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Poor farmer’s fungal skin condition gets approval from WHO as ‘neglected’ after lobbying by GAFFI

June 05 2017

GAFFI (Global Action For Fungal Infection) today welcomes news from the World Health Organisation (WHO) that it has classed the disease known as chromoblastomycosis - a disfiguring fungal disease of poor farmers in South America, Africa, and Asia - as a neglected tropical disease (NTD). Chromoblastomycosis also known as chromomycosis, is one of the most prevalent implantation fungal infections in tropical and subtropical regions around the globe. It is a chronic fungal disease of the skin and subcutaneous tissues, first described in the beginning of the 20th century from Brazil, Cuba and Madagascar. It occurs on a worldwide scale, particularly in rural areas and among poor men aged between 30 and 50. This chronic, mutilating disease is rarely fatal, but gross disfigurement and amputation of limbs is too commonly necessary. Inoculation of the fungus through the skin of plants or soil contamination leads to infection. Thus farmers, animal breeders and foresters are most at risk. The oil from the Babussu palm tree is used extensively in the beauty industry. However, the hard skin of the tree’s coconut is contaminated by a brown fungus that causes chromomycosis. When the skin is pierced by the tough coconut strands, a slowly progressive infection develops that becomes intensely itchy. Scratching leads to secondary body sites of infection, including the face. Many other plants carry the causative fungus, which are especially common in Madagascar and certain parts of Brazil. Medicines used for treatment for the majority of the poor are too expensive, and improved treatment availability is essential. Dr David Denning, Professor of Infectious Disease in Global Health at The University of Manchester, explains: “Most cases of chromo progress, and are rarely curative. Disfigurement and social exclusion are common. Sites most commonly affected are the lower and upper limbs and buttocks. Ear, face, neck and breasts have also been reported. Lesions slowly enlarge becoming verrucose and wart-like. Old lesions can be tumorous or cauliflower-like in appearance.
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Administration of steroids for immune rejection after keratoplasty in patients with fungal keratitis

May 22 2017

Initiating the use of topical corticosteroids in patients with fungal keratitis 1 week after keratoplasty can aid in rapid control of anterior segment inflammation and reduction of immune rejection, with no increase in the rate of fungal recurrence. In a prospective observational study performed at Shandong Eye Hospital between January 2009 – April 2014; Wang et al 2016 evaluated the introduction of the low dose steroid (0.02% fluorometholone eye drops) one week following corneal transplantation for proven fungal keratitis. The rates of anterior chamber inflammation, graft rejection and recurrence of fungal keratitis were observed.
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Chronic pulmonary mucormycosis: an emerging fungal infection in diabetes mellitus

May 10 2017

Three cases of chronic pulmonary mucormycosis have been reported from Pakistan in patients (all females in their 60s) with poorly controlled diabetes mellitus and with no other underlying conditions. In this report by Igbal et al 2017, productive cough, fever, haemoptysis and shortness of breath were the main clinical presentations of pulmonary mucormycosis; all the patients had poorly controlled diabetes with HbA1c ranging from 9.4 to 13.1%. Diagnostic bronchoscopy was performed on all the patients with subsequent histopathology demonstrating numerous aseptate hyphae. Fungal culture of bronchoalveolar lavage sample yielded Rhizopus species in one of the patients. Two patients with unilateral disease improved on intravenous amphotericin B deoxycholate and surgery (lobectomy/pneumonectomy). A patient with bilateral disease in whom surgery was not advisable responded on amphotericin B deoxycholate treatment only.
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Fungal meningitis still kills over 180,000 people per year despite the drugs are available

May 09 2017

International HIV experts on fungal meningitis in AIDS report finding nearly 250,000 cases annually, 73% in sub-Saharan Africa. Fungal meningitis due to the Cryptococcus fungus typically affects those in the prime of life, 35 years old, and affects the tissues covering the brain and spinal cord. Of those affected an estimated 181,000 people die, despite the existence of a simple blood test and long developed life saving medicines. Deaths from Cryptococcal Meningitis in AIDS are 15% of all 1,100,000 AIDS-related deaths. Yet, the vast majority of those who survive do so without complications and with treatment of their HIV infection, go on to make a full recovery. Published in the prestigious journal Lancet Infectious Diseases, Radha Rajasingham and colleagues from the University of Minnesota, which also runs a major research program on fungal meningitis in Kampala in Uganda, used 46 studies from around world to estimate current case numbers. The resurgence of interest in fungal meningitis arises from excellent diagnostic tests that take 10 minutes to perform and cost only about £5/$8. Patients can be picked up early with a blood test and treated. Without diagnosis and treatment fungal meningitis in AIDS is always fatal. Dr David Boulware, Associate Professor of Infectious Diseases at the University of Minnesota, and senior author of the study, said: “Still too many HIV-infected people enter care late and Cryptococcal Meningitis is an unfortunate excellent metric of HIV treatment programme failure. In 2017, no person with HIV should develop fungal meningitis, yet in a failed cascade of HIV care, too often Cryptococcus is a final death sentence.”
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Basidiobolus infection in children – a mimic of inflammatory bowel disease

May 02 2017

Basidiobolomycosis is a rare chronic inflammatory disease affecting immunocompetent hosts caused by the fungus Basidiobolus ranarum. Dr Khalid Shreef from the Zagazig University Hospital, Egypt and colleagues report the largest series to date - 18 patients (5-10 years old). The infection results in human disease mimicking soft tissue tumours restricted to subcutaneous tissues in the limbs, trunk and buttocks. Visceral involvement is rare but there are increasing reports of its role in gastrointestinal infections presenting with non-specific signs & symptoms. Prior ranitidine use and prolonged residence in endemic areas seem to contribute to the risk of acquiring gastrointestinal basidiobolomycosis (GIB). Shreef describes the commonest presenting features of: abdominal pain (94%), right sided abdominal masses (77%) involving the caecum and ascending colon at surgery and constipation (83.3%) which alternated with diarrhoea in a few patients. Other uncommon presentations included hepatomegaly (3 patients) and isolated liver abscess. Fever, vomiting, weight loss, abdominal pain and abdominal masses are some of the presenting symptoms of GIB infection.
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