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LIFE Newsletter - Leading International Fungal Education

December 2013

Welcome to LIFE's December Newsletter.

A new foundation - The Global Action Fund for Fighting Fungal Infections or GAFFI was launched in London, New York and Sao Paulo on November 6th. An international organisation, GAFFI will highlight the plight of 300 million people worldwide and start to reverse unnecessary deaths and suffering.
Fungal infections kill at least 1,350,000 patients with or following AIDS, cancer, TB and asthma as well as causing untold misery and blindness to tens of millions more worldwide. Yet its symptoms are mostly hidden and occur as a consequence of other health problems. The tragedy is that many of the best drugs for treating fungal infections have been available for almost 50 years.gaffi

GAFFI was officially launched by actor Rupert Everett who has pledged to help GAFFI raise awareness of the problems. Katie Melua endorsed GAFFI and allowed GAFFI to produce a moving video to her hit song "I'd love to kill you with a Kiss". Professor Denning, GAFFI's President stated at the London launch in the House of Commons: "This is a global plague on an unappreciated scale. Whilst the World Health Organisation has just developed clinical guidelines for doctors for fungal meningitis in AIDS; other critical fungal infections are ignored. The lack of basic fungal diagnostic capability and unavailable treatments in many countries results in millions of avoidable deaths and illness. GAFFI is here to change this dismal situation.” more

WMA adopts statement on fungal disease diagnosis and management
At their 64th General Assembly in Brazil, the World Medical Association adopted a statement on Fungal Disease Diagnosis and Management. The statement reads: “The WMA stresses the need to support the diagnosis and management of fungal diseases and urges national governments to ensure that both diagnostic tests and antifungal therapies are available for their populations...
The WMA encourages its members to undertake and support epidemiologic studies on the burden of fungal disease in their country and to inform the national government of the results". more


NEWS

Impact on quality of life of recurrent thrush

Recurrent vulvovaginal candidiasis (rVVC) is a chronic condition causing pain and much discomfort. In an international study, Samuel Aballéa and colleagues of the Université of Lyon describe the numerous  depression and anxiety problems suffered by women with rVVC. An online survey of women reporting rVVC using the EQ-5D and SF-36 questionnaires was done in France, Germany, Italy, Spain, UK and the USA. Of 12,834 women previously identified with VVC, 620 women with rVVC were studied. The quality of life scores were compared among those with current symptoms to assess the direct impact of a VVC attack, and the whole group compared with peers without rVVC.

During an acute episode of VVC, 68% of women reported depression/anxiety problems, and 54% between episodes, compared to less than 20% in general population (p < 0.001). All SF-36 domain scores in those with rVVC were significantly below general population norms. Mental health domains were the most affected. The difference was largest in Italy, where 60% reported anxiety/depression problems outside episodes vs. 9.3% in the general population. The impact on productivity was estimated at 33 lost work hours per year on average, corresponding to estimated costs between €266/year and €1,130/year depending on the country.

The average index score in women with rVVC is comparable to other diseases such as asthma or COPD and worse than diseases such as headache/migraine according to US and UK catalogues of index scores. There was a high level of consistency across countries. View report

Liver failure is often complicated by fatal invasive aspergillosis (IA)

Of nearly 800 patients with acute-on-chronic liver failure (ACLF), around 5% developed invasive pulmonary aspergillosis (IPA) with almost 95% of them, going on to die despite antifungal treatment. Jiajia Chen et al (Zhejiang University, Hangzhou, China) note that most deaths were due to progression of IPA, the remainder due to the progression of liver failure. Only two patients survived on antifungal treatment. Survival was only achieved in patients who were able to take antifungal drugs for more than 5 days.
90% of the patients who developed IPA were also prescribed corticosteroids, and these patients had worse survival (p = <0.01). Age and hepatic encephalopathy were also significant for increased mortality (p = 0.021 and p = 0.001). Until recently there was no analysis of the risk factors for IPA in patients with ACLF, with most prior emphasis being on transplantation and chemotherapy patients.
More info

Isavuconazole phase III trial demonstrates non inferiority vs voriconazole

Astellas who developed the new antifungal drug isavuconazole, have published results from their phase III trials on the treatment of invasive aspergillosis, indicating favourable data for isavuconazole in comparison to voriconazole link ."The randomized, double-blind isavuconazole study achieved its primary objective in demonstrating non-inferiority versus voriconazole for the primary treatment of invasive fungal disease caused by Aspergillus species or certain other filamentous fungi. Isavuconazole was effective as determined by the primary endpoint of all-cause mortality through day 42 in the intent-to-treat population (N=516). The all-cause-mortality was 18.6% in the isavuconazole treatment group and 20.2% in the voriconazole group". In the sample of 500 patients there was a 7% lower mortality and only 40% drug related adverse events with isavuconazole, compared to 60% drug-related adverse events for voriconazole. The isavuconazole is given once daily( IV or oral) compared to twice daily for voriconazole.
More info

Basilea announced on Dec 3rd that the U.S. Food and Drug Administration (FDA) designated isavuconazole as a Qualified Infectious Disease Product (QIDP) for the treatment of invasive aspergillosis.. QIDP status provides priority review and a five-year extension of market exclusivity following product approval in the United States. Info
Isavuconazole also received orphan drug designation for the treatment of zygomycosis, a life-threatening invasive fungal infection (IFI) caused by emerging molds.

See more News here


Featured LIFE website section: Candida peritonitis

Patients either develop Candida peritonitis after abdominal surgery or as a complication of peritoneal dialysis. The symptoms of Candida peritonitis are indistinguishable for those of bacterial peritonitis, and after surgery bacterial and Candida peritonitis may occur together. Candida peritonitis may present as tertiary peritonitis, defined as the persistence or recurrence of intra-abdominal infection following apparently adequate therapy of primary or secondary peritonitis or as a localized intra-abdominal abscess. Abdominal discomfort, continuing purulent discharge from an abdominal drain, fever, raised inflammatory markers and white blood cell count are all common features, although often milder than bacterial peritonitis. In those receiving peritoneal dialysis, cloudy bags are typical and may be first sign of infection.
The frequency of post-surgical Candida peritonitis is not known and is difficult to estimate.
Diagnosis is by observing yeast microscopically or having a positive culture for Candida of the peritoneal fluid collected during operation.
Treatment in post-surgery cases requires drainage of any abscess or percutaneous infection.
Antifungal therapy with an echinocandin (caspofungin, micafungin or anidulafungin) or, if the causative organism is susceptible, then fluconazole is critical. In a recent French study, 20% of the isolates were fluconazole resistant. Many patients also have concomitant bacterial peritonitis, this should also be treated. Prophylaxis with fluconazole reduces the occurrence in at risk surgical patients.
With end stage renal failure - where chronic ambulatory peritoneal dialysis is frequent, a key success factor in treating Candida peritonitis is early removal of the peritoneal catheter. Fluconazole, an echinocandin, or intravenous amphotericin B (sometimes with flucytosine) are the best treatment options. View section

For information on Aspergillus infections go to The Aspergillus Website.


Top Diagnostic Tip

 

Fungal culture on different growth media

Years ago in a retrospective study Horvath and Dummer (1996) showed that the positive culture rate of Aspergillus spp was higher on fungal media than bacterial media – by about 30%. Much larger volumes of sputum or the careful processing of sputum plugs also increase yield substantially, as shown in COPD patients (Pashley et al, 2012) or in BAL fluids (Fraczek et al, Mycoses, Dec. 2013). Chromagar has an equivalent yield for Candida species as other fungal media, may have as high a yield for Aspergillus spp. as for other yeasts (Bouchara, 1996). But rarer moulds and dimorphic fungi are unlikely to grow on bacterial media.
View LIFE site

Really Important Reviews

MALDI-TOF Matrix assisted laser desorption/ ionisation time of flight mass spectrometry is a new technique for identifying many fungal species. Some of the colony from a positive culture is mixed with a specialized reagent and directly analysed in the mass spectrometer. The time to get the result is approximately 1 minute. Chalupova J et al.


Books

 

Fungal disease in Britain and US 1850-2000 by Aya Homei & Michael Worboys

The book charts the history of fungal infections over the course of last century. It examines how some types of infection, for example invasive aspergillosis and systemic candidiasis - became more prevalent and serious. An open access Wellcome Trust book.

Pass it on

Help us to educate everyone about fungal infections - please forward this to anyone who may be interested.
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Courses

 

Molecular Diagnosis of Infectious Diseases: Applications and Challenges - Feb 4th 2014 The course is an intermediate practical course for laboratory personnel and is intended to provide in-depth discussions of current trends and challenges associated with molecular diagnostic methods as they are used and encountered in the clinical microbiology laboratory. more information

The Gorgas Courses in Clinical Tropical Medicine The Gorgas Diploma  26th January - 27th March 2015. To be held in Peru: Application forms online from Oct 1st  2014   (Course for 2014 fully booked). More information

Mechanisms in Fungal Infections  From the Science to the Clinical Setting  (e- learning course). Designed for oncologists, hematologists, and infectious disease specialists who treat patient groups at  risk from developing fungal infections.  More information


Help us evaluate the global burden.

Global burden@LIFE copyright

We are still looking for volunteers to assist with estimating the burden of fungal infection in the following countries: Angola, Algeria,Bulgaria, Cambodia, Chile , Congo, Central African Rep. Ghana, Honduras, Laos, Madagascar, Nicuragua, Poland, Tunisia and Venezuela. Can you help? Contact us