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Burden of fungal diseases in Belarus, Cameroon, Indonesia and Italy presented at ECCMID Vienna
April 25 2017
For the fourth year running, multiple country burdens of fungal diseases have been presented at ECCMID; 4 countries covering a population of 351 million people. The remarkable findings were:
· The annual incidence of candidaemia in Italy is 24/100,000 and was estimated at 5/100,000 for Belarus, Cameroon and Indonesia, in the absence of data.
· Cryptococcal meningitis was estimated to be common in Cameroon at an incidence of 30/100,000 compared with only 0.81, 0.6 and 0.22/100,000 rates in Indonesia, Belarus and Italy, respectively.
· The prevalence of chronic pulmonary aspergillosis was estimated to be very high in Belarus and Indonesia at 60 and 32/100,000, because of the high burden of TB in both countries, compared to 22 and 4.9 in Cameroon and Italy.
· Tinea capitis was remarkably common in Cameroon (3,240/100,000 population) and Italy (1,003/100,000 children) – there are no data for Belarus and Indonesia.
· Asthma and its complications ABPA and severe are thought to be especially common in Indonesia with an ABPA prevalence of 135/100,000 in Indonesia and also Italy 126/100,000 compared with Belarus and Cameroon (62 and 40/100,000).
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Ruling by World Health Organisation delights Doctors
April 05 2017
The WHO has ruled that itraconazole, voriconazole and natamycin 5% ophthalmic preparation are essential medicines, which is a Red Letter Day in the fight to and save hundreds of thousands of lives and reduce blindness.
GAFFI (Global Action Fund for Fungal Infections) applied for itraconazole (capsules and oral suspension), voriconazole (capsules and intravenous solution) and natamycin 5% ophthalmic solution to be placed on the World Health Organization (WHO) Essential Medicine List (EML), in collaboration with colleagues from the Instituto de Salud Carlos III, International Foundation for Dermatology, London School of Hygiene of Tropical Medicine and The University of Manchester.
The antifungal medicines itraconazole, voriconazole are essential to reduce deaths and illness, and natamycin to reduce blindness, and they are very inexpensive in most countries.
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1% clotrimazole more effective than 3% boric acid in alcohol for otomycosis: randomised trial
March 27 2017
In a randomised controlled trial 1% clotrimazole solution has been found to tbe more effective at treating otomycosis than its cheaper alternative, 3 per cent boric acid in 70 per cent isoproypyl alcohol. Otomycosis is a worldwide superficial fungal infection of the external auditory canal and auricle which is more prevalent in tropical zones.
Dr Romsaithong and colleagues compared 1 per cent clotrimazole solution with 3 per cent boric acid in 70 per cent alcohol at Khon Kaen Hospital, Thailand, where otomycosis has been reported in 11 per cent of patients presenting with inflammatory conditions of the ear canal. The trial was double-blind, controlled and randomised, trial and patients patients’ ear canals were examined under the operating microscope one week after a single application of the treatment. Their condition was either classified as cured or not cured, based on the presence or absence of fungus.
The cure rate for the clotrimazole group was significantly higher with 85.2%, compared to 67.3% for the boric acid group, giving an absolute difference of 17.9% (p = 0.028). The results of this study concurred with similar previous controlled trials.
The secondary outcome of the study revealed that patients treated with clotrimazole also reported fewer adverse events. While this study lacked long-term follow up of treatments, it was evident that a single application of 1 % clotrimazole solution is both more effective at treating otomycosis and less irritating than 3% boric acid in 70 per cent alcohol.
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Invasive fungal infections: High mortality and new underlying diseases in Middle East
March 20 2017
A retrospective study of 102 hospitalised patients with invasive candidiasis or aspergillosis in Saudi Arabia and Lebanon (Alothman et al 2017) identifies several non-traditional common co-morbidities including coronary artery disease (24%), congestive heart failure (15%), moderate-to-severe renal disease (16%), and diabetes (41%). In selected and diagnosed patients, some immunocompromising factors were also present, notably corticosteroids prior to admission (20%) and chemotherapy in the prior 3 months (26%). The authors caution their peers: “Earlier consideration ... of IFI in medically comorbid patients may reduce the time to antifungal treatment and improve outcomes.”
This study also highlights a high mortality of 42%, mean hospitalisation period of 32 days, the low use of Aspergillus galactomannan testing (11%), and the delay before a diagnosis of invasive fungal infection was made. They note that the median time from admission to diagnosis was 6 days (range 0 to 92 days), and it took another day for antifungal therapy to be started. A median of 2.5 days (range −3 to 80 days) elapsed between culture collection and treatment given. Fluconazole was the favoured antifungal, but over 50% of the infections were resistant to it.
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Efficacy of in-house fluorescent stain for fungus
March 15 2017
Increasing numbers of immunocompromised patients means that correctly diagnosing fungal infections is becoming more and more critical. Conventional diagnostic methods may not be the most effective, especially when there are small amounts of the causal agent in a sample. In a recent study of diagnostic tests for fungal infections, Kirani and Chandrika (2017) looked at the efficacy of an in-house calcofluor white (CFW) fluorescent stain, compared to conventional CFW stain, histopathology and culture. They also determined the sensitivity, specificity, negative predictive value and positive predictive value. The authors compared the results of the in-house fluorescent stain to the conventional stain with 100 cases of suspected dermtophytosis and found that the tests agreed perfectly (35 positive, 65 negative). The samples were then compared using culture, which found 30 positive samples and 70 negative samples. They also compared the results 15 tissue section smears from clinically diagnosed fungal infections using the in-house stain and standard histopathological techniques. Using the in-house stain, 12 samples showed evidence of fungal infections (Aspergillus, Mucor, Candida, Rhinosporidium seeberi and Pneumocysttis carinii) whereas conventional histopathology identified only 10 positive samples.
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