Multi-country burden of fungal disease presented at ECCMID conference
April 29 2013
The number of people suffering and dying from fungal infections has been estimated in 12 countries in which 3.1 billion people live, 45% of the world’s population. Posters presented at the ECCMID meeting in Berlin revealed especially high incidence rates of Candida bloodstream infection in Brazil (15/100,000) and Spain (10.7/100,000), an extremely high rate of mucormycosis in India (170,000 cases annually, 13/100,000) related to the burgeoning epidemic of diabetes there, over 160,000 cases of invasive aspergillosis in China (11.9/100,000), over 2,783 cases of cryptococcal meningitis in AIDS in Uganda (8/100,000, 75% mortality) and 75,000 and 18,000 cases of Pneumocystis pneumonia in Nigeria (48/100,000) and Brazil (39.6/100,000) respectively.
Even more prevalent were allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS) complicating asthma. For example, an estimated 390,000 ABPA cases were estimated for Brazil (201/100,000), 491,000 cases for China (36.1/100,000) and at least 592,000 ABPA cases in India (47/100,000). The prevalence of SAFS was estimated to be higher, but has yet to be studied epidemiologically. Estimates of tinea capitis were very high in Africa, notably 15,580,000 cases in Nigeria (~50% of 155 million population are children) (1000/100,000) and 1,700,000 children affected in Kenya (4,300/110,000).
More prevalent still, was recurrent Candida vaginitis (vulvovaginal candidiasis) in which the estimated prevalence rate in 15 to 50 year old women varied from 874 (Spain) to 3,800 (Nigeria) per 100,000 females.
Better treatment for cryptococcal meningitis with flucytosine in combination with amphotericin B
April 22 2013
A three-way randomised study of cryptococcal meningitis in Vietnam has convincingly shown the benefit of flucytosine with amphotericin B. Jeremy Day and 22 colleagues in Ho Chi Minh City at the Oxford University Clinical Research Unit studied 299 patients, all with AIDS and cryptococcal meningitis and found that the 100 patients who received amphotericin B (1 mg/Kg/d) and flucytosine (100mg/Kg/d) had a 40% lower chance of dying than amphotericin B alone or combined with fluconazole (800mg/d).
In addition to the 14 day survival benefit, the 70 day and 182 day survival was better with flucytosine as was the speed of yeast clearance from the cerebrospinal fluid.
Commenting on the results, Professor John Perfect of Duke University said; “Robust studies like this trial provide important insights for how to manage cryptococcal meningitis better, and it is our job to implement its initial therapeutic principles, such as the use of rapid fungicidal regimens, worldwide.”
Access to diagnosis and treatment for cryptococcal meningitis
April 02 2013
Better outcomes for AIDS patients with cryptococcal meningitis are in prospect following a crucial sharing and planning meeting in Geneva, March 18-19 2013. At the instigation of the US Centres for Disease Control, attendees from LIFE, WHO, Medicines Sans Frontieres (MSF), Clinton Health Access and numerous universities and public health institutions, the key barriers to access to cryptococcal antigen testing and antifungal drugs amphotericin B, flucytosine and fluconazole were identified.
Key recommendations were:
Ensuring Public Health Neutrality
March 26 2013
An article just published in the prestigious New England Journal of Medicine by Lee Roberts and Michael Van Rooyen has reported that twelve Deans from prominent US schools of public health have written to President Obama calling for the US government to desist from covert military or intelligence actions disguised as public health activities.
Protesting against the sham vaccination programme undertaken in Pakistan by the CIA - who employed a Pakistani doctor to go house to house on the pretext of vaccinating children - but was illicitly taking blood samples which were used to try and trace Osama bin Laden through DNA records.
The doctor was convicted of treason in Pakistan and sent to prison for 33 years. Pakistan then expelled staff from the international aid agency Save the Children which undermined a 30 year health network that SAVE the Children had established. The repercussions continued with the death of 8 polio vaccination workers in Pakistan in what seems a co-ordinated attack.
There were protests locally against this attack - but in the meantime the UN suspended its polio- eradication efforts in Pakistan - where 150,000 children die annually of vaccine preventable illnesses. This has also jeopardised the global eradication of polio - which now only occurs in Afghanistan, Nigeria and Pakistan. This vaccination programme is a multi-million dollar programme supported largely by both the US government and the Gates Foundation.
US Outbreak of Fungal Meningitis
March 18 2013
As reported in October 2012, officials in the USA are investigating an outbreak of fungal meningitis and other infections linked to contaminated steroids. At time of writing, a total of 720 cases have been reported in twenty states, with 48 deaths.1 The affected patients received preservative-free methylprednisolone acetate (MPA) epidural injections to treat back or joint pain. Three hundred and two patients presented with spinal infection or abscess at the injection site, 240 with meningitis, 32 with septic arthritis and the remaining patients presented with a combination of conditions. These infections do not transmit from person to person and have been linked to three batches of MPA released since May 2012.
The main agent appears to be Exserohilum rostratum, it has been detected in 141 patients as of 14/01/13.1 A further 12 different environmental moulds have been detected in 23 patients. These organisms rarely cause invasive infections in immunocompetent individuals.
E. rostratum is a black mould showing elongated, brown, beak-like conidia upon microscopic examination. It is mainly a plant pathogen but has been associated with sinusitis and skin infections.
The implicated organisms will grow on standard fungal isolation media but recovery may be poor, the US Centers for Disease Control and Prevention (CDC) have used polymerase chain reaction to aid detection.
Meningitis is characterised by fever, chills, headache, neck stiffness, photophobia and vision changes. Onset is invariably sudden for bacterial and viral causes but in this outbreak patients have presented with slowly progressing symptoms (weeks to months after MPA injection). Cerebrospinal fluid (CSF) findings include high protein, low glucose and high neutrophil count. Some patients in this outbreak have suffered strokes due to the fungal infection. Joint infection is characterised by swelling, redness, tenderness and reduced range of movement of the affected joint(s).