NAC Comms team becomes NAC CARES team

“So, what do you do?” What a difficult question! The communications team at the National Aspergillosis Centre have been mulling this one over a lot recently and have decided that they need to make things clearer.

They have been known as ‘the comms team’ for a long time. But what does that really mean? How can they explain what they really do? They have broken it down into five main areas and have become NAC CARES.

This is what they want to communicate about the National Aspergillosis Centre.

Community

NAC is at the centre of a community. That community is made up of people with aspergillosis, their families and carers, clinicians, researchers, academics and allied health care professionals. We work with the Aspergillosis Trust, the Mycology Reference Centre Manchester and the Manchester Fungal Infection Group. We’re available to consult with staff from any other hospital if they need specialist advice about aspergillosis. Together we are fighting against aspergillosis.

Awareness

We strive to raise awareness of aspergillosis. We champion World Aspergillosis Day. We provide research and clinical resources for academics and health care professionals. We provide free information to patients.

Research

NAC has an extensive clinical research portfolio including azole resistance, optimising diagnostics, clinical outcomes and quality of life, genetic basis of disease and immunity.

Education

We provide information to patients about aspergillosis. We also provide diagnostic and clinical training to health care professionals and technical staff through a variety of online learning resources.

Support

NAC is a friendly place to visit both on and offline. Our staff are helpful and knowledgeable. As well as clinical care, we support people with aspergillosis and their families by hosting face to face and online support groups.

NAC CARES!

The first letter of each of these areas spells out the word ‘cares’. And that’s exactly what we do. So, your NAC comms team will now be known as your NAC CARES team.

Graham Atherton, NAC CARES team lead, said “This is a real step change for us in terms of communicating our function to the people who use our service.”

World Aspergillosis Day 2020

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World Aspergillosis Day 2020 is almost here! The big day is February 27th and here’s a few ideas of ways that you can support the occasion and help to raise awareness of aspergillosis.

Submit your selfie!

The Aspergillosis Trust are asking people to show their support by downloading a selfie card, taking a selfie with it, and uploading it to their ‘Selfie Hall of Fame‘. Please get involved and show your support!

Add a WAD2020 graphic to your email signature.

We have produced a signature graphic for you to use on emails. Feel free to save your favourite colour version and share it far and wide!

Blue

Green

Pink

Show your support for WAD2020 on your social media profile pictures.

You can support the campaign to raise awareness of aspergillosis by adding our twibbon to your profile picture. Twibbon will create a new profile picture for you containing the WAD2020 logo. Download this image and upload it to Twitter. Voila!

For Facebook it’s much simpler! Just add our frame!

Use our social media header images for LinkedIn, Twitter and Facebook.

Please take a look and download and choose your favourite colours.

Display our poster in your office or in a window at home

Print out and display our WAD2020 poster.

Host a coffee morning to raise awareness

On February 27th at 10am The National Aspergillosis Centre will be hosting a virtual coffee morning whilst at AAAM2020. We’ll be talking online to patients, researchers and clinicians. We invite you do run your own events at home and at work. So why not gather your friends, family or colleagues, make a brew, enjoy a slice of cake and tweet about taking a moment out of your day to raise awareness using the hashtag #worldaspergillosisday2020

Here’s a few assets to download to decorate your home or office. There’s bunting, cake labels and invitations!

WAD2020 Coffee Morning Assets

 

Key Regulator of Antifungal Resistance in A. fumigatus

Resistance to systemic antifungal medication is an increasing problem worldwide as there are very limited (i.e. three: amphotericin, azoles and echinocandins) alternative drug classes available to clinicians to treat patients with invasive or chronic fungal infections. This has a profound impact on 3 million people with fungal infection worldwide, 600 000 of which die every year.

Azole antifungal drug resistance has arisen and spread quite quickly in clinical samples, with environmental factors such as the agricultural use of azole chemicals to control fungal infection in crops a prime suspect for the mechanism of spread. We need solutions to antifungal resistance soon!

Researchers at the Manchester Fungal Infection Group (MFIG) based at the University of Manchester have just published their work which aims to provide the tools to help researchers worldwide investigate the regulatory mechanisms involved in antifungal resistance. They have developed hundreds of strains of the pathogen A.fumigatus, each of which lacks one part of the mechanisms that control all cellular processes in the fungus. Each strain consequently behaves in a way that is different from non-mutated forms of the fungus (ie wild-type).

Researchers can use these strains to figure out what each cellular mechanism does – it is a bit like removing one part of the mechanism of a car (eg the brake pedal) and then driving it to see what happens (i.e. it would be unable to stop). Using these strains to look at antifungal drug resistance suggests that part of the solution to this pressing problem could be to better understand the mechanism of resistance that is present in Aspergillus fumigatus.

Two strains became resistant to most antifungal drugs as a result of the deletion of specific sections of DNA (NctA and NctB), therefore we may well learn a lot about how to stop resistance if we study what lies on those sections of DNA.

Author Norman van Rhijn explains:

Last week, Furukawa et al. published their findings in Nature Communications on identifying previously uncharacterised regulators in A. fumigatus involved in azole resistance. By generating a large library of deletion mutants (484 strains) several regulators involved in resistance to itraconazole could be identified. Two of these, NctA and NctB, form a complex to regulate a large set of genes, including sterol biosynthesis genes, drug exporters and other regulators involved in drug resistance. This caused a change in fungal growth and the immune response to these A. fumigatus gene deletion strains, but no loss of pathogenicity. Furthermore, these strains are cross-resistant to other azoles as well as the salvage therapeutic terbinafine and amphotericin B. However, hypersensitivity to the echinocandins was observed. This should prompt clinical centres to look for these mechanisms of resistance. The library of deletion mutants now provides an opportunity for the fungal community to further explore regulatory mechanisms and factors in the pathobiology of this important human fungal pathogen.

For more information see: https://www.nature.com/articles/s41467-019-14191-1

 
 

Update of the Consensus Definitions of Invasive Fungal Disease

Definitions of invasive fungal diseases were originally published almost two decades ago by the EORTC Infectious Diseases group and the Mycoses Study Group to foster communication among researchers in the field. They rapidly became the reference standard for clinical trials of antifungal agents, diagnostic tests and for epidemiology studies. However, these definitions needed revision almost as soon as they were published to extend them beyond immunocompromised patients with cancer and hematopoietic stem cell transplant recipients. Other deficiencies were the omission of nucleic acid tests such as PCR. Hence, a second consensus group was convened, again drawn from the same  academic groups, to refine and improve the definitions.  Importantly, the framework of proven, probable and possible IFD was retained with the only difference between probable and possible IFD being the presence or absence of mycological evidence. However, the revision failed again to include nucleic acid tests and had less than adequate definitions for  cryptococcosis and endemic mycoses, and none for pneumocystosis.

Consequently, a group of 65 experts from across the globe volunteered to join 10 working groups each charged with a specific topic covering special populations (paediatrics and patients in the ICU) , diagnostic tests (galactomannan, (1,3)-beta-D-glucan and T2Candida Assays, Aspergillus PCR 1-3, tissue diagnosis) and other disease entities (pneumocystosis, cryptococcosis, and endemic mycoses). The process proved more complex and took longer than anticipated but a consensus was finally reached for all but patients in the ICU.

  • Read the new guidelines (Donnelly et al, 2019) and accompanying editorial commentary (Rogers, 2019)
  • As before, the categories  of “proven,” “probable,” and “possible” IFD remain unchanged reflecting the level of certainty in the diagnosis.
  • The category of proven IFD and endemic mycoses can apply to any patient, regardless of whether the patient is immunocompromised but the probable and possible categories are only intended for immunocompromised patients.
  • Finally, Aspergillus PCR has now been accepted as a mycological test, galactomannan thresholds have been reset to improve the positive predictive value, T2Candida has been included and guidance on using  tissue for diagnosis has been included.

Undoubtedly there will be room for further improvement, but it is hoped that these updated definitions of IFDs will continue to prove their worth in clinical, diagnostic, and epidemiological research.

Fungal Infection Trust and University of Manchester’s Microfungi.net makes essential fungal pathology skills accessible across the globe

Image of the microfungi.net website

This week, November 4-10, medical professionals across the country will be observing National Pathology Week, an annual awareness week created by the Royal College of Pathologists that aims to both highlight the important contribution pathologists make to healthcare and improve public awareness and understanding of how pathologists and scientists diagnose disease.  

This year’s theme will focus on innovations big and small within pathology, including smart initiatives that help make a difference to the health of patients, and contribute positively to the work of other healthcare professionals.

A collaboration between the Fungal Infection Trust and The University of Manchester’s Division of Infection, Immunity & Respiratory Medicine has allowed the innovative Microfungi.net online microscopy course to make a difference in the careers of medical professionals worldwide.

microfungi.net website

Microfungi.net consists of an extensive range of free e-learning units, designed to teach the identification of fungal infection via lessons in microscopy, the examination of objects by means of a microscope, in a full range of tissue specimens.

Bright Ocansey, a 27 years old medical laboratory scientist and current PhD student from Ghana said of the benefits of Microfungi.net to his career:

“As an undergraduate in a developing country where medical mycology education and training is poor, the Fungal Microscopy and Histology e-learning course was for me the mycology laboratory practical’s session I never had in school. In addition to acquiring knowledge and practical skills in fungal diagnostics, it further fuelled my passion to work with medically important fungi and as a professional I became the fungal disease laboratory focal person in my facility.

Microfungi.net hosts its modules in English, Spanish, French, Portuguese and Chinese and is accredited by the Royal College of Pathologists, making top class educational content accessible to a global audience. It currently has over 1,300 students spread across 122 different countries and plans to add more languages in the future. You can find a link to Microfungi.net here.

Bright Ocansey continued:

There are very few medical mycology educators in the world (particularly so in developing countries) and time allocated for teaching and laboratory practical sessions is limited if existent. So for both students and practising professionals, the course is a rare opportunity to improve their knowledge and skills in fungal disease diagnosis. The transferable skills from the course really influence how I design and carry out my laboratory protocols. The course is the foundation of my expertise in fungal diagnostics.”

“Aspergillus and me” by Los Trensplantados

“Aspergillus and me” is a song written by Alessandro Pasqualotto, a medical mycologist from Brazil, and two transplant patients, Jimi Joe (kidney), and King Jim (liver). 

The initiative started when King was hospitalized due to a chronic cough. King is known for being asthmatic and he has some mild bronchiectasis, in addition to being a liver transplant recipient. A bronchoalveolar lavage (BAL) was performed, and Pseudomonas aeruginosa was recovered in culture, in addition to Aspergillus fumigatus (galactomannan testing was not performed). At that time, Alessandro Pasqualotto visited King in the hospital primarily as a fan, not as a physician. After collecting several autographs in vinyl albums from the 80’s (King was part of the famous rock band Garotos da Rua), Pasqualotto and King started a discussion on the relevance of A. fumigatus in his BAL exam. Despite being treated with voriconazole by order of the medical team in charge, Pasqualotto thought the musician was only colonized by the fungus. The dilemma surrounding the relevance of Aspergillus in this context motivated both Pasqualotto and King to write a song about that.

After being discharged from the hospital, King collected a group of experienced musicians to record Pasqualotto’s song. This included Jimi Joe, a kidney transplant recipient who together with King formed the band “Los Tresplantados”, a group of three transplant musicians that approaches the importance of organ donation, as well as opportunistic infections. Los Tresplantados, however, have never written a song about fungal infections, so this was a great opportunity to increase people’s awareness of such important diseases.

So this is what “Aspergillus and me” are all about. Alternatively, musicians also refer to this song as “When Black Sabbath meets Neil Young”. We hope you enjoy the song!

 

Contacts: Alessandro C. Pasqualotto (acpasqualotto@gmail.com)

WhatsUp number: +55 51 999951614

You tube link: https://www.youtube.com/watch?v=5ar1na385zQ

Interview link (Portuguese only): https://www.youtube.com/watch?v=ZyywH0LtS50

Using electromagnetic navigation bronchoscopy (ENB) to diagnose fungal infections.

electromagnetic navigation bronchoscopy

A new review explores the usefulness of electromagnetic navigation bronchoscopy in diagnosis of fungal infection and other benign and malignant diseases of the trachea and proximal bronchial tree.

The most common approach to lung lesion biopsy is computed tomography (CT) guided transthoracic needle aspiration (TTNA), giving a diagnostic yield of 92%. Ultrasound-guided TTNA is also used for subpleural lesions where there is no intervening air that would attenuate the ultrasound waves. It has a similarly high diagnostic yield of 89%. There are problems with these methods though, including collapsed lung and an unsuitability for biopsies in the lower part of the lung or in patients with COPD or patients who have had pneumonectomy – many of these issues would be present in patients with CPA and ABPA and so ENB may be a useful tool for such patients.

This review describes what electromagnetic navigation bronchoscopy (ENB) is and gives guidance on carrying out the procedure and an overview of when is can be used and its effectiveness. For example, it is particularly useful in patients at high risk of pneumothorax because it allows peripheral lung lesions to be reached through the bronchial tree, thereby avoiding trans-pleural puncture and contamination. The review provides some useful information on ENB use in diagnosing infections – particularly mycoses. This is because coexisting pulmonary disease and poor lung function is common in patients with fungal disease. ENB has the benefit of avoiding transpleural puncture and the risks of pneumothorax, hemothorax, and pain.

A must-read article for those with an interest in diagnosing fungal lung conditions.

New ESCMID-ECMM guidelines published for the diagnosis and management of invasive aspergillosis in neonates and children

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Presenting symptoms, distributions and patterns of diseases and vulnerability to invasive aspergillosis (IA) are similar between children and adults. However, differences exist in the epidemiology and underlying conditions, the usefulness of newer diagnostic tools, the pharmacology of antifungal agents and in the evidence from interventional phase 3 clinical trials. Therefore, the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) and the European Confederation of Medical Mycology (ECMM) have developed a paediatric-specific guideline for the diagnosis and management of IA in neonates and children.

Further information is available in the recently published guidlines.
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New diagnostic tool paves the way for faster and earlier diagnosis of chronic pulmonary aspergillosis

ASPGAb

A new screening test kit will speed up diagnosis of chronic pulmonary aspergillosis (CPA) say researchers from the University of Manchester. The test, available commercially from LDBio diagnostics, is very simple and needs no power source or equipment and therefore is likely to be very useful in resource poor settings.

CPA is a fungal disease associated with lung damage caused by other conditions including TB which is prevalent in low to middle income countries. CPA can get progressively worse over time and so early diagnosis is crucial to improve patient outcomes.

The team from the University of Manchester and the NHS Mycology Reference Centre, based at Wythenshawe Hospital, tested the LDBio Aspergillus ICT kit on blood samples collected from 154 CPA patients identified at the National Aspergillosis Centre in Manchester and 150 healthy volunteers. They found that the test had improved sensitivity (91.6%) and specificity (98.0%) for diagnosis of CPA in UK patients compared to existing diagnostic tests.

Limitations of current diagnostic procedures include high cost, long turn-around times, poor reproducibility and variations in performance. The new test is cheap, fast, reproducible and reliable. Therefore it is particularly useful in low to middle income countries where CPA diagnostics are a necessity for early recognition of CPA complicating TB, and to distinguish between these similarly presenting conditions.

Professor David Denning, Professor of Infectious Diseases in Global Health at the University of Manchester and Director of the National Aspergillosis Centre at the Manchester University NHS Foundation Trust said:

“With over 7 million people suffering TB in the lungs each year and 5-10% of them later getting the fungal infection aspergillosis in the lungs, a simple cost-effective test for aspergillosis is sorely needed. This new test fulfils these basic requirements and we are delighted to report that its diagnostic performance surpasses all the older tests as well. A real win-win for early diagnosis and reducing lung scarring and death.” 

The findings were published this month in the Journal of Clinical Microbiology.

Citation:

Evaluation of LD Bio Aspergillus ICT lateral flow assay for IgG and IgM antibody detection in chronic pulmonary aspergillosis. Elizabeth Stucky Hunter, Malcolm D. Richardson, David W. Denning. Journal of Clinical Microbiology Jun 2019, JCM.00538-19; DOI: 10.1128/JCM.00538-19

Antifungal resistant isolates of Aspergillus fumigatus found in flower beds close to city centre hospitals.

Spring-Flowers-Flower-Bed-Spring-Flowers-Tulips

Researchers from Imperial College London report this week that elevated levels of azole resistant Aspergillus fumigatus isolates are present in urban environments, particularly in flower beds close to hospitals.

Aspergillus fumigatus is an opportunistic fungal pathogen which thrives in decaying vegetation and soil. It can cause a number of conditions ranging from fungal asthma to invasive aspergillosis associated with a mortality rate of 40-90%.

Resistance to antifungal drugs, specifically azoles, is an increasing problem and it has been suggested that the broad application of azoles to agricultural crops is the primary contributing factor. Few studies have sought to investigate resistance in the UK across a diverse range of substrates.

The team from Imperial sampled soil from several environments, from remote forests to hospital flower beds, in order to determine the prevalence of azole resistant isolates in the south of the UK.

Resistance was detected in 6.7% of the soil samples, with urban areas showing a higher prevalence (13.8%) than rural sites (1.1%).  This contradicts the hypothesis that resistance is driven by the environmental application of azoles in arable agriculture. In fact in this study, of the 53 samples collected directly on or surrounding agricultural land, zero azole-tolerant isolates were identified.

Rather, the team found that the prevalence of resistance was higher in urban city centres, specifically flower beds and gardens, a finding that lends itself more readily to the hypothesis that the expanding range of azole resistant A. fumigatus stems more from the distribution and cultivation of horticultural crops, such as flowers, ornamentals and vegetables. A particularly concerning discovery was the repeat isolation of resistant isolates from flower beds surrounding city centre hospitals. Concerns over the use of azole treated flower bulbs has been raised before.

This is of particular concern because of the ability of A. fumigatus to cause serious, life threatening infections in immunocompromised patients. The authors suggest that the use of azole-treated plant bulbs in the environment around hospitals should be reconsidered and wider global monitoring of resistance is warranted due to the threat that this pathogen poses to diverse groups of susceptible patients.

The team are currently processing soil samples that have been collected from across the whole of the UK by the public as part of a citizen science experiment. The results of this project will add further data and information to this concerning topic.

Elevated prevalence of azole resistant Aspergillus fumigatus in urban versus rural environments in the United Kingdom.
Thomas R Sewell, Yuyi Zhang, Amelie P Brackin, Jennifer M. G. Shelton, Johanna Rhodes, Matthew C Fisher
Antimicrobial Agents and Chemotherapy Jun 2019, AAC.00548-19.

Read the full paper.

Flowers, Tulips, Flower Bed, Spring, Spring Flowers


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