LIFE advisers meet WHO’s Tuberculosis leader Mario Raviglione
January 22 2013
As Chronic Pulmonary Aspergillosis (CPA) may follow TB in about 10% of cases, discussion on establishment of coordination with the work of the WHO’s STB Department is important. Mario Raviglione, (Director), an Infectious Diseases physician originally from Italy who trained in the USA in Boston and New York in the early AIDS era, described CPA as one the ‘post-TB sequelae’ that had been neglected for too long largely due to lack of information and capacity to diagnose and treat.
In detailed discussions, which also included Dr Mukund Uplekar (Policy, Strategy & Innovations team) and Dr Salah Ottmani (Technical Support Coordination team), the need for research and standardization goals were emphasized. Raviglione articulated the value of surveillance and better estimate of the burden as well as of standardization of diagnosis and treatment management to achieve sustained healthcare benefits across different countries and societies.
The WHO Global Tuberculosis Report 2012 describes the impact of proper TB care in the past 17 years:20 million lives saved, annual number of TB cases have fallen 2.2% since 2011; and a rapid diagnostic test (GeneXpert) is now available in 67 low- and middle-income countries. The LIFE program should aspire to such uniform, effective and cost-effective approaches.
Appointment of David Warnock as LIFE advisor
January 14 2013
Fungal disease public health has been greatly strengthened by the work of Dr David Warnock, previously Chief of the Mycotic Diseases Branch at the US Centres of Disease Control. Following his retirement from CDC, Warnock has joined the LIFE Advisory team, bringing with him over 30 years of experience in fungal disease. He has published extensively on the epidemiology, laboratory diagnosis and therapy of fungal diseases. He has quietly and consistently championed the value of epidemiological data and public health tools in better understanding fungal infections, having been the architect of the TransNet study (fungal infection after transplantation) and encouraging the global estimate of cryptococcal meningitis.
Hidden Killers: Human Fungal Infections - call for action
December 28 2012
On December 20th, in the prestigious journal “Science Translation Medicine”, Gordon Brown and colleagues describe the numbers of people with various life-threatening fungal infections and the major development and research needs which are required to improve diagnosis, treatment and survival. They estimate there are over 200,000 cases of invasive aspergillosis; >400,000 cases of invasive candidiasis (Candida bloodstream infection), 1 million cases of cryptococcal meningitis and over 400,000 patients with Pneumocystis pneumonia in AIDS cases alone, worldwide. Numerous other estimates of the global frequency of fungal diseases are estimated including vaginal candidiasis, chronic and allergic aspergillosis, the endemic mycoses in N. America and other important fungal infections.
The authors point out the major advances in diagnosis and therapy, and yet there is a major gap in implementing these findings and in developing vaccines to prevent fungal infections. Immunity to fungal infections is now much better understood, and is ripe for translation into immuno-protection or immunotherapy approaches. Progressing antifungal vaccines into clinical trials is essential and will help reduce the global burden of fungal diseases. Rapid diagnostics will reduce mortality rates, yet funding is woefully inadequate for mycology compared to other pathogens. The total spent on medical mycology research was only 1.4 to 2.5% of that spent on immunology and infectious disease research by the Wellcome Trust, the U.K. Medical Research Council, and the U.S. National Institutes of Health. Much better diagnostics are required for all the serious fungal infections and because of emerging resistance - new antifungal drugs need to be developed.
Global burden of disease 2010
December 17 2012
Fungal skin diseases came out the 4th most prevalent disease worldwide at the Global Burden of Disease 2010 launch conference in London on December 14th 2012. Hosted at the Royal Society and chaired by Richard Horton (Editor the Lancet), Christopher Murray (Institute for Health metrics and Evaluation, Seattle) and Richard Peto (University of Oxford). Over 400 delegates and 13,000 online viewers participated in the extraordinary and unparalleled data release of the work over 5 years from 486 authors from 302 institutions and 50 countries. Most fungal diseases were not assessed, but skin fungal diseases were, and are the most prevalent infectious disease globally. Fungal skin disease include tinea capitis (estimated to be 200 million), ringworm, tinea pedis, onychomycosis (fungal nail infection) and tinea versicolor. Estimated at 985 million, only dental caries, tension-type headache and migraine were more common.
New Candida Guidelines
December 03 2012
After a 2 year process, the ESCMID Fungal Infection Study Group has this week published new guidelines on the diagnosis and management of Candida infections. The 2012 recommendations are published in the ESCMID journal ‘Clinical Microbiology and Infection’ as 6 papers occupying a full supplement. Link to Journal.
The papers detail:
The development an process of the guideline development
Diagnosis and management in non-neutropenic adult patients
Prevention and management of invasive infection in neonates and children
Diagnosis and management of adults with haematological malignancy and after HSC transplantation
Diagnosis and management in HIV and AIDS patients.