Predictors of survival in cryptococcal meningitis in AIDS
December 23 2013
Using existing data from 501 patients in clinical trials in Thailand, Uganda, Malawi and South Africa, Joe Jarvis and colleagues from St George’s Hospital in London discovered some key parameters of survival in cryptococcal meningitis in AIDS. One third of the patients had died by 10 weeks. Younger age, being fully alert, less weight loss before presentation to hospital and initial amphotericin B treatment were 3 important characteristics of those who survived. High CSF fungal load, higher blood white cell count and anaemia predicted death. At one year 60% of patients were still alive. One in 8 (13%) developed immune reconstitution syndrome which was more frequent if the brain fungal load was higher and interestingly had no relationship with when antiretroviral therapy was started. Low cerebrospinal fluid gamma interferon doubled the risk of dying from 9% to 19%.
Economic burden of lung diseases in Europe exceeds €370 billion
December 16 2013
A joint publication by the European Lung Foundation and European Respiratory Society provides detailed statistics on lung health in Europe. 1 in 8 deaths in the EU are as a result of respiratory disease and 6 million people are admitted to hospital each year. It is estimated for several diseases that this represents the “tip of the iceberg”, as many disease deaths are improperly recorded (report). Lung disease is often complicated by fungal infection.
The report concludes that there are almost 10 million people under the age of 45 living with asthma in Europe, of which approximately 1 million have severe asthma which difficult to manage clinically. It is thought that around 50% of patients with severe asthma have sensitisation to various fungi (SAFS), of which Aspergillus fumigatus is the most common.
Efinaconazole gets its first global approval
December 04 2013
A new topical antifungal, efinaconazole, has been approved in Canada and is undergoing regulatory review in the United States and Japan. For years, onychomycosis nail infections have been treated with topical antifungal agents such as amorolfine, or systemic antifungal drugs such as terbinafine or itraconazole. Response rates to topical therapy are low and oral therapy occasionally results in skin or liver toxicity reactions. Efinaconaozle, a triazole antifungal, inhibits 14α-demethylase—the enzyme responsible for conversion of sterols in fungal cell walls. It is administered as a 10% topical solution.
A recent phase III international trial showed that it completely cured between 15.2-17.8% of subjects, compared to 3.3-5.5% in the control groups, defined as no fungal involvement in the nail as determined by KOH testing and a negative culture sample after one year.
By using a secondary endpoint of <5% clinical involvement and 100% mycological cure, between 23.4-26.4% of patients were completely cured.
Liver failure often complicated by fatal invasive aspergillosis
November 26 2013
Of nearly 800 patients with acute-on-chronic liver failure (ACLF), around 5% developed invasive pulmonary aspergillosis (IPA) with almost 95% of those patients going on to die despite antifungal treatment. Reporting from Zhejiang University, Hangzhou in China, Jiajia Chen and colleagues note that most deaths were due to progression of IPA, the remainder due to progression of liver failure. Only two patients survived with antifungal treatment. Survival was only achieved in patients who were able to take antifungal drugs for more than 5 days.
Global Plague: How 150 people die every hour from fungal infection while the world turns a blind eye
November 08 2013
Launch of GAFFI - is supported by acclaimed actor Rupert Everett. GAFFI is to raise awareness of the scale of the challenge across the world
Neglected by policy makers and most international health agencies, wednesday saw the launch of Global Action Fund for Fungal Infections (GAFFI), an international organisation set to highlight the plight of 300 million people worldwide and begin to reverse unnecessary death and suffering.
Fungal infections kill at least 1,350,000 patients with or following AIDS, cancer, TB and asthma as well as causing untold misery and blindness to tens of millions more worldwide. Yet its symptoms are mostly hidden and occur as a consequence of other health problems, and the tragedy is that many of the best drugs have been available for almost 50 years.
In the House of Commons, in London* - and simultaneously in New York - GAFFI was officially launched by Hollywood star Rupert Everett and founding President, Professor David Denning of the University of Manchester, who highlighted the global issues. The potential for great health improvements including local access to diagnostics, antifungal medicines and better medical training were highlighted.