Research on Aspergillosis is gradually revealing that the fungus Aspergillus reaches into far more of our lives that we previously thought. Far from earlier assumptions that our airways are usually sterile places that contain no microbes, the latest research suggests that Aspergillus and many other microbes reside in many of our lungs as part of our normal micro/mycobiome and causes no health problems at all. In fact many bacterial & fungal species found in our microbiome are thought to protect us from infection by pathogens. This harmless growth is sometimes referred to as colonisation.
Paradoxically there are large numbers of people in the world who have serious fungal infections caused by Aspergillus colonisation of their airways and lungs which suggests that either something is different about the fungus or the infected person in each case.
In some cases the cause is clearer for example someone who receives a transplant (solid organ or bone marrow) usually experiences a period of several days when they are less able to fight off infections. People who have an impaired immune system due to having AIDS are similarly affected (estimated 300 000 cases of invasive aspergillosis worldwide). Those people are often kept in sterile rooms until they recover enough of a functional immune system to cope with our normal air which contains many potential pathogens. Despite these precautions some will get an infection such as aspergillosis and it is easy to speculate that such cases may be caused by an Aspergillus pathogen that had up to that point been harmlessly colonising their lungs.
What then of people with severe asthma with fungal sensitivity (SAFS: 6.5 million cases worldwide) who have a fungus growing in their lungs and they have become sensitive to its allergens, exacerbating their respiratory symptoms? How are they different to other asthmatics and non-asthmatics?
There are also 3 million cases of Aspergillus slowly eroding cavities into the lungs of people who apparently have a normal immune system (Chronic Pulmonary Aspergillosis CPA). Why are they so infected when many more have Aspergillus growing in their lungs with no ill effects?
We need to be able to identify individual at risk from infection as early as possible so that treatment outcomes are the best possible. To do that we need to understand why some people become infected or sensitised when most do not even though they have Aspergillus growing in their lungs.
The Aspergillosis Trust has several activities planned for WAD 2019, one of which is already in operation!
This banner features two of their patrons; Dr Emily Grossman and Alan Titchmarsh and can be seen on the back of 15 buses in the Hyde Park/South Kensington/Fulham/Richmond Park area of London, which includes a route going past the Brompton Hospital. The buses will run throughout January 2019 up to Feb 1st, World Aspergillosis Day itself.
Aspergillosis, lung and sinus disease caused by the fungus Aspergillus, affects around 15 million people and kills over 1 million each year. Announced today at the 8th biennial Advances against Aspergillosis international conference in Lisbon starting on February 1st (World Aspergillosis Day), are the 5 Aspirational targets for aspergillosis to be achieved by 2030:
Survival in invasive aspergillosis increased to 90% (up from under 50%)
New antifungal agents licensed for all major forms of pulmonary aspergillosis (invasive, chronic and allergic) and for all age groups (only 3 classes currently available)
The biological, immunological and genetic basis of aspergillosis understood (major gaps in our understanding currently)
Diagnostics (standardised and clinically validated) for disease widely available and simple screening tests developed (most countries, including all of Africa have no diagnostic capability at all)
At least one vaccine against aspergillosis in clinical trials or approved (none currently).
At the conference opening session, Professor David Denning, President of the Global Action Fund for Fungal Diseases (GAFFI) and the University of Manchester spoke on behalf of patients, doctors, and researchers in calling for radical improvements. Because diagnostics are not available in so many countries and cities, hundreds of thousands of people unknowingly die or are disabled by aspergillosis, yet could be saved or cured. He said:
“I have been looking after patients with aspergillosis for over 35 years, and yet we still lose patients and see too many people severely affected by this common fungus. I contributed to many clinical studies bringing the first effective oral drugs to patients (itraconazole and voriconazole), and yet the burden and deaths remain huge. Nothing less than a concerted international effort is required to address huge disparities in aspergillosis frequency.”
2018 marks the 20th anniversary of The Aspergillus Website www.aspergillus.org..uk), which the Fungal Infection Trust has been supporting. It provides a truly encyclopedic resource (>100,000 pages) and news feed to the world at no cost to the user, thanks to its many supporters over decades. Together with its sister Website for Patients (www.nacpatients.org.uk), they attract over 125,000 users per month, indicative of the need for information. In 2012, the Fungal Infection Trust launched a global educational website Life Worldwide (www.LIFE-Worldwide.org), in English and Spanish, which is also highly utilised.
The Advances in Aspergillosis conference series held alternate years, is the premier forum for detailed and dedicated discussion of all aspects of aspergillosis, attracting over 350 delegates from 35+ countries. Topical issues include: pan-azole and echinocandin resistance has emerged and requires unique approaches, new opportunities for both antifungal agents and immunotherapies in chronic and allergic aspergillosis, better molecular and low-cost strategies for diagnosis and publication of several recent clinical guidelines for clinicians offer detailed guidance.
Other major needs for health improvements in aspergillosis include:
Keeping homes free from excessive Aspergillus and other moulds, related to dampness, and therapy reduce asthma cases and severity
Hospital environments for vulnerable patients free of Aspergillus
Improvement in the public’s awareness of fungal diseases and specifically aspergillosis
Reduction in azole resistance with reduced use of azole fungicides in non-essential crops
Prevention of a new epidemic of resistance with any new classes of antifungal used for aspergillosis by not allowing such chemical class to be used as a fungicide
Need for better surveillance and detailed epidemiology data
Development of immunotherapies as well as vaccines
Patients are often diagnosed with one of the several different types of aspergillosis after a considerable time spent being treated for different medical problems for example tuberculosis or asthma. Aspergillosis is often only considered when treatment for their pre-existing condition becomes ineffective, and by that time aspergillosis can be well established. There is a pressing need for tests that may diagnose aspergillosis in all its forms more quickly. As we discover more about the genetics of vulnerability to aspergillosis it may also be possible to start screening high-risk populations for early treatment.
The Fungal Infection Trust (www.fungalinfectiontrust.org) Is a UK Company limited by Guarantee approved as a charity by the Charity Commissioners. Since 1991, the Fungal Infection Trust (FIT) has made a unique contribution to advancing the science and medicine of fungal diseases, in the UK and internationally.
GAFFI is a registered International Foundation based in Geneva and UK Charity and is focused on 4 major tasks related to serious fungal infections. These are:
Universal access to diagnostics for serious fungal disease
Accurate data on the number and severity of fungal infections
Health professional education related to better recognition and care for patients with serious fungal disease
GAFFI issued its 10 year Roadmap ’95-95 by 2025’ in 2015 calling on all governments and international health agencies to ensure 95% of the global population have access to fungal diagnostics and antifungal therapies by 2025: http://www.gaffi.org/roadmap/ GAFFI has enabled several antifungal drugs to be listed on the World Health Organisation’s Essential Medicine List, including those used for aspergillosis.
The Aspergillus Website (www.aspergillus.org.uk) was set up in 1998 by the Fungal Infection Trust. It is the most comprehensive source of information about Aspergillus and the diseases it causes available on the internet. An estimated 125,000 distinct visitors log on monthly and over 18,000 other websites link to the Aspergillus Website. Users are in over 140 countries. Over 3000 patients are currently registered with the support discussion groups on Facebook with over 500 LinkedIn members (Aspergillus and Aspergillosis Group). The Website for Patients supports the patient and carer community (www.nacpatients.org.uk),
LIFE is the international health professional education brainchild of the Fungal Infection Trust. LIFE’s goal is to improve the health of patients suffering from serious fungal infections primarily through health professional education and increased awareness internationally (www.LIFE-Worldwide.org). Summary information on fungi, fungal diseases, diagnostic tests and treatments are provided free in English and in Spanish.