in the National Aspergillosis Centre but with some more being awaited.
We would like this listing to become as comprehensive as possible so as to be able to assist all fungal researchers both new and established to find a protocol they need and which they can rely on. If anyone can add to our listing please let us know - just send us the rough copy and we will work it up to a publishable standard if needed.
Patients
Aspergillosis Specialist Physiotherapist Philip Langridge hosted an intensive question & answer session of the practical considerations & problems to be addressed when considering the benefits of exercise when you have a chronic pulmonary aspergillosis. This was followed by a short talk on breathing techniques to clear your lungs - active cycling technique. Information & video recording are/will be available here. The meeting was attended by 31 patients & staff.
We can now offer access to a recording of this talk and of Professor Richardson's talk in August on the Patients Website video resources. These are taken with a fixed camera and are unedited to attampt to give a full impression of what we do at these meetings.
Our first Patient's meeting outside of Manchester took place in Edinburgh on Sunday morning 3rd October as part of the 'From Another Kingdom' exhibition. The meeting was a great success with 29 attending a powerful and emotive talk by Liz Smith about her daughter Steph who died in 2009 from aspergillosis. Liz has since raised over £4000 in memory of Steph - when ready, a video will be available here.
There are plans developing to hold a second meeting outside of Manchester in London in mid 2011. If you are interested in attending as a patient or carer suffering from aspergillosis please let us know Email
 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. Christmas cards now available. 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
Jobs
Three jobs are currently being advertised:
- Research Assistant Professor/Research Scientist, Blacksburg, VA, USA. Closing date 19th November 2010
- Post doctoral position working on the molecular biology of dimorphism in Penicillium marneffei, Youngstown, OH, USA. Closing date 21st November 2010
- Physician Infectious Disease & General Medicine/1 Full Time Equivalent 50:50 role, Hamilton, New Zealand. Closing date 2nd December 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 Workshops
We 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:
- Course on Medical Mycology Nov 23 to Nov 27 2010. Peking University, Beijing, China.
- New Drugs and Targets for Asthma and COPD Nov 24 to Nov 26 2010. London, UK. This popular annual course is focussed on the identification of novel targets and development of new approaches and therapies for asthma, allergy and COPD. The course will be of particular relevance to those in the pharmaceutical industry, researchers in the field of respiratory medicine, and specialised clinicians and health care professionals.
If you know of a course that should be added to this list please add it by contacting us here
Veterinary
When to consider aspergillosis in dogs (external link)
Sinonasal and disseminated aspergillosis—the two classic presentations—are caused by different Aspergillus fungi. Learn how to manage these clinically distinct infections, and find out how the prognoses for affected dogs differ between the two.
Articular Aspergillosis of Hip Joints in Turkeys
"Although the respiratory tract is the most commonly affected, dissemination can occur into virtually
any organ. Here, we report an unusual outbreak of articular aspergillosis in a flock of meat turkeys with clinical signs of lameness. The findings suggest that fungal arthritis
may present a specific disease entity in turkeys and should be considered as further cause of lameness in turkeys."
NB Vets in the UK in need of assistance with acquiring antifungals please contact us here
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Donations
Buy.at. Give to the Fungal Research Trust while you shop - at no cost to yourselves. If everyone put their weekly supermarket bill through this service then the Fungal Research Trust would benefit by hundreds of pounds a week. See our donations page.
Many thanks to everyone who contributed to this fantastic total..
If you donated please check our list of donators for your name.
Technical Tips
Our discussion group (email and/or website) designed to promote discussion on technical issues for laboratory workers.
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