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LIFE Newsletter - Leading International Fungal Education

September 2013

Welcome to LIFE's second newsletter.
LIFE's objective is to educate health professionals and students, acting as a resource for serious fungal diseases. These infections occur in all communities worldwide and education is needed in each and every country.
LIFE's overall objective is to increase the survival and reduce the suffering from fungal diseases worldwide.
Estimates of the burden of fungal infection in Guatemala will be presented at the forthcoming ICAAC conference and Dominican Republic, France, Iran, Jamaica, Mongolia, South Korea, Sri Lanka, Trinidad and Tobago and Zambia at the TIMM meeting. We will issue a LIFE news item online at TIMM featuring all the abstracts. Our next abstract deadline is ECCMID and estimates for several other countries are in progress.


WHO reinstates Amphotericin B and Flucytosine on the Essential Medicines List

Following a meeting held in the WHO Headquarters in Geneva in April 2013,  the 19th Expert Committee on Selection and Use of Essential Medicines has placed intravenous amphotericin B and flucytosine and oral flucytosine on the WHO Model List of Essential Medicines (EML) for both adults and children. The decision followed representation from The CryptoMag group, partly sponsored by GAFFI. 
In addition to improved survival of patients with cryptococcal meningitis, both drugs have other uses, such as disseminated histoplasmosis, invasive candidiasis and aspergillosis. The decision was evidence based, primarily on the definitive trial from Vietnam lead by Dr Jeremy Day, showing that this drug combination yielded a 40% lower chance of death in patients with cryptococcal meningitis and AIDS (View report).

Ketoconazole is withdrawn by FDA & EMA

The world’s first oral azole antifungal, ketoconazole is being retired by the FDA & EMA. First launched by Janssen Pharmaceutica (Belgium) in 1985, it transformed the treatment of oral and oesophageal candidiasis and some endemic mycoses such as coccidioidomycosis. This week, the FDA restricted its use to the occasional patient with endemic mycoses, as a last resort. The FDA cites “severe liver injuries and adrenal gland problems", and advises "that it can lead to harmful drug interactions with other medications”. Early after launch, ketoconazole was extensively used for skin fungal infections, and was very effective for many and convenient. Unfortunately about 1 in 10,000-15,000 developed severe hepatic reactions, which were either fatal, or more recently required transplantation. Adrenal dysfunction is also a significant issue. The European Medicines Agency’s (EMA's) Committee on Medicinal Products for Human Use, has also recommended that the marketing authorisations of oral ketoconazole-containing medicines should be suspended throughout the European Union (EU). more

Study of birth defects in women taking fluconazole or itraconazole

In a study of nearly a million Danish pregnant women of whom 7352 were exposed to fluconazole and 687 to itraconazole in the first trimester, Ditte Molgaard-Nielsen and colleagues in Copenhagen found a 3-fold increase in the heart defect tetralogy of Fallot and a 2-fold increase in hypoplastic left heart with fluconazole exposure. Numerous other birth defects were not associated with fluconazole exposure. No birth defect was associated with itraconazole exposure.
Fluconazole is extensively used in patients with AIDS to suppress cryptococcal meningitis and oesphageal candidiasis, and avoidance of fluconazole in early pregnancy is clearly required.
Tetralogy of Fallot occurs in 3 per 10,000 births, and following fluconazole exposure an additional 6.5 cases per 10,000 live births would be expected, almost 1 per 1,000 births. Their studies showed other birth defects were not associated with fluconazole or itraconazole exposure. more

See more News here

Featured LIFE website section: Histoplasma capsulatum 

This fungus lives in the environment, usually it is found in association with large amounts of bird or bat droppings. Lung infections can occur after a susceptible person inhales airborne spores, however, many people who inhale the spores don't get ill. View LIFE
The symptoms of histoplasmosis are similar to pneumonia. Histoplasma capsulatum is geographically widespread in the Americas and Africa, rare in Europe and Australasia, but present in a few, poorly defined foci in Asia. As an intracellular pathogen, it produces an extraordinary range of diseases, partly attributable to poor host immunity. It is a leading cause of death in patients with AIDS in central and the northern parts of South America, and markedly under diagnosed.
The diseases associated with this fungus are primary pulmonary histoplasmosis, progressive disseminated histoplasmosis, chronic cavitary histoplasmosis,. These conditions may be treated with any systemic antifungal agent except echinocandins.

For information on Aspergillus infections go to The Aspergillus Website.

Top Diagnostic Tip


Evaluation of an Enzyme Immunoassay for Detection of Histoplasma capsulatum Antigen from urine samples

A paper just published has examined the detection of Histoplasma capsulatum urinary antigen (UAg) comparing the enzyme immunoassay using ASR from Immuno-Mycologica Inc. (IMMY) with the routine testing of quantitative antigen by MiraVista Diagnostics. An overall agreement of 97.6% was found between the assays, although some low false positives were identified with the MiraVista tests. In addition to the prospective study 11 urines from known positive patients were tested by the IMMY assay and were 100% positive. The study suggests that the IMMY ASR assay offers an alternative approach for the detection of H.capsulatum urinary antigen. View LIFE site

Really Important Reviews

Mycotic Keratitis: epidemiology, diagnosis and management by Thomas & Kaliamurthy 2013.
Microbial corneal diseases are serious ocular infections and the major cause of ocular morbidity and blindness in the world with around two million presentations. In South Africa and Ghana there are around 30 times the number of corneal ulcers as in the US. Due to the diversity of clinical presentation, the ophthalmologist encounters a challenge in diagnosing and treating this condition. This review covers all aspects of cause, diagnosis and treatment. see review.
More about keratitis.



Fungal Infection: Diagnosis and Management (4th Edition) by MD Richardson & D Warnock. View

A concise guide to the clinical manifestations, laboratory diagnosis and management of superficial, subcutaneous and systemic fungal infections. The book to help clinicians make informed decisions about diagnosis and patient management. (ISBN: 978-1-4051-7056-7)

Pass it on

Help us to educate everyone about fungal infections - please forward this to anyone who may be interested.
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Msc/Diploma in Medical Mycology (distance learning), University College London (2013-14) This course, taught through distance learning in conjunction with the British Society for Medical Mycology, is designed to provide systematic training in the increasingly relevant subject of fungal infections. The programme focuses on the practical elements of diagnosis, the identification of pathogenic fungi, the application of molecular techniques and therapy. More information.

Mycology Masterclass VI at Mantra, Salt Beach, Kingscliff, NSW, Australia.(Oct 31st- Nov 2 2013) More information

Medical Mycology Course, Institut Pasteur, Paris (March 2014).   Register Sept 2013

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, Tunisia, Egypt, Philippines, New Zealand, Venezuela, Chile, Bolivia, Honduras. Can you help?
Contact us