Toolkit to fight AIDS-related fungal infections proposed
April 14 2014
HIV/AIDS is a major underlying cause of invasive fungal infections (IFI) worldwide. Globally around 1 million people with AIDS die each year from an IFI, accounting for ~50% of all AIDS deaths. Most infections are the initial presentation of AIDS and death is frequent. Others acquire IFIs as a result of treatment for other AIDS-related diseases, such as after chemotherapy for Kaposi sarcoma.
A recent joint review by the Imperial College Fungal Diseases Group, University of Cape Town Institute of Infectious Diseases and the University of Aberdeen Fungal Group describes a shift in AIDS-related fungal deaths from primarily Pneumocystis pneumonia (PCP) to cryptococcal meningitis (CM), which kills an estimated 625,000 people annually.(Brown et al AIDS-related mycoses, 2014). Together, CM and PCP infect 1.35 million people each year. In localised areas, disseminated histoplasmosis and penicilliosis are very frequent. These serious IFIs are in addition to an estimated 10 million cases of oral candidiasis and 2 million cases of oesophageal fungal infection annually.
IV Posaconazole approved by the FDA
April 07 2014
First approved in 2006, posaconazole is the most broad spectrum antifungal available. Approval by the US Food and Drug Association of the intravenous formulation will allow many patients whose blood levels are low or predicted to be low with posaconazole solution, to be successfully treated.
The new IV formulation [NOXAFIL® ( 18mg/ml)] is indicated in adults is indicated for prophylaxis against invasive Aspergillus and Candida infections in high-risk patients, such as hematopoietic stem cell transplant recipients with GVHD, HIV patients or those with leukaemia.
Global tuberculosis and aspergillosis — submission to UK All Party Parliamentary Group
March 21 2014
Do some of the millions of smear negative ‘TB’ patients actually have TB at all? Drs Page and Denning have submitted evidence submitted to the All Party Parliamentary Group on Global Tuberculosis (APPG-TB), UK addressing this uncertainty. Data from multiple sources suggests 15-20% of these patients may have chronic pulmonary aspergillosis (CPA).
Chronic Candida vulvovaginitis syndrome – diagnostic criteria proposed
March 18 2014
Lead by Gayle Fischer in Sydney, Esther Hong, Jennifer Bradford and colleagues have proposed diagnostic criteria for chronic vulvovaginal candidiasis (VVC) for the first time. Many years of clinical observation suggested that chronic VVC was a distinctive clinical entity. The particular problem that required addressing was how to make the diagnosis when cultures were for Candida as they often are when patients are assessed in a specialist clinic, This negative finding is a major contrast with acute and recurrent VVC. Fischer and colleagues conducted a 3 stage study of 163 affected women and 42 controls to develop clinical diagnostic criteria.
Bipolaris hawaiiensis endophthalmitis from eye injection with contaminated steroids
March 10 2014
Seventeen cases of fungal endophthalmitis occurred after intravitreal injection of triamcinolone sourced from a single lot prepared by a compounding pharmacy in California. All were infected with Bipolaris hawaiiensis, a common plant pathogen and an uncommon human pathogen.
In a retrospective analysis- fungal endophthalmitis developed in 82% (14/17) of eyes after intravitreal triamcinolone obtained from the same lot. Median onset was 83 days (range, 6-322 days). Pre-injection visual acuity ranged from 20/20 to counting fingers (median, 20/50). Median visual acuity at last follow-up was 20/400 (range, 20/30-no light perception). The most common signs and symptoms were decreased vision (57% [8/14]), vitreous cell (64% [9/14]), and anterior chamber cell (50% [7/14]). Fungus was detected either by cytologic or culture examination in 7% (1/14) from initial vitreous tap. By comparison, vitreous samples obtained by pars plana vitrectomy (PPV) resulted in fungus-positive cytologic results in 43% (6/14) of eyes and positive culture results in 36% (5/14) of eyes. All culture-positive specimens (100% [5/5]) identified B. hawaiiensis as the infecting species. Overall, fungal infection was confirmed in 57% (8/14) of eyes by either cytologic or microbiologic analysis.