Friday, 19 December 2008

Case histories and their importance

Case histories are the detailed descriptions of the diagnosis, treatment & outcomes of specific patients suffering from unusual illnesses. They can offer a large amount of information on unusual illnesses though tend to be very specific in their applicability.
Aspergillosis is quite rare in many of its forms and we have a database of more than 70 case histories on the Aspergillus website which we hope provide a lot of important information to medical practitioners looking to treat similar cases.

Some case histories were/are published in mainstream medical journals but many more (1500 in 2008) are now published in dedicated 'open access' journals such as the Journal of Medical Case Reports and its sister journal Cases Journal.

Biomed Central (the organisation behind the publication of the latter two journals) has announced the following event:



Case reports and the importance of stories in health care
We are hosting a one-day academic symposium on case reports and the importance of stories in health care, and we invite you to join us. The event will take place on Friday 15th May in central London, and will be chaired by our Editors-in-Chief, Professor Michael Kidd and Dr Richard Smith.

Confirmed speakers include:
Sir David Weatherall, Emeritus Regius Professor of Medicine at the University of Oxford
Ann McPherson, Medical Director of Health Talk Online/DiPEX
Jeffrey Aronson, Reader in Clinical Pharmacology at the University of Oxford
Geoffrey Pasvol, Professor of Infection & Tropical Medicine at Imperial College London
Brian Hurwitz, Chair of Medicine and the Arts, King's College London
Paul Hodgkin, Founder and Chief Executive of Patient Opinion
Tom Jefferson, Cochrane Collaboration
Sir Iain Chalmers, James Lind Library

Attendees will hear topics ranging from the history of case reports, to how case reports fit with evidence-based medicine, reporting of adverse drug interactions, how patients can be helped by case reports, the internet's role in the future of healthcare, and more. As well as the strong academic programme, the event will be an excellent networking opportunity.

More details will follow, but please contact us now to register your interest and secure a place.

Suitable for professional and layperson alike, well worth attending.

Tuesday, 16 December 2008

Care needed when feeding birds

The recent cold weather in Clinton County has coincided with the deaths of a dozen Canada Geese from aspergillosis.

At this time of year the birds are likely to be stressed from shortage of food and water, and their immune systems will be operating at a less than optimal levels, leaving them exposed to infections.

Feeding birds is a popular pastime for many people but this can be a double edged sword when it comes to bird welfare. Feeding can persuade birds to delay migration or even not migrate at all, thus leaving them under threat of colder conditions than they would normally be exposed to.

More than likely the infection of the geese mentioned in this article originated from mouldy food left out for the birds so this is a timely reminder that food used to feed wild animals should be in good condition, and that any uneaten food should be cleared away before it goes mouldy.

Friday, 12 December 2008

Nine metre high fungus!

Asian countries tend to have a more positive impression of the value of the fungi we all live with. While western foods tend towards use of yeasts (a non-filamentous fungus) to make breads and beverages, eastern foods make fuller use of filamentous fungi such as Aspergillus oryzae in the manufacture of Soy sauce and other foods. It is not so surprising then that it is in the east that an exhibition in celebration of fungi has opened:
The extent to which we are surrounded and affected by bacteria, fungus and molds is the subject of "Kinrui no Fushigi" currently running at the National Museum of Nature and Science in Tokyo's Ueno Park. Molds, bacteria and, mostly, mushrooms of every shape and form fill the museum, as do drawings by mangaka Masayuki Ishikawa, author of the series Moyashimon: Tales of Agriculture, from which the characters come.
Second only to insects, there are 80,000 different known forms of fungus, mold and bacteria--and a suspected 1.5 million that have yet to be discovered--so there is a lot of ground to cover in very little space.
However, some of the most interesting fungi on exhibit are at the beginning, where there are protolaxite fossils dating back 440 million years. These ancient fungi grew to as much as nine meters tall and 1.5 meters wide, a fact illustrated by two lifesized replicas.

Well worth a visit if you are passing!

Tuesday, 2 December 2008

Sex life of Aspergillus fumigatus is revealed

The discovery of a sexual cycle in the pathogenic fungus Aspergillus fumigatus has just been described in Nature by Scientists from The University of Nottingham and University College Dublin. Aspergillus fumigatus is an opportunistic human pathogen in individuals with weakened immune systems, causing potentially lethal invasive infections and is also associated with severe asthma and sinusitis.

First described 145 years ago this killer fungus, previously had no known sexual cycle and was only thought to reproduce by the production of asexual spores. Dr Paul Dyer (from Nottingham University) is an expert in the sexual development and population variation of fungi said "This discovery is significant - providing both good and bad news. The bad news is that we now know that Aspergillus fumigatus can reproduce sexually, meaning that it is more likely to become resistant to antifungal drugs in a shorter period, and the sexual spores are better at surviving harsh environmental conditions. The good news is that we can use the newly discovered sexual cycle as a valuable tool in laboratory experiments to try to work out how the fungus causes disease and triggers asthmatic reactions. Once we understand the genetic basis of disease we can then look forward to devising methods to control and overcome the fungus."

The discovery of a sexual cycle in A. fumigatus provides insights into the biology and evolution of the species. It helps explain the presence of diverse genotypes despite predominantly clonal reproduction, the conservation of sex-related genes, aspects of genome evolution and defence against repetitive elements. In addition, production of ascospores might aid survival in adverse environmental conditions. The discovery has significant medical implications. Sexual reproduction can result in progeny with increased virulence or resistance to antifungal agents, and can confound diagnostic tests based on the assumption of clonality.


It is hoped the results of this research will lead to new ways of controlling this deadly disease and improved treatments for patients infected with it.
News report

Wednesday, 26 November 2008

'Know your air for health' site to help communicate EU air quality information

Air pollution affects us in many ways, often more than we realize. Obvious effects are those which directly impact on human health. Aspergillus species produce airborne spores which we all breathe in on a daily basis. For most of us in good health that is not a problem but for people with immune suppression, asthma and other problems which weaken the immune system, Aspergillus spores can infect a person and become a serious threat to health if not suspected and treated early.
Air quality and "Know your air for health" is a joint project by the Health & Environment Alliance (HEAL) and the European Federation of Allergy and Airways Diseases Patients Associations (EFA). Their website's main objective is to help communicate EU air quality information and alerts to allergy, asthma and COPD patients in Europe. The site contains much information on EU legislation on ambient air quality and specifically on emissions. Amongst many useful links "Find your EU pollen forecast" takes you to http://www.polleninfo.org/ where a europe-wide breakdown of pollen spore forecasts can be summarised or viewed for an individual country. Pollen types and mould spores are listed individually in a typical pollen forecast. A Countdown service to the start of the pollen/spore seasons and data charts of pollen counts for individual sites and regions are available for clients of Pollen UK. Much information is available on the site and historical data from ~300 pollen monitoring stations has been used to produce load maps of the likely intensity of pollen loads for a given month and area.

Aspergillus blog service interrupted

Users may have noticed that we have not published since the 11th November. The reason for this is that we were denied access to the blog while Google assessed this blog for its potential to be spam. Google 'antispam-robots' identify blogs that they consider are potential 'spam blogs' (Wiki) which are essentially fake blogs designed to promote use of commercial websites.

As we do no such thing our access was restored once the blog was reviewed this morning.

We cannot say with confidence whether or not this will happen again as we will remain the same blog and I can only assume Google 'spam-bots' will stay much the same. We can only hope that they will ignore us in future.

We apologise for the break in service.

Tuesday, 11 November 2008

Identification of an Aspergillus fumigatus protein which is involved in fungal growth in hypoxic conditions and in drug resistance


The incidence of potentially lethal infections caused by normally benign molds has increased tremendously over the last two decades. One disease in particular, invasive pulmonary aspergillosis (IPA), predominantly caused by the common mold Aspergillus fumigatus, has become the leading cause of death due to invasive infections. Currently, we have a limited understanding of how this opportunistic pathogen causes disease in immunocompromised patients.

A recent study by Willger et al has explored a mechanism required by this mold to cause disease, hypoxia (low oxygen) adaptation. The study states that hypoxia adaptation in Aspergillus fumigatus is mediated in part by a highly conserved transcription factor, SrbA, a protein in the sterol regulatory element binding protein family.
A mutant strain, not expressing SrbA was found to be unable to grow in hypoxic conditions, it also displayed increased susceptibility to the azole class of antifungal drugs - specifically it was highly susceptible to fluconazole and voriconazole, and was unable to cause disease in two distinct murine models of IPA.
Importantly, the authors report the discovery of a novel function of SrbA in molds related to maintenance of cell polarity. The finding that SrbA regulates resistance to the azole class of antifungal drugs presents an opportunity to uncover new mechanisms of antifungal drug resistance in A. fumigatus. Further details.

Wednesday, 5 November 2008

Wythenshawe Hospital, Manchester, to provide National Service for Chronic Pulmonary Aspergillosis

The Department of Health has announced that from April 2009 funding will be provided for a ‘National Aspergillosis Centre’ at Wythenshawe Hospital in South Manchester, UK. It will be the first national centre for aspergillosis in the world, and will form part of Wythenshawe Hospital’s North West Lung Centre, which has a long history and international reputation for treating lung disorders. This will end any postcode lottery for patients with chronic pulmonary aspergillosis (CPA) – an incurable fungal disease of the lung.
It is estimated that there are 500 – 750 cases of CPA in England, and that the new National Centre will provide access to specialised services in an area of high unmet patient need.

The National Aspergillosis Centre will provide patients from across the country with access to a team of specialist staff including two consultants (Professor Denning and Dr Hope), specialists nurses, surgeons, radiologists, clinical research fellows and the Regional Mycology Laboratory, already situated at Wythenshawe Hospital. Clinical research on these uncommon disorders will be a major focus of the work, already underwritten by the recent NIHR Translational Research Centre in Lung Disease being co-located at Wythenshawe. This development will deliver a better quality of care for patients with aspergillosis and should help to reduce mortality rates.

The Clinical Director of the new National Aspergillosis Centre, Professor David Denning says: “We’re delighted that the Department of Health will be funding a National Aspergillosis Centre here in South Manchester, which is an area with high rates of respiratory disease. This national service will benefit patients across the UK, by building on the extensive expertise in chronic fungal lung infections (at Wythenshawe) and sophisticated laboratory support and allowing us to invest further in our clinical and research capabilities.” More information

Friday, 31 October 2008

New class of antifungal drug emerging


There are currently several different antifungal drugs available for treatment of aspergillosis - six approved drugs in current use: amphotericin and derivatives, itraconazole, voriconazole, posaconazole, caspofungin and flucytosine (see the Aspergillus Website Treatment section for details here). 
There are currently 6 new drugs relatively close to use on aspergillosis in the clinic; isavuconazole, ravuconazole, micafungin, albaconazole, anidulafungin and SPK-843.

This sounds like a lot of choice for the clinician but unfortunately their usefullness is a little limited as most belong to only three classes of antifungal drug: the polyenes, the triazoles and the echinocandins (details here). In fact there are 6 triazoles, 2 polyenes and 3 echinocandins that are  usefull to treat aspergillus infections.

This is important as all antifungals in a particular class tend to work in the same way, so the fungus can build up resistance to a whole class of antifungal drug once it has become resistant to one drug, or a particular class can be less good at treating some conditions - for example at one time there were only polyene drugs available which tended to be very toxic for some people, so when the triazoles arrived that group of people benefitted greatly as they tended to be much less toxic.

New classes of antifungal drugs are therefore much sought after. This week we saw reports in the media of news of the emergence of a new class of antifungal. f2g (a company based here in Manchester, UK) has announced that it will present research results at a forthcoming major scientific conference (ICAAC 2008). We have few details of the announcement but it looks clear that there is activity against Aspergillus in the laboratory and possibly in animal models. It is also clear that there has been no work carried out on treating patients in the clinic, so all this optimism must be tempered by the knowledge that many drugs look promising at this stage but then prove to be too problematic to use to treat humans, or have little activity against Aspergillus in patients.

If there are any more details to report when we can read the presented research we will do so in a few weeks. Until then we can only hope trials go well and this represents the beginning of the development of a new tool to use against aspergillosis.


Disclosure: f2g has as an advisor Prof David Denning who is also Senior Editor for this website, but no prior knowledge of this announcement was made available to us here at the website. We feature this announcement as an important development in antifungal research and not because any inducement was made by any member of  f2g or its advisors to publish this news.

Monday, 27 October 2008

Bone marrow donor genetics is linked to risk of fungal infection


A bone marrow transplant can be a life-saving treatment for some
patients with leukaemia and some other forms of cancer. But sometimes recipients of bone marrow transplants, come down with invasive aspergillosis - a fungal infection that can be fatal.

Invasive aspergillosis occurs in up to 12% of bone marrow transplant recipients and one-year mortality rates range from 50% to 80%, making it "one of the leading infection-related causes of death," the researchers said.

Toll receptors are found on the surface of cells in the body's innate immune system and help to recognise invading pathogens. Because the toll-like receptors (or TLRs) play a key role in the immune response to fungal pathogens such as aspergillus, the researchers decided to see if genetic variation affected who came down with disease.

This study of bone marrow donors has shown that a particular genetic variation in TLR4, the gene for the toll receptor 4 is associated with a five fold increase of invasive aspergillosis in recipients of bone marrow - when the donor is unrelated. Recipients related to the donor do not appear to be at increased risk which is as yet unexplained, but the relatively small size of the groups in this study may be partially responsible. Further studies will be required to elucidate this. More information.

Read the paper by Buchud et.al. here.

Wednesday, 22 October 2008

Genomics to target fungal lung disease


The European Science Foundation has announced the following in this weeks 'Lancet' journal:
The European Science Foundation (ESF) has announced the start of a new pan-European collaboration, FUMINOMICS, to study the opportunistic pathogen Aspergillus fumigatus. This saprophytic filamentous fungus causes severe nosocomial infections that are increasingly problematic for clinicians; invasive aspergillosis is now the leading cause of early death in many transplant centres in Europe.
Jean-Paul Latgé (Institut Pasteur, Paris, France), chair of the new FUMINOMICS steering committee, added, “Our ability to carry out research into this pathogen has only become feasible recently because of the publication of the complete A fumigatus genome and new molecular and biochemical tools that make it possible to genetically modify the fungus in order to undertake large-scale studies including proteomic, transcriptomic analysis and the construction of mutant libraries”.
This collaboration has been made possible by the publicly available genomic sequence of Aspergillus fumigatus, such as that hosted by the Aspergillus Website (for whom Jean-Paul has been an editor for several years). The aims of the project are outlined as:
One of the main clinical objectives will be to investigate how the fungus grows in vivo, to discover the mechanisms that enable it to gain a foothold to establish disease. Another is to develop methods for better early diagnosis—aspergillosis is currently diagnosed very late and drug treatment fails because fungal burden is too high. “We also hope to identify new drug targets to tackle this opportunistic but deadly pathogen more effectively”

Friday, 17 October 2008

PET detects Aspergillosis

Detection of the first positron
Positron Emission Tomography (PET) works by generating a harmless radioactive 'version' of a common metabolic molecule such as glucose (the radioactive version for glucose in this case is known as FDG). The radioactive molecule is injected into the bloodstream of a patient and accumulates in the areas that are most active. In the case of FDG it accumulates in areas where cells have a higher growth rate as in those areas the cells are using more glucose.

Detectors measure where the radioactivity accumulates and thus show up where the actively growing cells are. This is particularly useful when looking for cancer tumours and those cells are rapidly growing and using lots of glucose. It is also useful when needing to tell the difference between benign (slower growing) tumours and malignant (fast growing) tumours.

Unfortunately a recent article states that things aren't quite a simple as they seem for this hugely expensive procedure. Infections such as Aspergillosis also cause an accumulation of FDG causing confusion between what is an infection and what is a tumour. For this reason the article suggests that PET is best used when it is already known that a tumour exists and the PET scans can follow the progress of the tumour during and after treatment, or can differentiate between benign and malignant.
It might be suggested that PET could equally also be used to follow an Aspergillosis (or aspergilloma?) as it is treated, but given the high cost of these scans that seems unlikely in the near future.

NB it is interesting to note that the PET is one of the first practical uses of antimatter as a positron is literally an anti-electron. First postulated in 1928 antimatter has been the subject of many science fiction productions and scientific speculations as to why the known universe is made up almost entirely of matter with virtually no antimatter (given that the two should exist in balance) - perhaps there are entire antimatter galaxies we currently don't know about!

Monday, 13 October 2008

The risk of Aspergillus infection after dental work

Image from Aspergillus mycetoma of the Maxillary Sinus Secondary to Overfilling of a Root Canal by Luciano Giardino, MD, DDS, Francesco Pontieri, MD, Enrico Savoldi, MD, DDS, and Federico Tallarigo, MD
This article mentions that Aspergillus can cause sinusitis. One reason that Aspergillus and other airborne micro-organisms can infect sinuses is that there are air channels leading from the nose directly into the sinuses - partly to provide a natural drainage channel for mucus. Aspergillus spores (seed-like particles) are so small and light they float freely in the least puff of air, so accessing nasal passages and chambers filled with air branching off the nasal passages e.g. the sinus' is quite easy. Taken together with the fact that all of us breathe in Aspergillus spores every day it is not hard to conclude that infection is not prevented by lack of supply of spores!

For the most part our natural defences against infection destroy spores quickly and efficiently - there are movies of precisely that happening in the Educational section of the Aspergillus Website.

Another 'mechanism' of preventing fungal growth in the sinus' that has some speculative merit stems from the observation that there is very little available zinc in the cavity. Fungi such as Aspergillus need zinc to grow, so the absence of zinc prevents fungal growth.
Zinc is plentiful in the material used to fill teeth and a little known fact is that that material can protrude right through a root canal filling into the maxillary sinus. There are two papers (1, 2) which discuss cases of root canal amalgam protruding into the sinus which are covered with fungal growth within the sinus, consistent with the amalgam aiding growth as described above.

We should emphasise that this is an incredibly rare phenomenum - there is no need to question your dentist on his technique just yet, except perhaps to remind him/her not to overfill!

Monday, 6 October 2008

EU go-ahead for paediatric anti-fungal

The European Medicines Agency's paediatric committee last week gave the go-ahead for a paediatric version of Merck Sharp and Dohme's Cancidas, for use in fungal infections - which like the adult version contains the echinocandin, caspofungin acetate, and now only needs to be authorised for marketing by the European Commission. This should happen within two months or so.

The product is already available for paediatric use in the US, where the FDA approved it in August for use in children aged three months and older. In Europe the new indication was submitted for approval under the paediatric regulation, which came into effect in January 2007 and is intended to address the shortage of suitably adapted forms of drugs and the lack of information on paediatric dosing.

Companies have generally been reluctant to develop drugs for use in children, mainly because of the costs involved. Instead, doctors have had to estimate the dose or use drugs off label, which has often led to adverse reactions or denied children access to the latest or most effective treatments.

The EU's new regulations in January 2007 intended to address the shortage of suitably adapted drugs for paediatric use. As well as encouraging trials on new paediatric indications of existing drugs like Cancidas, the regulation also targets new active substances. As of July this year, all new drug applications must include the results of trials conducted in children in accordance with a paediatric investigation plan (unless the company applies for a waiver). View full article.

Tuesday, 23 September 2008

Aspergillus threatens crops damaged by Hurricane Ike

The power of a hurricane
Hurricane Ike swept through the US state of Ohio last week just as fields of grain were ripening.



This article discusses the damage done by the storm to crops and the potential for infection by Aspergillus.

The most severe damage seem to be done to crops stressed by drought which collapse to the ground when blown by severe winds.

The plant is therefore already vulnerable to infection, presumably because there are already several dead leaves on the plant due to early growth dying back when little water is available. All that is needed is sufficient moisture and direct contact with spores - both of which happen if lying on moist soil.

The next immediate threat is from mycotoxins - toxic chemicals produced by Aspergillus and other fungi which will make the crop inedible. There are specific conditions required before the infecting fungus can produce mycotoxins (e.g. Aflatoxin) which are mentioned in the article:

Aspergillus can infect grain and produce aflatoxin under a wide range of conditions: temperature between 54 degrees and 108 degrees Fahrenheit; kernel moisture between 15 percent and 25 percent; and relative humidity above 80 percent.

“Downed corn will certainly be exposed to these conditions, especially high moisture if it rains, and since aspergillus is a soil-borne fungus infection could easily occur,” said Paul.

But, he added, growers should also pay attention to such ear mold diseases as fusarium and diplodia, which could develop if damaged ears come in contact with moist soils.

Any condition that increases moisture in the grain, puts maturing grain in contact with the soil, restricts drying, and makes harvest operation difficult could promote fungal growth and toxin contamination.

Tuesday, 16 September 2008

Aspergillus produces most of the world's citric acid

Citric acid is used for a multitude of purposes around the world, most obviously as a food & drink additive (E330) for flavouring or as a preservative but also for purposes as diverse as soaps & detergents, hair dying, explosives, industrial pipe cleaning, photography and many more - even heroin users seek it out.

1.7 million metric tonnes of citric acid are produced worldwide per year, and most of that is made by Aspergillus niger. The ability of A. niger to make citric acid was originally identified in 1917 by James Currie and industrial level production began two years later by Pfizer. Up to that point when citric acid was needed citrus fruit juices were employed.

The process of citric acid production by A. niger is pretty simple, the Wikipedia entry is as follows:
In this production technique, which is still the major industrial route to citric acid used today, cultures of Aspergillus niger are fed on a sucrose or glucose-containing medium to produce citric acid. The source of sugar is corn steep liquor, molasses, hydrolyzed corn starch or other inexpensive sugary solutions. After the mold is filtered out of the resulting solution, citric acid is isolated by precipitating it with lime (calcium hydroxide) to yield calcium citrate salt, from which citric acid is regenerated by treatment with sulfuric acid.
More modern techniques separate the growing fungus from the sugary liquid using a rotatory biological contactor (RBC). The fungus grows on the RBC and is rotated allowing alternate exposure to the liquid, then the air, then liquid again some 10 times per minute.
This makes the process more efficient as there is no longer a need to filter out the fungus when purifying the product and the sugar solution can be replaced many times before the fungus has to be replaced.

Tuesday, 9 September 2008

FDA Alert: TNF-blockers can increase the risk of fungal infection


The FDA is concerned that it is not widely enough known that the use of TNF-blockers (used to treat a variety of conditions such as rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, plaque psoriasis, ankylosing spondylitis, and Crohn's disease) also suppresses the immune systems of patients taking the drug.

Patients with a suppressed immune system are more vulnerable to potentially serious and difficult to treat infections such as Aspergillosis.

The announcement went as follows:
FDA ALERT [9/4/2008]: FDA is notifying healthcare professionals that histoplasmosis and other invasive fungal infections are not consistently recognized in patients taking tumor necrosis factor-α blockers (TNF blockers), Cimzia (certolizumab pegol), Enbrel (etanercept), Humira (adalimumab), and Remicade (infliximab). This has resulted in delays in appropriate treatment, sometimes resulting in death.

FDA has received reports of patients developing pulmonary and disseminated histoplasmosis, coccidioidomycosis, blastomycosis and other opportunistic infections while taking TNF blockers. In some patients, the diagnosis of histoplasmosis was initially unrecognized and antifungal treatment was delayed. Some of these patients died from histoplasmosis. There were also deaths in patients with coccidioidomycosis and blastomycosis.

For patients taking TNF blockers who present with signs and symptoms of possible systemic fungal infection, such as fever, malaise, weight loss, sweats, cough, dypsnea, and/or pulmonary infiltrates, or other serious systemic illness with or without concomitant shock, healthcare professionals should ascertain if patients live in or have traveled to areas of endemic mycoses. For patients at risk of histoplasmosis and other invasive fungal infections, clinicians should consider empiric antifungal treatment until the pathogen(s) are identified. Consultation with an infectious diseases specialist should be sought when feasible. As with any serious infection, consider stopping the TNF blocker until the infection has been diagnosed and adequately treated.

FDA will require the makers of the tumor necrosis factor-α blockers (TNF blockers) to further highlight the information about the risk of invasive fungal infections, such as histoplasmosis, in the Boxed Warning and Warnings sections of the drugs’ prescribing information and the Medication Guide for patients. FDA will also require that the makers of the TNF blockers educate prescribers about this risk.

More detail of this report here.

Friday, 5 September 2008

New rtPCR kit to detect Aspergillus infection


Rapid detection of aspergillus infections are of prime importance for a good patient prognosis (see review). Existing methods are very slow (culture) or lack sensitivity for some applications (antigen or antibody detection).
Real-Time Polymerase Chain Reaction (RT-PCR) is very quick (less than 2 hours from start to finish) and can be very sensitive and specific, providing a way to improve on many of the aformentioned problems. Myconostica are launching a new assay based on RT-PCR technology in an attempt to take advantage of this potential:

********************** Advertisment******************************

FXGTM: RESP (Asp +) - a new Real-Time PCR assay for the detection of Aspergillus spp. in clinical respiratory samples

FXGTM: RESP (Asp +) is a rapid, molecular based assay for detecting the common respiratory fungal pathogens Aspergillus spp. (and Pneumocystis jirovecii) in human clinical respiratory specimens.

The kit is designed for use by qualified laboratory professionals; its results assist physicians to arrive at the correct diagnosis in immunocompromised adult patients suspected of having a life-threatening respiratory infection. Myconostica's kit offers increased sensitivity, specificity and speed of diagnosis, all of which are key factors critical to improving patient survival rates.

****************************************************************************

There are two other kits on the market in the EU, both of which can also be found in the EU Approved Kits part of the Diagnosis section.

Friday, 22 August 2008

St. John's Wort interferes with Voriconazole (Vfend) Dose


St. John's Wort is commonly used around the world to treat depression. There is some scientific evidence to support its use for mild to moderate depression but this remains controversial as there is also evidence that suggests it has no such effect. This herb is also known to increase the levels of cytochrome P450 enzymes and that can cause problems for other drugs.

Voriconazole (Vfend) is one of the newer antifungal drugs that is in use to treat aspergillosis. Its concentration in the blood is reduced by the action of cytochrome P450 enzymes, so an increase in the level of those enzymes will reduce the amount of voriconazole available to attack fungal growth:
In vitro studies have indicated that voriconazole is metabolized by the cytochrome P450 isoenzymes 2C19, 2C9, and 3A4. Because long-term use of St. John's Wort (a cytochrome P450 inducer) could lead to reduced voriconazole exposure, concomitant use of these drugs is contraindicated.
If a patient is prescribed voriconazole it is therefore best if they do not take this herbal medication. The FDA in the US have required that a warning is added to Voriconazole medication prescribing information

Caspofungin Acetate (Cancidas) Approved for Pediatric Indications


Caspofungin acetate (Cancidas) is the first of a new class of antifungal drugs (echinocandins). It works by interfering with the mechanism a fungus uses to build its cell wall which is quite different to all other antifungal drugs which mostly work by inhibiting cell membrane synthesis. This makes it particularly useful when other drugs have been tried and failed as it attacks a different target - there would be little point in using an antifungal which tried to 'hit' the same target when inhibiting that target molecule has already failed.

As with most drugs approval is often granted in stages as research confirms or denies the efficacy of that drug in different patient groups. Caspofungin has been approved for some time for adult patients that had been treated and failed with other antifungals, but this new approval now allows use in children from 3 months to 17 years of age for the following conditions:
invasive aspergillosis in patients refractory or intolerant of other therapies. It also may be used as empiric therapy for presumed fungus infection in patients with fever and neutropenia.
Caspofungin was found to be superior to established drugs in particular circumstances in children in two separate papers and was thus granted approval for the US by the FDA.

Tuesday, 12 August 2008

Aspergillus causing problems in outer space

A russian spacecraft launch
Russian scientists have been exploring the causes of corrosion inside spacecraft (translation of original article). An initial (somewhat alarming) observation that manned spacecraft suffered from corrosion more than unmanned spacecraft prompted further investigation.

The corrosion in question is of the aluminium alloys widely used in spacecraft because they are lightweight and highly resistant to corrosion - normal chemical corrosion. Biocorrosion is the term coined to cover corrosion caused by living organisms growing on the metal surface (biofilm). The organisms can secrete acids and other corrosive chemicals such as ammonia which cause the damage.

Aspergillus versicolor has (amongst others) been isolated from spacecraft even though growth conditions are harsh, and it has been found that the conditions of high humidity and ultrasonic irradiation found in a spacecraft allow these organisms to grow well. They grow readily on most surfaces of the spaceship and contribute to microscopic caverns appearing on and in equipment/work surfaces along with Penicillium expansum, Cladosporium cladosporioides and others.

Monday, 11 August 2008

Improving nutritional content of crops using aspergillus

phytase structure
In many parts of the world the diet is limited and deficient in the nutrients needed to maintain a healthy body. There are many difficulties in providing a complete diet - both for humans and for their food animals - but the one we are focusing on here is called phytate.
Phytate is sometimes referred to as an 'antinutrient' because it locks up phosphates and minerals into a form most animals cannot digest because they lack the enzyme needed to break up phytate , and that enzyme is called phytase.

One effect of this problem is that foodstuffs for some animals (birds & pigs) must be supplemented with phosphates in order to replace the phosphates locked up inside phytate - increasing the cost of producing meat.

There is an additional problem concerning the environment. Foodstuffs rich in phytate are corn and soybean which are routinely the staple diet of fowl and pigs. Combine the effect of supplementary phosphates (not all of which are absorbed) and all that unabsorbed phytate on the living quarters of commercially produced chickens, turkeys & other fowl along with pigs and you have a lot of phosphate pollution. Microbes produce an abundance of phytase so the phytate does not last long once on the floor! Should that rich phosphate soup make its way into river systems or onto land the result can be eutrophication - severe pollution.

Ruminants such as cows, horses, deer & sheep make their own phytase and thus do not need extra phosphates .

Phytase is made by many microbes including Aspergillus, and it is known that the addition of phytase to feeds can aid uptake of phosphates along with other important minerals such as calcium, magnesium and iron. This has now been taken a step further and instead of adding phytase purified from aspergillus (which would be expensive as well as having the potential to cause health problems for people allergic to aspergillus), the phytase gene has been extracted from aspergillus and inserted directly into the crop DNA. When expressed alongside another gene from soybean called ferritin the resultant transgenic crop has far higher nutritional value without the need for supplements.

The potential for this technology has several benefits including for the environment, food safety and for the improvement of the diet of humans and animals. Whether or not foods manipulated in this way will enter the foodchain is a topic for a different column!

Thursday, 31 July 2008

GM and insecticides reduce mycotoxins in crops

European Corn Borer hatchlings
Food crops can become infested with insects which will reduce the yield of the crop - bad enough news for the farmer but it gets worse. A heavily chewed plant such as maize becomes susceptible to infection by fungi including aspergillus and that fungus can start to synthesise mycotoxins:
"How severely a maize plant is infected with fungi and whether this leads to mycotoxins being produced depends on a large number of factors. Humidity and temperature during the growing season, soil cultivation and the susceptibility of the variety in question all play a role, as does the time chosen for harvesting. The complex process, which is not fully understood, makes it difficult to control mycotoxin formation in individual cases and to reduce contamination reliably. Studies in Germany, for instance, have shown that mycotoxin levels vary widely between individual maize plants, even on the same site. There are many indications that stress – both for the maize and for the fungus – results in higher mycotoxin production"
As the infestation gets worse so the levels of mycotoxin get worse:
"But it is also clear that a heavy infestation of chewing pests leads to higher mycotoxin contamination. In many maize-growing regions of Europe the European corn borer is the main maize pest: the larvae bore their way into the maize plants, leaving holes through which Fusarium and other fungi can enter."
Mycotoxins can be extremely toxic so their levels are strictly controlled in food for both animals and humans.

Prevention of insect infestation effectively reduces the levels of mycotoxin in the crop, introducing a greater level of control over toxin levels.
"The more effectively the corn borer is controlled, the fewer chewing sites there are that can be used by the fungal pathogens to colonize the maize plant, in addition to the stigma route."

Certain genetically manipulated crops (e.g. Bt Maize) are effective at controlling insects without the aid of chemical insecticides and it has been shown that these crops also suffer from far lower levels of mycotoxin contamination:
"On all sites, the Bt maize varieties used showed the best results: only isolated corn borers were found in the crops. On almost all the trial fields the mycotoxin values measured were lower in the Bt maize plants than in the conventionally grown control plants."
The GM crop therefore benefits from both increased yield and lower toxin levels - two benefits for the price of a single modification.

Wednesday, 23 July 2008

Tea manufacture and Aspergillus

How tea works


Tea is the most widely drunk beverage in the world (Wiki) with over 3 million tonnes produced per year.
Many different types or grades are produced and I was intrigued to read this article which states:
"Poria Cocos Brick (Fu Tea) is the top grade in the ancient kind of brown tea. Being complete ferment tea, Poria Cocos Brick Tea is the most complex and unique brown tea which has the longest production processing cycle. It products Aspergillus Cristatus, brick-like in appearance, with flourishing golden flowers all over, dark and shining, red and strong tea soup, mellow to the taste with lasting scent."
Not making much sense but clearly indicating that Aspergillus is involved in the manufacture of this tea I decided to do a bit more research.

Some teas are fermented using enymes or crude extracts of fungi and Aspergillus is one of the best producers of those enzymes. This patent goes into this in much more detail:
"In fermentation, a microorganism (mold) is preferably co-present, in order to sufficiently obtain the flavor and physiological activity specific to fermented tea. An example of the microorganism that is used is mold. The mold that is used can be present in nature and examples are molds of Aspergillus sp. including Aspergillus awamori, Aspergillus saitoi, Aspergillus niger and Aspergillus orizae, Rhizopus sp. including Rhizopus delemar and also, other molds for processing food such as tempeh mold. From the viewpoint of exhibiting physiological activity, mold of Aspergillus sp. and Rhizopus sp. are preferably used. The type of mold that is used can be one type or a mixture of several types, but pure fermentation using one type of mold is preferable."
I was then intrigued as to how the mold is added to the tea, and where it comes from:

"Examples of the method of applying the mold to tea leaves and tea leave stems are the method of dry mixing tea leaves, tea leave stems and sporules of the mold as they are, the method of diluting the sporules of the mold by dry mixing together with a food diluent such as wheat flour, rice powder and barley flour and then mixing with tea leaves and tea leave stems, and the method of preparing a suspension of the sporules of mold in saline and then spraying onto the tea leaves and tea leave stems. The amount of mold is preferably 0.001 to 1 % by weight, more preferably 0.01 to 0.5 % by weight, based on the total amount of tea leaves and tea leave stems. When the amount of mold is less than 0.001 % by weight, fermentation tends to be insufficient. When the amount of mold is more than 1 % by weight, production costs tend to become too high.

These strains are easily available, as commercially available mold species such as koji for sake, koji for sweet sake, koji for shochu and koji for tempeh, and also, the fermented tea leaves can be left and reused as a mold starter.

Subsequently, the tea leaves and tea leave stems to which the mold is applied are spread on a bed in the fermenting chamber and then fermented. The temperature of the fermented substance when fermenting is preferably raised to 32°C or higher, more preferably 32 to 45°C, further preferably 35 to 42°C, within 25 hours after beginning fermentation. When such conditions are not satisfied, that is the temperature is not raised to a high temperature in short period of time, progression of fermentation tends to be insufficient. This temperature is preferably maintained for at least 5 hours, more preferably 5 to 100 hours, further preferably 5 to 10 hours."

So the use of Aspergillus is vital to the final taste and caffeine content of some fine teas. This is another example of the historical and ancient uses of Aspergillus to produce foods in the far east - more good uses for this mold with a bad image!

It is worth noting that most tea is NOT prepared using molds so readers worried about eating foods derived from molds can rest easy with their usual tea bags. Most tea is prepared by crushing, oxidising and drying.

Friday, 18 July 2008

Overcoming resistance to antifungals

Artwork by Nature - click here to go to journal
The latest copy of the journal 'Science' features a series of special articles on drug resistance in bacteria and fungi, a major area of research to attempt to improve the effectiveness of many of our antibiotics.
Antibiotic resistance has four main mechanisms, one of the least specific of which is to pump the antibiotic out of the bacterial cell as fast as possible - the active efflux pump. The same mechanism has been discovered in fungi and is discussed here in detail. One of the main things that make the efflux pump mechanism a threat to the use of antibiotics & antifungals is that it is pretty non-specific about which antibiotic/antifungal it removed from the cell interior - one type of pump can remove most of the azole antifungal drugs so the cell that possesses that pump automatically becomes resistant to a whole series of drugs all at the same time - also known as multidrug resistance.
One feature of reflux pump resistance is that the antifungal drug itself is remains active, it is just that it is removed from the cell too quickly for it to kill the cell.

The Science review looks at attempts to interfere with or destroy the efflux pumps thus allowing antifungal drugs to accumulate within the cells, killing them.
It turns out that there are a few possible strategies: stop the cell from making the pumps (transcritional/translational control) or switch off the pumping mechanism by using molecules that look like azole drugs which the pumping mechanism can 'grab hold' of but can't release, thus effectively blocking the pump.

More intriguingly a more thorough understanding of the function of these pumps has revealed that one of them, the plasma membrane proton pump (Pma1p) is important for both ensuring the cells remains healthy and is involved in the function of two other drug efflux pumps (ABC and MFS) . Interfering with that single pump attacks the fungal cells on more than one way - more encouragingly no resistance to inhibitors of that pump have been found, suggesting that the cell can find few ways around the loss of that pump. A two pronged attack involving a Pma1p inhibitor plus an antifungal drug could well prove to be an extremely effective combination in the war against fungi.

NB more good news - resistance mechanisms in bacteria are passed from pathogen to pathogen quite readily, rapidly leading to whole mixed populations of multidrug resistant bacteria. Such drug resistant transfer does not seem to happen as often in fungi such as Aspergillus and infections by drug resistant fungi are correspondingly uncommon.

Saturday, 12 July 2008

Biofuels development relies on Aspergillus

Biofuels - are they good for the environment?
There are numerous efforts underway to find new fuels to power devices that are currently powered by oil-based fuels - particularly as the oil supply comes under increasing demand and reserves start to taper off. Biofuels are one solution as these are made from plants and are therefore renewable - as long as the sun keeps shining! One strategy is to generate sugars from plant material and then ferment that sugar to produce ethanol - a burnable fuel made from plant material currently unused.

"It is estimated that more than a billion tons of lignocellulosic plant biomass could be utilized each year to produce liquid biofuels in North America alone." (ref)

Plant material is largely composed of cellulose and other complex sugars that need to be broken down into simple sugars before they can be fermented. Simple sugars are made by treating the plant material with enzymes called cellulases, and many efforts are being made to find the most efficient ways of carrying out this vital stage in biofuel production - the more sugar produced, the more fuel made.

Aspergillus is used as an enzyme production factory for several industries as it can produce many times the amount of enzyme normally available in the natural host organism for that enzyme - in this case Trichoderma reesei. In this paper a refinement is suggested for the enzyme production process in order to improve activity once produced in Aspergillus.

This report states that Aspergillus will play a major role in research into efficient ways to make biofuels by using Aspergillus to make the cellulases which will be the key to converting plant material into fuels that will eventually surely replace oil based fuels.

Wednesday, 2 July 2008

Anticancer drug developed from Aspergillus fumigatus

The Harvard team
Fumagillin is a secondary metabolite of Aspergillus fumigatus and belongs to that much-feared and maligned group of substances associated with fungi - mycotoxins.

This report follows the story of the discovery that this toxin might be useful.

First came a stroke of luck (and the ability to take advantage of that luck) reminiscent of the story of Fleming's discovery of penicillin.

"The fungus was discovered by Harvard’s Donald Ingber by accident while trying to grow cells that line blood vessels, or endothelial cells. The cells were affected by the mold in a way that prevented the growth of small blood vessels called capillaries."

The 'mycotoxin' was found to 'toxic' towards cancerous tumours as it prevented the growth of blood vessels in tumours, thus limiting their ability to grow (an activity referred to as anti-angiogenesis).

Having recognised this tremendously useful property a man-made version of the metabolite (TNP-470) was developed in the early 1990's by a company in Japan in an attempt to develop an anticancer drug. Unfortunately it was not successful:

"the drug would not stay in the body for very long and required continual infusions. It also affected the patients’ brain causing dizziness, depression, and other side-effects. Takeda Chemical Industries dropped it."

Years later we have developed the technology to encase drugs in molecular capsules that prevent them being broken down via stomach acid. An encapsulated version of TNP-470 was developed (now called to as Lodamin) and now it was found to be absorbed by the intestines and then go straight to the liver with no sign of side effects in mice.

Tests on mice show good activity against aggressive liver tumours but there are no reported results in humans yet.

Friday, 20 June 2008

Mould and flooded homes

Image from http://toolhire.wordpress.com/
There have been several incidents of extensive flooding of homes throughout the world over the last few years (UK), USA & Bangladesh.
In this article Prof. H. James Wedner of Washington State University discusses a major problem that follows flooding - mould.
The consequences of mould growth in homes and other buildings have been controversial for some time now, especially in the US where there are many legal arguements ongoing as residents try to establish that 'toxic mold' growing in damp homes has effected their health.

Prof Wedner asserts facts such as all mold is not toxic and that there has never been a case proven were breathing in fungal material in the home (i.e. spores) has been shown to be harmful to human health. Those cases that have been reported are for farm workers inhaling massive quantities of fungal material after encountering agricultural scale dust clouds.
There is no doubt that fungi can produce highly toxic substances (see the toxic metabolite listings here) and will do so in the home environment, especially after flooding. The contentious issue is whether or not enough fungal material could be breathed in as dust in the home environment to cause health problems due to mycotoxicosis - toxins are cleared from our bodies at a steady rate via our livers.

The assertion that toxicity has never been proved is potentially insufficient as little work has been reported in this area. One neglected area is of the effects of chronic cumulative exposure to low levels of mycotoxins - in a damp home this could well be a realistic scenario.

Johns Hopkins Hospital recently released a set of guidelines based on a well researched review entitled 'The medical effects of mold exposure'. One assertion made was

"It is highly unlikely that you could inhale enough mold in your home or office to receive a toxic dose".

While for most cases that is probably true, the review that that assertion is based on claims that mycotoxins

"are not cumulative toxins, having half-lives ranging from hours to days depending on the specific mycotoxin."

Again this is largely true but there are papers that suggest that some mycotoxins and/or their health effects can accumulate in the body - in humans in Asia and humans in USA and in laboratory animals.

The paper referenced in that review clearly states at the bottom of page 125 that studies on cumulative exposure to toxins at a level that might be reached in human exposure have not been done. Considering that exposure might include exposure to multiple toxins which might interract it is worthwhile underlining that the statement made by Johns Hopkins and the review is that it is 'improbable' that there are no health effects arising from breathing in the air in damp homes - and not 'impossible'.

Some health effects of molds in the air are well known - allergies are well established for example and Prof Wedner talks about these at length. There is therefore plenty of reason to ensure homes are kept free of moulds and no person should be compelled to live in a mouldy environment. The debate continues in the scientific media (2006). Other causes of health problems in damp houses are also investigated.

The Aspergillus Website has several useful resources on indoor air quality here.

NOTE: it has been brought to my attention that the paper mentioned above entitled 'The medical effects of mold exposure' has been the centre of much debate centred partly around the criticisms I made above. Several doctors strongly refute several statements in that paper - I have added links to the debate to the top of the original paper.

Friday, 13 June 2008

Warning for all gardeners - man killed by Aspergillus in his compost

Image from madpenny.com
This is a very unusual case of an apparently completely healthy man with a normal immune system (the system in our bodies that fights infection) who accidentaly inhaled a cloud of fungal spores while opening bags of compost. The case was so unusual it has been recorded in detail in the medical journal The Lancet. The article was reported in the UK press here.

The huge number of spores inhaled penetrated deep into his lungs as he breathed them in while he worked. This seems to have completely overwhelmed his bodies normal defences and many of the fungal spores grew quickly. He died within days from invasive aspergillosis.

It must be emphasised that this is a very rare case - the only other similar case I have heard of were of a farmer inhaling a cloud of spores from mouldy grain poorly stored in a silo. Nontheless it is important to highlight the importance of awareness of this risk as gardening is a hugely popular activity across the world - take care to avoid breathing in clouds of spores when disturbing decomposing plant material!

Thursday, 12 June 2008

New standardised allergy testing across europe shows way forward.


Allergy testing is notoriously unreliable from test to test as there can be large differences in the results given by different versions of the same test on the same person. This can be due to differences in the allergen preparations used to test the allergy - one frequently contains more allergen than another as the quantity of allergen present can be very difficult to control

This summary of a presentation to the 27th European Academy of Allergology and Clinical Immunology Congress (EAACI) describes the use of a standard test panel across Europe:

"Inhalant allergens tested as the GA2LEN standard prick-test core panel included Aspergillus, cat, dog, Dermatophagoides pteronyssinus, Dermatophagoides farinae, blatella, hazel, alder, birch, plane, cypress, olive, grass mix, artemisia, ambrosia, alternaria, cladosporium, and parietaria, with further region-specific antigens added. Histamine 1:100 was used as positive control, diluent as a negative control."

Comparisons could now be made between countries whereas before each country would have used different versions of the same test. Interesting results included widespread sensitisation to pet hairs and mites across Europe and unexpected reactions such as southern European people reacting to tree pollen found only in the north of Europe!

Aspergillus was tested for but the results aren't mentioned - regardless standardisation of allergy testing across the whole of Europe can only be a good thing as a more compete picture of allergy is built up over time. Correlating this data with disease such as asthma & sinusitis could give valuable clues about what is causing the illness.

Tuesday, 10 June 2008

Bird feeders - keep them clean

Freddy the Parrot
People who feed wild birds and those who keep birds are warned in this article to ensure:

1. The feeders are kept clean by regular removal of old food, washing and thorough drying of the feeder
2. Food is kept dry

These two steps will prevent food becoming mouldy and poisoning the birds - damp foods will rapidly grow fungi and some of those can easily produce mycotoxins which can be lethal. We have an extensive article on avian (i.e. bird) aspergillosis here.

The areas under the feeders should also be kept very clean and clear of fallen seed which can quickly go mouldy and cause respiratory problems for the birds and the people involved. In severe cases (e.g. immunocompromised people, fungal asthmatics, ABPA) this is especially important to such an extent that they should avoid going near the bird feeders altogether.

Good attention to these details will minimise the possibilities of making the birds or their human friends ill.

Thursday, 29 May 2008

Old dog gets a new trick - inhaled amphotericin for fungal respiratory infections.


Amphotericin has been used as a treatment for aspergillus infections for many years. It is one of the oldest drugs still in use for this purpose and many alternative antifungals have now been developed that are less toxic. Amphotericin is still very useful in some circumstances and is one of the cheaper drugs useful against aspergillus.
Changing the subject slightly - one of the main suspects why treatment for aspergillus infections of the lungs fail is that the fungus grows in the airspaces of the lungs. Oral and injected antifungals travel through the body via the blood supply - there is very little blood supply to the air spaces of the lungs so antifungals do not get to the fungus.
In addition treatment using oral or injected drugs leads to the drug being dispersed around nearly all of the body. Some parts of the body can be more sensitive to the drug than others so it is only possible to give as much drug that will not damage the most sensitive parts of the body. This can severely limit effectiveness of the treatment.

Much better results might be obtained for a fungal infection of the lungs if the antifungal drug could be applied via the air breathed in - that way the drug could attack all of the fungus in the air spaces AND would only be applied in the limited area of the body it was needed i.e. the lungs. Much less drug would be needed and much more fungus would be attacked - in theory.

This paper is a first successful step in the use of aerosolised amphotericin applied via an inhaler. Patients vulnerable to infection (in this case they had no immune system for a few days - referred to as neutropaenia) where given this medication and far fewer became infected with aspergillus compared with the placebo control.

This is not a new treatment as it has been in use in principle for 5 years or so (e.g. to treat vulnerable CF patients) but this is quite a large study so the result is more convincing than most.

Now let's see if it works on patients already chronically infected - particularly ABPA and aspergilloma patients perhaps?

Thursday, 22 May 2008

Aspergillus Warning for Owners of Air Conditioned Cars


Air conditioning is well established as a potential source of fungal spores in the air of buildings. The units tend to get wet as warm moist air hits cold cooling surfaces, and if that moisture is not efficiently drained away then conditions for fungal growth are quickly established - along with a highly populated source of fungal spores in the warm air that is sucked into the unit.

A car warranty company has recently released a reiteration of established advice to car owners on the best use of air conditioning units in cars to avoid a face-full (or perhaps more sinisterly a lung-full) of spores. They make the point that in these days of high fuel prices people will be more inclined to switch the air-con off in their cars to save on fuel use (an air-con unit can increase fuel consumption by 10-15%).
If air con is left on the assumption is that there will be a steady flow of spores, but if it is switched off for a period of time the spores will build up and be released in a far more concentrated cloud when the unit is activated.

I would say that the situation is more complicated than that - there will only be a problem if the air con unit remains wet for some time for example. Some interesting points are made in this article and some guidance to avoiding fungal contamination of your car air-con is given.

The dynamics of mould contamination from car air-con's is examined in the scientific paper entitled "Effect of air-conditioner on fungal contamination".

The main findings seem to be that using your air conditioning for more than 20 days in the summer increases the amount of fungi in the air of that car some 400% over not using it at all, but less regular use increases that figure only a further 50% (Table 4).After the first blast the amount of fungal spores drops 75% over the next 10 mins (Table 2).

One in four cars tested had 1000 spores per cubic metre of air, while one in eight had over 2000 spores per cubic metre - pretty high figures for a person suffering allergies, ABPA or immune compromised.

Take home message is that if you are vulnerable to fungal spores, rather than run it more frequently turn your car air conditioning off completely. If you must keep cool pay for careful maintenance of the unit and/or ensure HEPA grade filtering is in place!

Friday, 16 May 2008

Orca (Killer whale) killed by Aspergillus


The worlds first captive Orca (named Moby Doll) was kept in captivity in North Vancouver in a dry dock. At that time (1964) little was known about Orca's and it took two months of trial and error to workout that it ate fish!

Observers quickly realised that preconceived impressions that Orca's were simple man eating killers that interfered with fishing were wrong. Orca's were discovered to be intelligent, gentle creatures.
Unfortunately, presumably due to lack of food, Moby Doll fell ill and died less than 3 months after capture. Post mortem revealed the cause of death to be aspergillosis in the creatures lungs - an infection that usually afflicts those with a poor immune system.

Moby Doll marked the beginning of a new era of capturing this animal, especially when it was revealed that a commercial aquarium had been willing to pay $25 000 for the Orca.

Monday, 12 May 2008

Public advised 'old rice not good for health'


Public health information given out in India following a detailed scientific study contains the following worrying phrase: "Old rice cooks well but it may cause severe health problems including poisoning if it is not washed properly."

The suggestion is that there is a practice of storing rice for long periods of time to improve its cooking properties. It follows that this practice is carried out by people who are going to be difficult to reach with the health advice contained in this article. Practices that have been carried out for years tend to be handed down from parent to offspring and in this case they could be playing a mouldy form of 'russian roulette' with their health.
If a batch of stored rice becomes damp it will grow Aspergillus and runs a high risk of becoming contaminated with high levels of mycotoxins - many of which are extremely bad for health.

Unfortunately the article seems to say that washing the rice before use will counteract toxicity, but I think it is far from accepted that a simple rinse in water will remove the mycotoxins - far better to clearly state that damp & mouldy rice should be disposed of.

What if you have no alternative to eating mouldy rice? In this old story from China in 2004 there was a strong suggestion that mouldy rice finds its way back into food for some people - particularly poorly fed migrant workers.

The fact that people are not being reported as dying in large numbers from these contaminated foods may either say that people are dying but mycotoxins are not being identified as the cause - amongst poorly fed workers for example there could be many other health problems causing death - or perhaps ingestion of low to medium amounts of mycotoxins isn't lethal.

What the cumulative effects are of eating mycotoxins regularly are not know (as far as I know). Perhaps a study looking at the frequency of illnesses related to mycotoxins in poorly fed areas is indicated?

Friday, 9 May 2008

New antifungal Micafungin approved in europe

Micafungin chemical structure
Approved for use only against Candida infections. Particularly useful in young children, micafungin also has activity against Aspergillus and indeed is licensed for use against Aspergillus in Japan.
"Micafungin is expected to launch first in the United Kingdom and then across Europe shortly thereafter. The antifungal has been available in Japan since December (Funguard for Infusion), where it has established its therapeutic efficacy against fungal infections caused by Aspergillus and Candida and safety through all therapeutic results. Micafungin has been available in the United States since May 2005 and is now indicated for treatment of patients with candidaemia, acute disseminated candidiasis, Candida peritonitis, and abscesses; treatment of patients with oesophageal candidiasis; and prophylaxis of Candida infections in patients undergoing haematopoietic stem cell transplantation."

Hopefully approval for use against Aspergillus will be forthcoming in the future.

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