The Aspergillus Website is dedicated to providing information on aspergillus, aspergillosis, aspergilloma and other health problems caused by aspergillus to the professional and layperson. This blog will be used to provide latest information, news, current events, announcements and links to useful information.
Stump the Professor – Interesting clinical dilemmas
John E. Bennett, MD
Souha Kanj, MD
Session 9: Diagnostics and Imaging Chairs: Dimitrios P. Kontoyiannis, MD & Malcolm Richardson, PhD
09.15 – 09.40 Application of diagnostic markers for IA in children
Emmanuel Roilides, MD
09.40 – 10.05 Impact of prophylaxis on galactomannan, beta-D-glucan and PCR
J. Peter Donnelly, PhD
10.05 – 10.30 Which antigens are important and why?
Max S. Topp, MD
10.30 – 10.40 Oral Poster Presentation: Impact of current antifungal therapy on PCR based investigation of bronchoalveolar lavage samples for diagnosing pulmonary aspergillosis in patients with hematologic malignanciesMark Reinwald, MD
Session 10: Pfizer Symposium The Treatment Options Strategies for IAChairman: J. Peter Donnelly, PhD
11.10 – 11.15 Welcome and introduction
J. Peter Donnelly, PhD
11.15 – 11.30 Stratification of risk for IA in immunocompromised patients
Raoul Herbrecht, MD
11.20 – 11.45 Pre-emptive versus empirical anti-fungal therapy in neutropenic hematologic patients
Omrum Uzun, MD
11.45 – 12.00 Combination therapy: who benefits?
Keiren Marr, MD
12.00 – 12.10 Panel discussion
Session 11: Antifungal Resistance Chairs: David A. Stevens, MD & Beyza Ener, MD
14.10 – 14.35 Global status of azole resistance in Europe and Asia
Sevtap Arikan-Akdagli, MD
14.35 – 15.00 Update on resistance mechanisms
David S. Perlin, PhD
15.00 – 15.10 Oral Poster Presentation: Aspergillus fumigatus biofilms releases extracellular DNA which plays a role in phase dependant antifungal resistance
Ranjith Rajendran, MSc
15.10 – 15.35 Current section and species complex concepts: recommendations for routine daily practice
Manuel Cuenca-Estrella, MD, PhD
15.35 – 16.00 Implications of resistance in Aspergillus treatment guidelines
Dimitrios P. Kontoyiannis, MD
16.00 – 16.10 Farewell
David A. Stevens, MD
16.20 Farewell Drinks and Discussion about the next AAA Meeting
Session 2: Emerging Clinical Associations with Aspergillosis Chairs: David W. Denning, FMedSci & Omrum Uzun, MD
11.35 – 12.00 COPD and aspergillosis
Jesús V. Guinea Ortega, PharmD, PhD
12.00 – 12.25 Aspergillosis in cystic fibrosis – insights from new and old diagnostics
Caroline Baxter, MD
12.25 – 12.50 Invasive aspergillosis in ICU – are we moving forward?
George Dimopoulos, MD
12.50 – 13.15 Immune regulation in idiopathic bronchiectasis
Rosemary Boyton, PhD
Session 3: Top Six Papers in Aspergillosis in 2011 Chair: Sevtap Arikan-Akdagli, MD & Jay K. Kolls, MD
13.45 – 14.45 and concurrent with lunch
Murat Akova, MD and Nir Osherov, PhD
Session 4: Novel Immunological Insights into Aspergillosis Chairs: Richard B. Moss, MD & Emmanuel Roilides, MD
14.45 – 15.10 Innate immunity to Aspergillus
Mihai G. Netea, PhD
15.10 – 15.35 Neutrophil extracellular traps and A. fumigatus
Matthias Gunzer, PhD
15.35 – 15.45 Control of neutrophil ROS responses to A. fumigatus
Keith Boyle, PhD
15.45 – 15.55 Oral Poster Presentation: T-cell responses to several Aspergillus antigens may be detected in patients with invasive Aspergillosis and may be exploited for diagnostic and therapeutic purposes: a multicenter study Leonardo Potenza, MD, PhD
Session 5: Portraits of Non-Fumigatus Aspergilli – What is so Special About: Chairs: Paul Bowyer, PhD & Karl V. Clemons, PhD
16.25 – 16.50 Specification of polarity sites during growth and development ofAspergillus nidulans
Steven D. Harris, PhD
16.50 – 17.15 Aspergillus niger a perfect host for industrial biotechnology: systems biology approaches for the production of building block chemicals
Peter J. Punt, PhD
17.15 – 17.40 Diversity of Aspergillus flavus on crops and in the environment can be exploited to reduce aflatoxin exposure and improve environmental health
Peter J. Cotty, PhD
17.40 – 17.50 Oral Poster Presentation: Unique polysaccharide cell-wall composition responsible for dysregulated inflammation of A. nidulans infections in chronic granulomatous diseaseStefanie Henriet, MD
It is a fairly well-established fact that many of the antibiotics that have been developed in the past are starting to become less effective as the microbes they are designed to attack gradually become resistant. This is a slow process and can be managed quite effectively by limiting use of our current antibiotics to the more severe cases of infection - this slows the rate at which resistance can occur.
Despite precautions there is still a need to develop new antibiotics to replace those that become useless. Antibiotic-resistance mechanisms can affect more than one antibiotic at a time - a microbe can sometimes become resistant to several similar antibiotics at the same time - so ideally we need new antibiotics that attack microbes in different ways (i.e. new targets) to that which have already been developed.
How can we find new antibiotics that work on new targets? One new strategy is to look at our own immune systems for inspiration. Defensins are naturally occurring small proteins found in some of the cells in our immune systems - in particular neutrophils.
Neutrophils line our lungs and engulf spores (see movie above) to destroy them. Once engulfed it is defensin proteins that attack the spore, punch holes in the cell membrane and literally 'burst' the cells wide open.
The fact that Candida can be treated with defensin with such efficacy at least in one clinical context (the mouth) raises the possibility that they may also be effective against Aspergillus infections. They seem highly effective in the laboratory - let us hope that this is the dawn of an new era of highly effective drugs that can be used to treat a much wider range of infectious agents compared with older antibiotics, and one that resistance is very slow to develop against.
Newsbite: The 5th Advances against Aspergillosis conference opens in Istanbul next week on the 26th January 2012. AAA5 is the main conference focussing entirely on Aspergillosis, its causes, diagnosis, treatment, clinical research, clinical management and more.
The conference will be reporting back to this blog every day and will be using Twitter @AAA5Conference. more...
Though it may appear to be obvious few studies have convincingly demonstrated that the source of an outbreak of invasive aspergillosis is unclean air in the hospital environment. It is not generally enough to show that there are spores present in the air of a hospital as spores can also be present prior to the entry of a patient into the hospital, in their airways, on their clothes or in their food
In this study patients undergoing open heart surgery in a dedicated unit suffered an outbreak (December 2006 to April 2008) with seven becoming infected during this time and mortality was high (86%). The authors were able to look at the monthly surveillance records for the air in the heart surgery unit over this time and correlate the species found in the air with those found to be infecting the patients.
Aspergillus fumigatus was the main infecting species (6/7) and no spores were found during the periods prior to and after the outbreak. However during the outbreak a series of six abnormal air tests were recorded showing from 50 to 400 viable A. fumigatus spores per cubic metre of air in the intensive care units where patients spent time recovering from surgery - there was clearly a correlation between the presence of these spores in the air of ICU and the seven cases of invasive aspergillosis. The air in the operating theatres was clean throughout this time.
However there was still the problem of proving whether or not these spores caused the infections - perhaps the infecting spores were present prior to the operations?
To address this problem the authors have genotyped the strains of A.fumigatus found in the air of ICU and compared them with those found growing in infected patients and found them to be the same strains in half the patients - strongly indicating that in at least half of the cases the source of the infection was indeed the spores found in the air of ICU.
This is strong evidence for the importance of maintaining clean air for patients throughout their time in hospital after major surgery, during the operation and afterwards.
Testing of milk produced by the company Mengniu found it to be contaminated with unacceptably high levels of aflatoxin (occasionally found in cattle feed) after testing was carried out before Christmas 2011. New tests show the levels of aflatoxin are now much lower and are at levels deemed safe to drink. Regular routine screening for aflatoxins in milk has now been introduced in China more...
There are a number of new drugs coming into use which are intended to correct the immune system response of the patient to specific challenges. These drugs hold high promise for the treatment of auto-immune diseases where our immune systems mistake their own host tissues as an invading organism and attack tham as if they were eliminating a bacterium or other micro-organism.
Unfortunately glucocorticoids have many unpleasant side effects so many efforts are made to minimise their usage. It is beginning to be possible to manufacture drugs that will selectively inhibit parts of our immune systems and prevent painful inflammation caused by an overactive immune system e.g. Certolizumab. These are antibodies that can very precisely eliminate proteins causing particular types of inflammation.
The amazing trick this new generation of antibodies can perform is to fool our bodies into thinking that the injected antibody is a human antibody (humanised antibody) which allows them to persist in our bodies for longer period of time. They then have a much larger effect.
These humanised antibody drugs are achieving success in treating many people who are having difficulty with inflammation - arthritis being one group but other groups are also being treated e.g. omalizumab (Xolair) to treat those with severe asthma and in some cases Allergic Bronchopulmonary Aspergillosis (ABPA). Many can reduce or eliminate their dose of steroid while taking the antibody - different antibodies are used in each case.
Revolutionary though they may be, there is a small risk with some of these medications. If you adjust parts of the immune system there is a risk that you can also reduce the ability of that person to fight off infection. Using Certolizumab on its own doesn't seem to cause a problem but if that patients is immunocompromised by taking a steroid drug at the same time as the antibody then there can be a small increased change of getting a number of infections including aspergillosis.
This article is a summary of a research project into the use of Certolizumab to treat arthritis. It gives a warning for users of Certolizumab to be cautious if they have had or still have tuberculosis, aspergillosis and other infections and are taking steroids at the same time. One outcome of this study may well be to investigate this risk more carefully.
NOTE: It is worth reiterating that there is no data suggesting that treating ABPA with Omalizumab can trigger more aggressive aspergillosis, this study only refers to Certolizumab - a quite different medication.