Invasive Candida infection is the 3rd commonest infection in intensive care units and has a high mortality rate (35-67%). A study from China has just been published (Liao et al 2015) and indicates that 41% of infected patients in ICUs had fluconazole resistant candidemia. A potential risk factor for resistance was identified as the length of time spent in time in ICU prior to testing positive for Candida sp. The longer the interval the more chance of resistance developing. This study indicated it is therefore inadvisable to treat long stay ICU patients with fluconazole as a first-line drug before testing isolates for drug sensitivity.
In Taiwan an investigation into the status of azole resistance in A. fumigatus (38 clinical isolates over a 3 yr interval) has been published (Wu et al 2015). Three isolates obtained from respiratory samples of two azole-naïve patients with pulmonary aspergillosis were found to display multi-azole resistance and cross resistance to agricultural azole fungicides, and all carried TR34 /L98H mutations in cyp51A gene. The prevalence rates of azole resistance were 7.9% and 6.5% based on isolates and patients respectively. Phylogenetic analysis suggested genetic diversity of the TR34 /L98H isolates, including a unique genotype distinct from strains outside Taiwan. The result underlines the emergence of such isolates in Taiwan as well, emphasising the importance of further surveillance for azole-resistant A. fumigatus and implementation of strategies that prevent fungicide-driven resistance selection.
Antimicrobial resistance (AMR) has been a subject of intense interest over the last 2 years with major governmental efforts to address the growing issues. A report commissioned by the UK government and lead by economist Lord Jim O’Neill predicts increasing deaths attributable to AMR from 700,000 in 2015 to 10 million by 2050, and an increasing cost from 1 trillion US dollars a year in 2025 to $8 trillion a year by 2050 (total >$100 trillion), if not addressed. O'Neill report
Guatemala to have life-saving fungal diagnosis for HIV patients
Guatemala could soon be leading the way in providing better fungal diagnostic services for HIV patients in Central America, thanks to a partnership between the Asociación de Salud Integral (ASI), and Global Action Fund for Fungal Infections (GAFFI). Amongst a population of 14.7 million, an estimated 58,000 people are HIV infected, but only 15,136 patients currently attend the country’s HIV comprehensive care units and late HIV diagnosis is common. Only 53 per cent of the HIV population receive anti-retroviral therapy but HIV infected patients tend to present very late because of denial and stigma, and early death is the biggest problem. Guatemala is an excellent global location to both make big improvements in healthcare and demonstrates the value of combined fungal diagnostic availability and enhanced clinical training. At the end of the program, the country will have the first national reference laboratory specialized in mycology providing diagnostic services to HIV patients in Central America.
More information; News item in Spanish
New inhaled anti-infective to treat fungal infections in cystic fibrosis
Pulmatrix, Inc. have announced a new drug candidate, PUR1900,which is an inhaled anti-infective to treat fungal infections associated with cystic fibrosis (CF). Pulmatrix is strategically focused on developing innovative, first-in-class inhaled therapies for rare pulmonary diseases. Fungal lung infections are difficult to treat, so methods for safely delivering effective agents directly to the lung address an important un-met medical need. More information
Disseminated histoplamosis in India is not so rare in immunocompetent patients
Histoplasma exists in mycelial form at soil temparatures, but switches to the yeast form at normal human body temparatures (37C). The fungus persists in soil particularly where bird faeces are present. De & Nath from Kolkata describe a small study of 7 patients with disseminated histoplasmosis - none of whom had immunocompromised status. Only one patient gave positive cultures from a swab, diagnosis was from either bone marrow aspiration or biopsy. Most patients responded well to amphotericin B or itraconazole. Clinicians should be aware of disseminated histoplasmosis, which is similar to visceral leishmaniasis, in India. More information
Blastomycosis in Indiana over 30 years
Blastomycosis is not currently a reportable disease in many US states including Indiana. Cases can be mild but blastomycosis can lead to severe sequelae including disseminated infection, especially in immunocompromised individuals. There is new evidence of a rise in blastomycosis in endemic areas. Dr Chadi Hage, Dr Marwan Azar and colleagues describe characteristics of 114 patients seen with blastomycosis in 4 hospitals in the endemic Marion County over a 30 year period. Their report provides insights into the difficulty in diagnosis and treatment of very ill patients requiring ICU admission and those with meningitis, as well as the more typical ambulant patients. The introduction of a highly-sensitive and commercially-available assay for the detection of Blastomyces dermatitidis antigen in 2004 could be the reason for the higher incidence in Marion County. More information; Article