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LIFE Newsletter - Leading International Fungal Education

November 2014

Histoplasmosis in French Guiana drastically reduced by providing Mycology reference laboratory and increasing awareness and education

Histoplasmosis is an endemic fungal infection in French Guiana. It is the leading cause of AIDS related deaths and the most common AIDS-defining illness. Diagnosis is difficult and it is often misdiagnosed as TB or a neglected disease. A retrospective study was conducted by Adenis et al, to describe early mortality rates observed in persons diagnosed with HIV-associated Histoplasma capsulatum admitted to one of the three main hospitals in French Guiana over a 19 year period. Early mortality was defined by death occurring within 30 days after antifungal treatment initiation. Notably a reference laboratory specialized in parasitology-mycology was established in 1997 in Cayenne Hospital.
Among 274 patients there were 46 early deaths (16.8%). The two main trends over the 19 years were: the proportion of early deaths significantly reduced four fold and the annual incidence of identified histoplasmosis cases increased three fold. The present example testifies that rapid progress can be attained when you improve education and clinical and laboratory diagnostic facilities in order to diagnose and treat this curable disease. Adenis et al 2014


NEWS

The burden of disease of 6 more countries- covering 260 million people were presented at the ICAAC conference in Barcelona in September 

The rate of candidaemia in Saudi Arabia is amongst the highest in the world at 10/100,000 which contrasts with low rates in Argentina (1.1/100,000) and Australia (1.87/100,000). Large numbers of cases of cryptococcosis and histoplasmosis in AIDS are seen in Mexico (4,906-35,049 and 6,484-22,256 respectively). The estimate for Tanzania which has around 1.5 million HIV infected people and 90,057 with CD4 counts under 200, is estimated to have only 2,672 cases of cryptococcal meningitis based on cryptococcal antigen screening survey. This may be an underestimate as there are 80,000 AIDS deaths a year in Tanzania. More information

100 years of chromoblastomycosis

In Sao Luis, Brazil in early October, world experts met to review this difficult disease. It is a global disease with highest frequency in tropical and sub-tropical Africa, Central and South America, Asia and Australia  - characterized by the appearance of proliferating chronic skin lesions which arise after traumatic implantation of the fungus. Sites most commonly affected are the lower limbs with upper limbs and buttocks  frequently involved. The causative agents are melanised or black fungi - often found growing on thorns or undergrowth usually Fonsecaea in tropical areas, Cladophialophora in semi-arid areas and to a lesser extent of Rhinocladiella  species.

In Maranhao, on the fringes of the Amazon rainforest in Brazil, thousands of families are involved in harvesting the babassu nut (Orbignya phalerata) from a palm tree. Babassu oil is an important component for local and international beauty products. The industry is an important source of income for the local population and helps to cover the cost of providing their children with an education. Fonsecaea has been isolated from babassu shell fragments and is a risk factor for developing chromoblastomycosis after skin trauma sustained whilst working. But it could be largely prevented by the provision of protective clothing - eg. gloves and footwear - to the workers whilst handling the tough nut shells. The education of  agricultural workers- of the mode of  transmission of this disease is critical. The disease is disfiguring - lesions are hard to eradicate and become chronic- and can lead to neoplastic transformation. There is no gold standard treatment - but itraconazole and terbinafine have been used with limited success.
Should chromoblastomycosis be an orphan neglected disease recognised by the WHO? More Information 

GAFFI president delivers keynote speech on enormous burden of fungal infections at IUMS in Montreal

The number of people suffering or dying from fungal infections has now been estimated in 33 countries covering 55% of the world's population. Variation between countries is very high.
A synopsis reveals - especially high incidence rates of Candida bloodstream infection in Brazil (15/100,000) and Spain (10.7/100,000); an extremely high rate of mucormycosis in India (170,000 cases annually, 13/100,000) related to the burgeoning epidemic of diabetes there; over 160,000 cases of invasive aspergillosis in China (11.9/100,000) - partly related to COPD. An estimated 38,000 cases of cryptococcal meningitis in AIDS in Uganda (110/100,000) and 75,000 and 18,000 cases of Pneumocystis pneumonia in Nigeria (48/100,000) and Brazil (39.6/100,000) respectively. Both ABPA and SAFS were high in Brazil, China and India. Read more

GAFFI celebrated its first anniversary in November and has called on all policy makers and health agencies to wake up to the plight of 300 million people a year. First year report; Read more

See more News here


Featured LIFE website section: Granulomatous sinusitis

Up to 30% of cases of chronic fungal rhinosinusitis are in fact granulomatous invasive fungal rhinosinusitis in certain geographic location including Sudan, middle east and India. In USA and Europe the disease is rare. The disease is prevalent (~70%) in villagers of tropical regions especially who are active in farm work. The fungus responsible is often Aspergilus flavus or sometimes A. fumigatus or A.niger.

Patients usually present with nasal obstruction, enlarging mass in the cheek, orbit, nose, maxillae, and paranasal sinuses. Sometimes proptosis or cranial nerve palsies are the reason for medical attention. The disease has a gradual onset and takes a chronic course, usually over many months, and sometimes years. The patients are typically immunocompetent.
CT imaging reveals a soft tissue mass in one or more paranasal sinuses, usually with extension to orbit or brain.

Chronic granulomatous fungal sinusitis appears endoscopically as a firm to hardantifungal appantifungal mass in the nasal cavity which often extends to the adjoining sinuses (ethmoids or maxillary sinus) and to the orbit, especially if proptosis present. The mass is relatively avascular and often does not bleed on biopsy.The disease is often initially mistaken for malignancy on endoscopy.

Diagnosis is made on histopathology of the biopsy taken or mass removed during surgery. Histopathologically, a granulomatous response is seen with considerable fibrosis. Non-caseating granuloma with foreign body or Langhans types of giant cells may be seen, sometimes with vasculitis, vascular proliferation and perivascular fibrosis.  Treatment is usually by surgical removal of the mass and antifungal therapy with itraconazole or voriconazole or amphotericin B.
LIFE website.


Top Diagnostic Tip

Fontana-Masson stain for melanin

The Fontana-Masson stain is useful to demonstrate that a fungus is a melanin producer, as in dematiaceous fungi and Cryptococcus. The cell wall and extracellular melanin are both stained. Caution should be exercised when interpreting Fontana-Masson staining for fungal identification, since Aspergillus spp. showed variable positivity and intensity. Even some Mucorales genera, and Trichosporon can also show positive staining.

CryptococcusCryptococcus neoformans with Fontana-masson stain
  (© Spencer's Pathology of the Lung,2013)

 


Really Important Reviews

Invasive fungal disease in systemic lupus erythematosus (SLE) - review of disease characteristics, risk factors and prognosis
This review aims to characterise invasive fungal diseases in SLE. In total, 393 cases from 182 studies met the criteria for inclusion. Cryptococcus spp., Aspergillus spp.,and Candida spp. were the most common fungal pathogens. Disease activity and corticosteroid dose >60 mg/day, emerged as riskfactors for IFD which was associated with a mortality rate of 53% (161/316
cases), and worse in the absence of antifungal therapy. Wang et al 2014



APP for Antifungals interacting with other prescription medicine

A free smartphone APP is now launched for health professionals and patients to check interactions between their antifungal medicines and any other prescription medication they are taking.
When a patient is on two or more drugs there is always the possibility that those drugs will interact with each other. Occasionally that can cause a problem that might require further action by that patient's doctor.
This database aims to provide up to date information for all drugs known to interact with the key antifungals.

APP antifungal interactions The APP can be found in google play (Android) and itunes (Apple) app stores called "Antifungal Interactions". (Produced By the Fungal Infection Trust in conjunction with Stockley's Drug Interactions).



Books

 

The Biology of fungi impacting human health: by W A Shipton. Publishers: Partridge Publishing.

On a world- wide basis, fungal disease of humans are becoming more prominent. The new threats arising from these microbes primarily are a result of an increase in the immunocompromised population.

s.ISBN:978-4828-9476-9 & ebook ISBN: 978-1-4828-9479-0

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

 

Msc/Diploma in Medical Mycology (distance learning), University College London (2013-14)

Free online learning opportunity (CME module)Fungal pulmonary infections: pulmonary aspergillosis in non-hematological patients.

Course of Medical Mycology at the Institut Pasteur will be held in Paris, March 30 to April 24, 2015. The course will be taught in English and is aimed to microbiologists (MDs, PhDs and veterinarians) with previous practice in a medical mycology laboratory.  Application deadline is Nov. 15, 2014.  For information and registration, click here.

HFP2015, the 6th FEBS Advanced Lecture Course on Human Fungal Pathogens, May 16-22, 2015 La Colle-sur-Loup, France: first announcement

Masters in Medical Mycology at Manchester University, UK. An MSc programme specially designed for graduates who wish to develop skills as Mycologists. This is a new MSc which is unique, combining much time in the  laboratory, with work experience in the NHS Mycology Reference Laboratory and clinics and ward rounds. The course can be full or part time taught programme.More information.

More courses


Help us evaluate the global burden.

Global burden@LIFE copyright

We are looking for volunteers to assist with estimating the burden of fungal infection in the following countries:
Angola, Bulgaria, Bosnia, Burkina Faso, Cambodia, Central African Rep., Chad, Congo and DRC, Costa Rica, Honduras, Mali, Myanmar, Nicaragua, Panama, Poland, Portugal, Slovak Republic, Tunisia, Uzbekistan and Venezuela.
 Can you help? Contact us