At the ISHAM conference in Melbourne on May 5th, GAFFI (Global Action Fund for Fungal Infections) has launched the project ‘95-95 by 2025’, calling on all national governments and public health agencies to reduce the toll of death and blindness from fungal diseases. 95-95 means 95 percent of patients with life or sight-threatening fungal disease are diagnosed and 95 percent treated. Currently the figures are at best 50 percent and, at worst, as low as one in three.
GAFFI states that:
- Simple antifungal remedies are unavailable to half the world's population
- Public health agencies ignore fungal diseases, despite 1.5 million deaths per year
- People are dying needlessly although medicines to save them have been around for over 50 years
GAFFI has launched a 10 year roadmap outlining the way forward and objectives that must be addressed in order to change course and save the unecessary loss of many lives.
Professor Tania Sorrell who chaired the launch commented: “95-95 by 2025 is a bold and necessary call to action for fungal disease experts, the diagnostic and pharmaceutical industry and the public health community to really make an impact, especially among the disadvantaged in the world.”
GAFFI roadmap; News item; More information;
ABPA found in 26% of paediatric patients with poorly controlled asthma in India
Many adults with asthma are sensitised to fungi, especially those with severe asthma. Total IgE level is regarded as a good marker for allergic bronchopulmonary aspergillosis (ABPA) - rising during exacerbations and falling during remissions. However there is little data on ABPA in paediatric patients with asthma.
In a study from India, (Singh et al 2015) ABPA was found in 26% of 100 paediatric patients with poorly controlled asthma. ABPA diagnosis was obtained using approved criteria. There was a significant difference in the forced expiratory volume (FEV1) between ABPA positive and negative children, which is consistent with adult ABPA.
Many more boys were affected with ABPA than girls, with a ratio or 4 to 1, compared with those without ABPA in whom the ratio was 3:1. This study indicates a higher rate of ABPA in paediatric patients with problematic asthma than expected from other studies – but also that a higher cut off value of total IgE 1200 IU/mL is proposed as a predictive parameter for ABPA in children with asthma, rather than the 1000 IU/ml used in adults.
The results from this study provoke the question as to whether paediatric patients with poorly controlled asthma should be tested for fungal sensitivity and offered antifungal therapy at an early stage in their management. More information
Fungal disease burdens from 9 more countries presented at ECCMID, ISHAM & API
The burden of fungal disease from nine countries and covering a further 490.5 million head of population has been estimated by LIFE collaborators and presented at these conferences. Data from Nepal and Thailand, Canada, Ecuador and Chile, Jordan and Egypt and Indonesia and New Zealand were presented. Some of the notable findings were: a high rate of asthma and likely ABPA in New Zealand, Egypt, Jordan and Chile. High rates of cryptococcal disease in Thailand, higher than average rates of disseminated histoplasmosis and cryptococcosis in HIV patients in Ecuador.
Also fungal keratitis is common in Nepal, Thailand and Egypt (19,938, 9,765 and 11,550 cases annually in each country) but rare in New Zealand (31 cases). More information
How to bolster the antifungal pipeline
The last new class of antifungal emerged in 2002 and no new antifungals have been licensed since 2006. An estimated 300 million people worldwide have serious fungal disease with 1.3- 2 million dying and new agents are desperately needed. Prof Denning and Dr Bromley highlight the problems for doctors in a recent article. Dr Bromley, a Lecturer at Manchester University is trying to identify new drugs, he commented ‘New antifungals are tough to find, partly because the human cell machinery is quite similar to fungi, so killing a fungal cell without damaging a human cell is tricky. We have several promising leads however, which we are working on as fast as resources allow.’
Very low numbers of funded positions in this area - in the UK and USA (few grants awarded), greatly impedes research in the area. Also high drug resistance rates for Candida and Aspergillus are of serious concern as there are limited types of antifungals available.
Improved 12-month survival when community support is given with cryptococcal antigen screeening in HIV
Around 10 million people in Africa receive antiretroviral therapy (ART) for HIV infection, but mortality in the first few months and during the first year is higher than in Europeans. Tuberculosis and cryptococcal meningitis account for the majority of deaths in Africa in HIV patients. A paper published in the Lancet online this week has highlighted that the provision of a short period of community support from lay workers alongside screening for cryptococcal antigen, substantially reduces mortality in patients with advanced HIV disease, who are commencing antiretroviral therapy.
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