Friday, 30 April 2010

Lucy Laws recovers from Aspergillosis and goes home

2 years ago we wrote in this blog of a little 3 year old girl who had contracted leukemia and then seemingly the final blow - invasive aspergillosis. Lucy and her medical team fought back against both diseases and by easter 2008 she was able to return home for the holiday. At that time it was a huge step but there was so much more to do.

Now, 2 year later we are delighted to note that Lucy has been given her last treatment of chemotherapy and is doing very well. Lucy is in remission and off treatment. Her doctors will have to monitor her for another 5 years but for now the news couldn't be better.

Aspergillosis in patients with leukemia is so dangerous as the cancer itself  and the chemotherapy can be very effective in removing the ability of their bodies to fight infection. Leukemia is a disease of the immune system so the immune system itself has to be wiped out to treat it. Once this happens Aspergillus can get into their bodies and grow unhindered until their immune system recovered. This is a straight race between Aspergillus and the immune system recovery which is all too often lost to the fungus.

Lucy is living hope to everyone that it is possible to recover from this dreadful infection & disease and we wish her all the best for the future.

Monday, 19 April 2010

Volcanic ash hazard to chronic respiratory patients

The World Health Authority backed by Asthma UK and others have announced that asthma and emphysema sufferers should take precautions if there is a threat of volcanic ash being present in the air that they breathe.\

In the UK there is a chance that the particle size of volcanic ash emitted in Iceland which reaches ground level could fall into the range that can be inhaled deep into the lungs
"If people are outside this evening and notice symptoms such as itchy or irritated eyes, runny nose, sore throat or dry cough, or if they notice a dusty haze in the air or can smell sulphur, rotten eggs, or a strong acidic smell, they may wish to limit their activities outdoors or return indoors."

"Those with existing respiratory conditions such as chronic bronchitis, emphysema and asthma may notice these effects more than others and should ensure they have any inhalers or other medications with them. Any such health effects are likely to be short-term."

"The Health Protection Agency, Health Protection Scotland and the Met Office will continue to monitor the situation and issue any further advice or updates as necessary as the weather changes."

It is thought that the quantity of ash falling to ground level is unlikely to be harmful but our advice here at the Aspergillus Website is to be vigilant. If you notice an increase in the symptoms mentioned above it might be best to return indoors.

An N95 facemask would be useful to have as a precaution. These masks are available from a range of suppliers including Amazon, 3M etc. -search Google for 'N95 facemask'.

Thursday, 15 April 2010

FDA drug information that never reaches the clinician

Important information regarding the benefits and harms of FDA approved prescription drugs, does not make its way into the hands of the clinician - writes Lisa Schwartz in the New England Journal of Medicine. The FDA is the American drug regulatory body.

Drug labels (package inserts) are the direct way of communicating prescribing information to physicians- but they are written by the drug companies and then negotiated or approved by the FDA. Drug approval requires that preclinical studies and the results of at least two phase 3 studies in patients - are submitted to highly qualifed FDA experts which may take a year to evaluate.

The FDA produce review documents recording the reasoning behind approval. These are lengthy and can be complex - the problem seems to be that important information is getting lost - and never makes it onto a drug label. The authors report a number of possible harms - which fail to make it onto the drug labels, but also efficacy data that can be useful, but again is lost from the final drug sheets.

The FDA has recognised some problems with drug labels and in 2006 introduced a highlights section to emphasize drug warnings and indications. It has also issued guidance about reporting trial results in labels - but in at least 2 drugs studied, labels remained unimproved.
It seems that a better way of communicating information that is already known, but not passed into the clinicians hands must be expedited.

Tuesday, 6 April 2010

An evaluation of caspofungin treatment of invasive fungal infections in solid organ transplant patients

Invasive fungal infections are a significant factor in causing death in solid organ transplant recipients, particularly following lung or liver transplantation. Amphotericin B was the only drug available for transplant patients with post-invasive fungal infections for many years, and was often used to treat these patients despite the risks of kidney damage and liver failure.

In this report ( see Transplantation Infectious Disease) by Winkler et al, the antifungal drug caspofungin was evaluated as a post-transplant antifungal treatment in patients undergoing solid organ transplants - who then went on to develop an invasive fungal infection.
Caspofungin has not shown significant drug-to-drug interactions involving the metabolism of immuno suppressive drugs - which are necessary in transplant patients. This was significant in this report as 9 patients were switched to caspofungin therapy as a result of another antifungal interaction with their immunosuppressive treatment.
A total of 81 patients were included in this observational study from 4 countries, with various types of solid organ transplantation. Candidiasis was diagnosed in 64/81 patients (79%) and aspergillosis in 22/81 patients (27%). Most patients received caspofungin monotherapy (75%).

Caspofungin was effective as first- and second-line therapy in this group of patients with a favorable response rate of 87% in transplant recipients with proven or probable invasive fungal infections. It was noteworthy that 89% of patients with proven or probable invasive Candida infection and 74% of patients with proven or probable Aspergillus infection responded to caspofungin treatment, consistent with results reporting that caspofungin was an effective treatment in invasive aspergillosis after thoracic transplantations.

The authors point out that there are limitations to the conclusions of this study - particularly as there is a lack of any possible control study and the small numbers - however the use of caspofungin looks promising - for the treatment of invasive infection relating to solid organ transplants.
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