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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.
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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.
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Impact on quality of life of recurrent thrush

November 05 2013

Recurrent vulvovaginal candidosis (rVVC) is a chronic condition causing pain and discomfort. In a masterful international study, Samuel Aballéa and colleagues of the Université of Lyon describe the numerous depression and anxiety problems suffered by women with recurrent vulvovaginal candidiasis (rVVC). An online survey of women reporting rVVC using the EQ-5D and SF-36 questionnaires was done in France, Germany, Italy, Spain, UK and the USA. Of 12,834 women previously identified with VVC, 620m with rVVC were studied. The quality of life scores were compared among those with current symptoms to assess the direct impact of a VVC attack, and the whole group compared with peers without rVVC. During an acute episode of VVC, 68% of women reported depression/anxiety problems, and 54% between episodes, compared to less than 20% in general population (p < 0.001). All SF-36 domain scores in those with rVVC were significantly below general population norms. Mental health domains were the most affected. The difference was largest in Italy, where 60% reported anxiety/depression problems outside episodes vs. 9.3% in the general population. The impact on productivity was estimated at 33 lost work hours per year on average, corresponding to estimated costs between €266/year and €1,130/year depending on the country.
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World Medical Association adopts statement on fungal disease diagnosis and management

October 29 2013

At their 64th General Assembly in Brazil, the World Medical Association adopted a statement on Fungal Disease Diagnosis and Management’. The statement reads: “The WMA stresses the need to support the diagnosis and management of fungal diseases and urges national governments to ensure that both diagnostic tests and antifungal therapies are available for their populations. Depending on the prevalence of fungal diseases and their underlying conditions, specific antigen testing or microscopy and culture are essential. These tests, and personnel trained to administer and interpret the tests, should be available in all countries where systemic fungal infections occur. This will likely include developing at least one diagnostic centre of excellence with a sufficient staff of trained diagnostic personnel. Monitoring for antifungal toxicities should be available. Physicians will be the first point of contact for most patients with a fungal infection and should be sufficiently educated about the topic in order to ensure an effective diagnostic approach. The WMA encourages its members to undertake and support epidemiologic studies on the burden of fungal disease in their country and to inform the national government of the results.”
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New Histoplasma-like fungus causing disseminated infection in AIDS

October 17 2013

In this week’s New England Journal of medicine, Chris Kenyon and colleagues describe disseminated infections in HIV infected patients with CD4 counts <50 caused by a dimorphic fungus, not recognised before. The fungus was cultured from skin and blood, but not sputum of CSF. Its yeast morphology was similar to that of Histoplasma capsulatum, on agar and in tissue, although the mycelial phase is distinctive. Cases have only been recognised since 2009, but probably have been occurring for longer. The clinical features included fever, loss of weight, anaemia, skin lesions and a chest Xray similar to that seen in tuberculosis. Night sweats, hepatosplenomegaly and lymphadenopathy were less common. Patients were treated with a variety of antifungal agents but dramatic response was seen to IV amphotericin B (1mg/Kg) followed by itraconazole. Three patients died, early after presentation.
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