FUNGUS - FRIEND or FOE? How Schoolchildren Will Make The Link Through Art and Music

A competition – the first of its kind to explore the relationship between fungi and and the illnesses that they cause using art and music – launches this week across the region’s schools.

For the next ten weeks thousands of young people in more than 400 schools in the North West and North Wales will be invited to interpret how they see the deadly role fungus can play in human diseases through creative arts and music.

Project Director, Professor David Denning explains: “Fungi are beautiful and fascinating they are essential to our ecosystem in the carbon and nitrogen cycles, and are valuable in commerce. Many industries use “good” fungi, for example in the making of alcohol, bread and cheese. However some fungi can also cause human infection. Fungal infections are mostly hidden and diagnosis is often missed. As many as 300 million people worldwide are affected, in many different forms of illness, some of which are deadly. This is an exciting project because never before has the mystery and beauty of microscopic fungi been explored in art and music.”

The competition is being run by LIFE Worldwide which has three fundamental aims:

Ø  To promote awareness of LIFE and its aims through the work of young artists and musicians

Ø  To give budding artists and musicians the recognition they deserve by promoting their talents

Ø  To educate young people about fungi and how they can cause illness.

The project, which is open to all young people aged between 13 and 18 and has a deadline of April 29^th , is supported by the UK charity the Fungal Research Trust and the University Hospital of South Manchester. This is based at Wythenshawe Hospital, and the Manchester Academic Health Science Centre.

The competition website can be found at www.projectlifecompetition.org. It  includes videos of interviews with patients living with fungal disease and a photo gallery displaying the vast array of different types of disease causing fungi.

Winning entries to the competitions will be receive an individual winners cash prize and a separate cash prize will be awarded to their School. Other prizes will include the opportunity for valuable work experience in a clinical environment.  The panel of judges includes:

•      Clark Rundell, Director of Contemporary Music and Head of Conducting at the Royal Northern College of Music in Manchester

•      Dr Lizzie Burns, Director of Science to Life, Oxfordshire

•      Sally Nash, a Landscape Architect with Gillespies in Manchester, and

•       Bob Devereux, Poet, Artist and Gallery Director of the Salthouse Gallery in St Ives, Cornwall.

Background on LIFE:

LIFE is the international education and advocacy brainchild of the UK charity the Fungal Research Trust (www.fungalresearchtrust.org). The FRT was set up in 1991 and since then has distributed in excess of £3,500,000 in research grants resulting in more than 145 research publications in clinical and scientific aspects of fungal infection. It has contributed to the postgraduate training of more than 25 scientists and doctors in the UK and overseas, and provides travel grants to scientific congresses. It also supports the encyclopaedic Aspergillus Website at www.aspergillus.org.uk.  As well as being a key resource for clinicians and researchers, the website also devotes a section to patients and relatives to help them understand more about the disease.

Fungal infection

Over 300 million people are acutely or chronically infected by fungi, leading to death, long term illness, blindness, psychological problems and reduced work capacity. These diseases have mostly been neglected. Many recent improvements in diagnostics and treatment have not reached treating clinicians in all countries, and access to appropriate diagnostics and simple antifungal agents is far from universal.

Deaths from fungal infections

Ø  Cryptococcal meningitis – 10% death rate in the USA, >80% in Africa. 600,000 deaths annually. Diagnosis simple with antigen test, but often late and appropriate medication not available.

Ø  Invasive aspergillosis – 200,000+ cases annually; 50% mortality treated, 100% if not, >100,000 deaths. Diagnosis difficult; treatment often too late, and only partially effective.

Ø  Chronic pulmonary aspergillosis – ~3 million cases and 450,000 deaths; diagnosis often confused with TB, and requires radiology and aspergillus antibody test; 30% mortality in 6 months, often by coughing up blood. Treatment partially successful but long term.

Ø  Pneumocystis pneumonia - ~ 400,000 patients annually; ~15% mortality in UK in AIDS, ~50% non-AIDS, 100% if not diagnosed and treated. >80,000 deaths. Diagnosis difficult without PCR or fluorescence microscopy. Treatment straightforward and available.

Ø  Candida bloodstream infection – 300,000+ cases worldwide; ~40% mortality, treated. ~120,000 deaths. Diagnosis by blood culture. Treatment straightforward, best drugs expensive.

Ø  Severe asthma with fungal sensitization (SAFS) – probably over 3.5 million patients worldwide; increased risk of asthmatic death (estimated to be 100,000 annually worldwide).

Major fungal infections and their impact or health and wellbeing

Ø  Oral and oesophageal thrush – unpleasant, reduced food intake and weight loss.

Ø  Allergic bronchopulmonary aspergillosis (ABPA) [~4 million people worldwide] and SAFS – breathlessness with severe asthma, reducing work capability especially for manual workers, co-morbidity issues with smoke from home cooking – easy diagnosis (skin prick tests), if considered, antifungal treatment 60-80% effective.

Ø  Chronic pulmonary aspergillosis – progressive breathlessness and weight loss, with significant hospitalisation and medication costs (typically mis-directed).

Ø  Fungal eye infection – ~1 million cases annually; usually results in unilateral blindness as diagnosis late, good outcome if treated early. Diagnosis requires expert input; treatment intensive initially but unaffordable for most afflicted.

Ø  Candida vaginitis – ~75 million women with at least 4 attacks a year; mis-diagnosis and anxiety major problems; impaired sex life and therefore relationship issues.

Ø  Fungal hair infection – over 100 million children affected; most common in black children, who suffer patches of hair loss, exclusion from school and psychological problems as a result. Diagnosis and treatment usually straightforward and highly effective.

UK Universities Given £5.1 million to Collaborate on Fungal Infections

Invasive fungal infections are responsible for around 1.5 million deaths worldwide each year.

Yet fungal infections are poorly understood and have much less public awareness than diseases caused by bacteria, viruses and parasites.

Now the University of Aberdeen has been awarded £5.1M from the Wellcome Trust to lead a major UK collaboration which will take a ‘laboratory bench to hospital bedside’ approach to tackle the problem.

The Aberdeen Fungal Group - the biggest fungal research group in Britain and one of the largest in the world – will head the new 'Medical Mycology and Fungal Immunology Consortium' which will also be supported by scientists at Imperial College London and the Universities of Newcastle, Manchester, Birmingham, Kent, Exeter and other UK institutions.  The Consortium’s aims include:

·         Taking research from the lab into the clinic and pharmaceutical industry to develop better diagnostics and more effective treatments for fungal infections

·         Leading a research and training programme, harnessing UK expertise, to better understand fungal infections and immunity to these diseases and to train a new generation of scientists and clinicians

·         Promoting greater public awareness of fungal infections using channels such as You Tube and the web.

Professor Neil Gow, Chair in Microbiology at the University of Aberdeen, is Director of the Consortium.  He said: "People are very familiar with superficial fungal infections, such as ringworm and athlete’s foot, which affect approximately a quarter of the world’s population and are usually easily treated.

“Fungal infections of the mouth and genitals are also common – thrush is estimated to affect 75 million women each year while oral infections are common in babies and denture wearers. Again these can be treated relatively easily in healthy patients.

“However invasive fungal infections - infections in the major organs of the body - are associated with high mortality rates.

“Immunocompromised patients, such as cancer, trauma and HIV patients; and people who have undergone bone and organ transplants, are more susceptible to fungal infection.

“For example, a patient who contracts septicaemia caused by the fungal pathogen Candida, has only a 60% chance of surviving it despite the use of anti-fungal drugs. The fungal pathogenCryptococcus has a 40% mortality rate too, and with Aspergillus this mortality rate is increased to 70%.

“These kinds of infections are sometimes known as ‘the disease of the diseased’, and yet the study and awareness of fungal infections lags behind studies of other classes of microbe that cause disease.

“New strategies are desperately required to combat these life-threatening fungal infections.”

Professor Al Brown, a chair in Microbiology at the University of Aberdeen and Co-Director, said: "There are a number of different fungal pathogens but the big four that pose the most risk areCandida, Aspergillus, Pneumocystis and Cryptococcus.

“Each year Candida is estimated to cause 400,000 life-threatening systemic infections of the body’s major organs.

"We need better treatment for fungal infections, better ways of diagnosing the problem and better understanding of its immunology and pathology and those are the challenges our consortium will tackle.”

Professor Gordon Brown, Sixth Century Chair in Immunology at the University of Aberdeen and Co-Director, added: "There are more than one million cases of Cryptococcus infections per year in Sub-Saharan Africa and these claim more lives than AIDS-associated tuberculosis.

"Other fungal species cause major endemic problems in developing countries where local expertise in fungal pathology is often limited.

“The award from the Wellcome Trust will enable the Consortium to promote national and international collaborations to enhance the understanding and treatment of fungal infections in developing and developed countries.”

Professors Gow, Brown and Brown together with Professor Mihai Netea at Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands, spent two years developing and refining plans for the Consortium before seeking funding from the Wellcome Trust.

Professor Ian Diamond, Principal and Vice-Chancellor of the University of Aberdeen, added: “The Wellcome Trust Strategic Award is the single biggest award ever granted in the UK to the field of medical mycology and fungal immunology.

“It places the University of Aberdeen at the heart of a major research and training consortium that will deliver a new generation of clinical and research scientists to fight these devastating infections.”

The Consortium will also create 10 international PhD studentships, three clinical PhD studentships and six postdoctoral research assistant posts that will be spread across UK institutions.

Notes to Editors

Professor Neil Gow, Professor Al Brown and Professor Gordon Brown are available for interviews and photographs. To arrange, contact Jennifer Phillips on 01224 273174.

The Aberdeen Fungal Group is the largest research group in the UK specialising in medical mycology and fungal immunology and comprises around 50 research staff.

About the University of Aberdeen:

The University of Aberdeen is a centre of excellence for life sciences. Translational research is a particular strength for the University as its health campus is based on one of the largest teaching hospital sites in Europe.

Issued by the Communications Team, Office of External Affairs, University of Aberdeen, King's College, Aberdeen. Tel: (01224) 272014.

Antifungal drug resistance, an update from AAA meeting

The recent 5th Advances Against Aspergillosis meeting saw a turning point in the recognition of Aspergillus resistance research.

Relatively few researchers have been studying drug resistance in Aspergillus. Much of the recent work on patient samples has been conducted by the teams in Manchester (UK) and Nijmegen (The Netherlands), who both see a particularly high frequency of resistance against the azole antifungals voriconazole, itraconazole and posaconazole - the most common drugs used to treat aspergillosis. But other groups have argued that these are isolated hot-spots, and resistance is not of concern to patients elsewhere.

However there are increasing reports of resistance cases around the globe, and it has now been observed across Europe, North America, Asia and Australasia. Unfortunately however, many centres still do not routinely check for resistance, so it may be under-reported.

As well as few centres testing for resistance, the problem is also complicated because many samples from patients with aspergillosis do not grow Aspergillus in culture, making it difficult to test for resistance. However a recent report from Manchester describes the use of a new technology which is able to detect resistance in a patient sample, even when Aspergillus does not grow. In that study, resistance was identified in over half of patients samples where Aspergillus DNA was detected but it did not grow, suggesting it may be much more common than believed. Furthermore, in these patient cases, resistance would not have been identified otherwise, so this may be an important future diagnostic tool.

During the recent 5th Advances Against Aspergillosis meeting there was a whole session devoted to resistance, with several speakers commenting that it is 'a significant emerging clinical problem'. This will hopefully raise its profile further, and encourage other researchers to check for resistance in their own centres. This greater recognition could help secure more funding that will aid us gaining a better understanding of the extent of the problem, and what measures we can put in place to help minimise it.

Related Blog

WikiProject Medicine: a Useful Tool for Medical Education?

There is an ongoing discussion amongst doctors in the 'heavyweight' medical press about the advantages and disadvantages of using the medical information found on the open source, openly edited encyclopaedic web resource Wikipedia.

 Wikipedia is run by a non-profit charity in the US and is available in several languages.

It is essentially written by its own readers, everyone writing about subjects that lie within their own areas of expertise and which they feel should be included in the encyclopaedia. Naturally at first there are disagreements about what is written in a particular article and after one author has finished another is free to alter or comment the article. After several rounds of debate a consensus is reached, references are linked in and the level of editing drops considerably as an article stabilises.

The net effect has been to provide articles (nearly 4 million English articles at the last count) that are arrived at via collaboration, albeit in a system where we have little idea of the status or reliability of the authors in question. The articles can be constantly updated as new information crops up.

 In practice Wikipedia does have an active panel of moderators who work to limit obvious acts of vandalism and misinformation - many changes have to conform to an editorial policy and while anyone can make a change those changes are checked quite quickly - within hours in my experience.

 This is all very well and has been a highly successful approach, largely consigning encyclopaedias produced in more traditional ways to the past

Pretty much anyone who uses the internet does so to look for information. Most use Google to find that information and Google ranks Wikipedia articles very highly, increasing the numbers of readers Wikipedia has and therefore the number of editors & authors. This 'virtuous circle' has helped form a very effective free, collaborative tool that is highly comprehensive and does pretty well with regards to accuracy and detail. Articles tend to be written from the 'non-expert' point of view and are easy to understand for the average man in the street.

 But what of subject that may ultimately put our lives at risk? Medical information has been the subject of a special sub-category of Wikipedia for some time - WikiProject:Medicine. The goal of this project is given here:

To produce reliable and neutral information on medical conditions, diagnosis and treatment in a readable and standardized format. It aims to deal with these diseases in every context, from molecular biology, symptomatology and diagnosis to therapeutical issues and historical and geopolitical ramifications. To this end, the WikiProject will collaborate with other WikiProjects relating to the health sciences.

There is much debate. One author contends that there is something to be gained in working with Facebook on this project, not least that it attracts 150 million viewers a month, arguing that this impetus could be harnessed by improving quality guidelines a little and with more involvement from moderators on 'unstable' pages.
There is a feeling that as long as contributors remain anonymous there will be a problem of verification of quality - but the involvement of laypeople is a good thing opening up many subjects to a wider audience in plainer English and may act as useful feedback from laypeople as to what is an important issue for ordinary people, bringing doctors back into writing for the needs of their patients.

Once suitable safeguards are in place this resource could become even more successful across the world, English speaking and otherwise, especially where money and facilities are minimal. It is already estimated that 70% of junior doctors (and the vast majority of medical students) use Wikipedia more than once per week, in its own way validating much of what is written.
Wikipedia is simple to use, simple to read and provides short clear summaries that are as useful to doctors & teachers as they are to the layperson. The writing is on the virtual 'wall' - there is a huge amount to be gained from engaging with this massively successful enterprise.

Other articles in the medical media on the use of Wikipedia:

• Wikipedia versus Facebook: Social networking holds the key
• Medical Wiki audience issues were not considered

Mold Remediation Products - None Completely Effective

A recent research paper describes testing a range of ten products sold to remove and remediate mould and mycotoxin.

Method: Manufacturer

1. Ozone: Ozone-generator device Airmaster 
2. Peroxide: ALRON Chemical Ltd. 
3. Hot air: Black & Decker 
4. Flaming: Commercially available burner 
5. Steam: Karcher Ltd. 
6. Boron-based chemical 1: Svenska reimpregnering Ltd. 
7. Boron-based chemical 2: WSJ Sanitation Oy Ltd. 
8. Ammonium chloride based chemical: BlOkleen Ltd. 
9. Sodium hypochlorite based chemical: Colgate-Palmolive Ltd. 
10. Drying

None were completely effective in removing all viable molds or mycotoxins, raising the point that none of these methods which are widely used in the remediation of buildings is completely effective. The authors suggest:

1. that more research is needed to identify new protocols and/or sterilising substances in order to improve the end result of remediation
2. manufacturers need to be under more obligation to prove the efficacy of their products under conditions that represent remediation more closely so as to get a genuine guide of the effectiveness of their product when in use

I would also suggest that this is a strong hint to move towards replacement of mouldy materials (particularly mouldy wood and plasterboard) rather than make attempts to clean them.