World Aspergillosis Day 2022 Q & A

The National Aspergillosis Centre in Manchester, UK hosted a day of talks from NAC experts and patients together with some of our research colleagues at University of Manchester and MRC Medical Mycology Centre in Exeter, and the European Lung Foundation.

During the talks, we offered the option to ask questions in the Zoom chat. If after you have watched the recorded video of the meeting you also wish to ask a question please contact us at NAC.Cares@mft.nhs.uk.

Questions & answers

Participants asked a series of questions using our chat facility that did not get answered on the day – we will answer them below.

Q. Can SAFS turn into APBA.?

Severe Asthma with Fungal Sensitisation (SAFS) seems to be quite different to Allergic Bronchopulmonary Aspergillosis (ABPA) in that SAFS patients do not suffer from mucoid impaction or bronchiectasis, and patients with ABPA do not have to have severe asthma.
Can some SAFS develop into ABPA? As yet we don’t have much evidence to decide one way or the other, but as SAFS is a relatively newly identified condition it may take more years to be sure, so we cannot completely rule it out.

Q. Do u get cases of TB & IA coinfection ?

I assume that you mean TB and Chronic Pulmonary Aspergillosis (CPA) as these two are quite closely linked? The two can co-exist and infect the same host – it was mentioned during one of the talks this afternoon.
IA (Invasive aspergillosis) is an infection of immunocompromised people who are usually people with severely compromised immune systems eg transplant recipients.

Q. May I know for molecular testing of azole resistance, what is the reference/target gene and what do you use as its positive strains?ATCC since there are no breakpoint for anti fungal for ATCC

Q. Can ABPA “progress” and turn into CPA/IA? Being ABPA patient they also take blood test of my galactomannan levels.

Small numbers of Allergic Bronchopulmonary Aspergillosis (ABPA) patients progress to form lung cavities (Chronic Pulmonary Aspergillosis). It is something we keep monitoring during regular clinic visits for people we think may be at risk.

Q. If Itraconazole has caused more peripheral Neuropathy….. how long after stopping Itraconazole will the symptoms reduce?

Most cases (>90%) resolve once itraconazole has been stopped for a month. https://pubmed.ncbi.nlm.nih.gov/21685202/

Q. Letrozole interaction with antifungals

None noted – so we cannot rule out that there may be some but it hasn’t been reported – see https://antifungalinteractions.org/

Q. I am in the group of people mentioned by Dr Baxter that have no other respiratory conditions or other known allergies. My consultant suggested it may be genetic in causation. Is this likely? is there any research into this?

Assuming that you have ABPA as you mentioned allergies, there are a few genetic traits that have been identified with more to come.

  • People with cystic fibrosis (a genetic disease) tend to get ABPA more frequently
  • There are few cases where more than one person in the same family have got ABPA, but it is rare
  • Specific genes have been shown to be expressed differently in ABPA https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0185706
  • Specific immune system differences that lead to more inflammation have been detected https://www.jacionline.org/article/S0091-6749(04)04198-3/fulltext
  • ZNF77 mutation seems to encourage fungal growth in our airways¬† https://www.manchesterbrc.nihr.ac.uk/wp-content/uploads/2021/01/Gago_BRC.pdf