Wednesday, 29 April 2009

National Aspergillosis Centre, UK

Dr Chris Steele
The first national centre for the treatment of aspergillosis sufferers will be formally launched at the University Hospital of South Manchester (Wythenshawe Hospital) on Friday May 1st 2009.

The UK National Aspergillosis Centre has been commissioned by the Department of Health, initially to provide long term care for patients with chronic pulmonary aspergillosis. This condition is one of several types caused by the common airborne fungus Aspergillus.

The centre aims to provide comprehensive, excellent care for all patients with aspergillosis and will link specialist consultants, nurses, surgeons, radiologists and researchers with specialised laboratory facilities to reduce fatalities and deliver a better quality of care.

The centre will be opened by TV doctor Chris Steele who said it will not only provide a valuable service for patients but also provide a national focus on a little known but highly debilitating disease.

The National Commissioning Group commission medical services for specific groups of patients with extremely rare conditions or which require unusual or costly treatment and advise ministers on which NHS services are best commissioned nationally rather than locally.

Friday, 17 April 2009

How we tell one Aspergillus species from another

Traditionally Aspergillus species were identified by looking at how they grew in the laboratory, by careful examination of the structure of their fruiting bodies - the conidium and by comparing those features with special reference strains. It is possible to read how these features are recorded in the species section of the Aspergillus Website.
As time has gone by and more an more potential new species are identified these techniques have proved to be inadequate. Some species were shown to be so closely related they were listed as varieties within a group rather than as distinct species - it wasn't possible to tell enough difference between them.

At the same time a slew of new information has become available which helps show us the differences between species in different ways. Principal among these new technologies is DNA sequencing and the new science of genomics. Similarities and differences between the DNA sequences of species can now be routinely examined and that information is used to say whether or not 2 candidate species are distinct, related or virtually the same.

This still isn't the full story and genomics data cannot be taken in isolation from all the other data, some new and some old. The way forward has been strongly suggested to be a polyphasic approach (first suggested many years ago) involving taking into consideration features from all available evidence: morphology; physiology; DNA; protein; ecology; metabolites, and reaching a concensus.

The result is complicated but often very robust: the full concept can be read in this recent paper.

Wednesday, 8 April 2009

Mobile phones as a reservoir for Aspergillus

A recent study in India shows that Aspergillus, amongst others can often be isolated from the mobile phones of professional health workers.
The mobile phone consists of a number of cavities and surfaces that can provide adequate moisture (from sweat) and food (the contents of pockets, human skin cells) for fungal growth. Phones are rarely if ever cleaned adequately so microbes lie largely undisturbed.

Considering that many professionals use mobile phones on and off the wards this may be another route through which Aspergillus and other infective microbes (e.g. MRSA) can get to the patient.

Outbreaks of aspergillosis occur in wards despite all the care taken to prevent the spores of the fungus gaining entry. Many routes have been considered (Barnes 2000) but maybe this relatively new source requires attention too.

Friday, 3 April 2009

A quick new test for Aspergillus infections in patients

A rapid new test for Aspergillus fumigatus fungal infections has been described at the Society for General Microbiology meeting in Harrogate on April 2nd. Fungal infections by Aspergillus species are a major cause of death in patients whose immune systems are suppressed or damaged - for instance transplant patients or those undergoing chemotherapy.

These groups of patients are susceptible to an invasive form of aspergillus infection with a high fatality rate. Invasive aspergillosis is currently difficult to diagnose and tests are lengthy and expensive. Current tests are not always specific and false positives are not infrequent.

Dr Christopher Thornton and colleagues, of the University of Exeter, UK has developed a test for invasive aspergillosis using a technology similar to that in home pregnancy tests. The test uses a monoclonal antibody which binds to a glycoprotein antigen secreted specifically by Aspergillus species. It does not apparently give a cross reaction with any other clinically important fungi and takes 15 minutes to perform, making it quicker and less costly than conventional laboratory-based tests. Being user friendly it may be useful at the point of care as a result of its speediness.
The test is currently being developed with a multinational clinical diagnostics company to develop a commercial version of the test.

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