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LIFE Newsletter - Leading International Fungal Education

February 2014

Welcome to LIFE's February Newsletter.

The LIFE-worldwide site is now translated into Spanish with an introductory video from Juan Luis Rodriguez Tudela, a LIFE advisor. Please view here. To change between English and Spanish watch out for the flags in the top right of each web page. Please forward to a Spanish speaking colleague you know!

This newsletter highlights the notable antifungal resistance of Candida glabrata to caspofungin
as reported by Chinese researchers from 67 intensive care units. C. glabrata is also fluconazole resistant. This data mirrors emerging resistance of C. glabrata in the USA.

Detailed statistics on lung health in Europe have just been released by the ELF and ERS. The economic burden of lung disease in Europe now exceeds €370 billion. An estimated 1 in 8 deaths in the EU are as a result of respiratory disease and 6 million people are admitted to hospital each year. The report concludes that there are almost 10 million people under the age of 45 living with asthma in Europe, of which approximately 1 million have severe asthma which is difficult to manage clinically and around half of these maybe sensitised to fungi.


NEWS

Resistance in Candida glabrata reaching epic proportions

Chinese researchers this month report a 14% rate of caspofungin resistance in Candida glabrata, an organism that is also fluconazole resistant. In 67 intensive care units in China, 389 isolates of Candida from 244 patients were susceptibility tested using CLSI M27-A3 methodology. 50 isolates identified C. glabrata and over 50% had fluconazole MICs of > 4mg/L (either: susceptible, dose-dependent, or resistant) and 14% had elevated caspofungin MICs (0.25mg/L). These multidrug resistant isolates would be clinically responsive to amphotericin B (and possibly flucytosine) only. These data mirror the emergence of fluconazole and echinocandin resistant C. glabrata in the US, illustrated by the experience at Duke University hospital. View report

Predictors of survival in cryptococcal meningitis in AIDS

Using existing data from 501 patients in clinical trials in Thailand, Uganda, Malawi and South Africa, Joe Jarvis and colleagues from St George’s Hospital in London discovered some key parameters of survival in cryptococcal meningitis in AIDS. One third of the patients had died by 10 weeks. Four important characteristics of those who survived were - young age, being fully alert, less weight loss before presentation to hospital and initial amphotericin B treatment. High CSF fungal load, higher blood white cell count and anaemia predicted death. At one year 60% of patients were still alive. 1 in 8 (13%) developed immune reconstitution syndrome which was more frequent if the brain fungal load was higher and interestingly had no relationship with when antiretroviral therapy was started. Low cerebrospinal fluid gamma interferon doubled the risk of dying from 9% to 19%. Prof Harrison, senior author said “The results suggest earlier diagnosis, more rapidly fungicidal amphotericin-based regimens, and prompt immune reconstitution with ART are priorities for improving outcomes.”
More info

Economic burden of lung disease in europe exceeds €370 billion

A joint publication by the European Lung Foundation and European Respiratory Society provides detailed statistics on lung health in Europe. 1 in 8 deaths in the EU are as a result of respiratory disease and 6 million people are admitted to hospital each year. It is estimated for several diseases that this represents the “tip of the iceberg”, as many disease deaths are improperly recorded. Report. Lung disease is often complicated by fungal infection. The report concludes that there are almost 10 million people under the age of 45 living with asthma in Europe, of which approximately 1 million have severe asthma which is difficult to manage clinically. It is thought that around 50% of patients with severe asthma have sensitisation to various fungi (SAFS), of which Aspergillus fumigatus is the most common. More info

See more News here


Featured LIFE website section: Antibody Testing

Antibody tests for fungal infection and fungal allergy have a firm place in the management of certain diseases notably: for the diagnosis and treatment of Coccidioidomycosis, chronic pulmonary aspergillosis, ABPA, Aspergillus rhinosinusitis, histoplasmosis, paracoccidioidomycosis & supporting a diagnosis of Aspergillus bronchitis.
Several test formats are used for the detection of antibody in blood including double-diffusion (DD) or immunodiffusion (ID), counterimmunoelectophoresis (CIE), enzyme-linked immunosorbent assay (ELISA) and complement fixation (CF). Less commonly used methods include haemagglutination, radioimmunoassay, immunoblotting and co-CIE.
Almost all tests detect IgG or IgE antibodies, with the exception of IgM for coccidioidomycosis. No utility has been found for the detection of IgA antibodies to fungi. It is possible that IgM antibodies might have more clinical utility than currently realised, especially for aspergillosis but are not routinely available. The immunodiffusion technique is described in a video. View section

For information on Aspergillus infections go to The Aspergillus Website


Top Diagnostic Tip

 

Open source lab diagnostic software spreads its wings across Africa
C4G BLIS is a free, open-source laboratory management system, designed to be ultra-configurable in order to meet the highly varied needs of laboratories across developing countries. It is also designed to require minimal training for laboratory staff with no prior computer experience, in environments with little or poor internet connectivity and without constant power. It allows laboratories to incorporate standardisation, as desired, at their own pace. An extensive reports system includes the ability to track prevalence rates of infections and could be a useful tool against the spread of disease.
The BLIS system has several advantages over paper. It manages laboratory data from specimen receipt to report generation. It has a simple, intuitive user interface that requires minimal user training. It augments current practices (e.g., paper records) without imposing new burdens and it exposes trends/patterns that are not possible to see currently allowing regional and national officials to react to health risks or spreading infection quickly.

Computing-for-Good (C4G) is an initiative of the college of computing at Georgia Tech to address pressing societal needs using ideas and artefacts from computing. C4G BLIS (is available freely for download and use from http://blis.cc.gatech.edu)
View LIFE site

Really Important Reviews

Fungal Diagnostics - review of commercially available methods
Significant progress has been made over the last 10 years in the field of fungal detection and identification. Technological advances and introduction of new technologies have led to availability
of a wide variety of commercial tests. The ultimate objective is to determine the infectious agent as quickly as possible. A review of all the latest methods of detecting fungi.
Review by Marcos JY & Pincus DH


Books

 

Fungal Infections in Asia - The Eastern Frontier of Mycology by Arunaloke Chakrabarti

Asia has a particularly high incidence of fungal infections. The authors describe the frequency and unique peculiarities of fungal infections in Asia and the diagnostic challenges in resource constrained settings. Suited to both mycology students and clinical care teams.ISBN:978-81-312-3556-0

Pass it on

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

 

Educational programme on transplant Infectious Diseases (25-26th April 2014) Sao Paulo, Brazil  ESCMID Postgraduate Course

Diagnostic Medical Mycology - University of Leeds, UK (7-11 April 2014).  More information here and application forms available by emailing Ruth Ashbee.

3rd ECMM Educational Symposium on the diagnosis and treatment of rare yeast infections - Royal Tropical Institute, Amsterdam, Netherlands (15th May 2014) - More information

Molecular Mycology: Current Approaches to Fungal Pathogenesis, Massachusetts, USA (July 2013). More information
More courses


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, Nicaragua, Poland, Tunisia and Venezuela. Can you help? Contact us