OBSERVING FUNGAL DISEASE AWARENESS WEEK 2019.

Last year, during fungal disease awareness week , organised by the Centre for Disease Control in Atlanta, U.S.A, we opined that Nigeria deserves a day or week to raise awareness about fungal diseases. As professionals passionate about the populace to whom we provide care, we know for a fact that a sizable number of patients suffer and even die from fungal infections. The greatest driver of this morbidity and mortality is lack of awareness about fungal diseases among healthcare professionals.

As a society, therefore, MMSN has taken up the responsibility of raising much needed awareness by participating in the CDC’s fungal disease awareness week. There will be walks, talks and an art competition.

Wherever you are, do something, no matter how small to spread the word and get more people to  #thinkfungus.

HISTOPLASMOSIS IN THE AMERICAS: THE ROUTE TO AWARENESS

Histoplasmosis is a systemic mycoses that is often misdiagnosed and mistaken for tuberculosis. In a recent commentary in the Journal of fungi, Nacher et al have described how specialists in 4 countries became fully aware of the threat posed by histoplasmosis to immunocompromised HIV patients. The countries are French Guiana, Brazil, Guatamela and Colombia. These countries are now known to be hotbeds of histoplasmosis and disseminated disease is recognised as an AIDS defining condition.

This was not always so.

In French Guiana, it took  the dermatologists’ proactive search for pathogens in skin lesions to shed light on the problem.

In  Fortaleza, Brazil, the first cases of disseminated histoplasmosis (DH) were “accidentally” diagnosed when buffy coat was used to look for Leishmania in the peripheral blood of patients with presentations compatible with Kala-azar. A microbiologist (Jacó Ricarte L. Mesquita) working at the laboratory of São José Hospital, increasingly saw images of yeasts inside leukocytes in peripheral blood smears of febrile AIDS patients. He sent these samples for fungal culture at a reference laboratory at the Federal University of Ceará, which identified the presence of Histoplasma. The adoption of diagnostic methods such as microscopy and culture of buffy coat and later screening with lactate dehydrogenase were useful in reducing mortality due to histoplasmosis.

The experience in Guatamela could be summed up as ‘the more you look for histoplasmosis, the more you find it’.

In Africa, histoplasmosis is still very much a neglected disease. However, some countries are well on their way to awareness. Several studies have sprung up from Cameroon and South Africa documenting disseminated histoplasmosis in HIV patients. In Nigeria, the first histoplasmin skin sensitivity test survey in over thirty years was conducted in 2017: the results showed a prevalence of 4.4%. There is work to be done as we begin this journey to uncover the toll on the advanced HIV disease populace. The more we look, the more we will find.

E-LEARNING OPPORTUNITIES FOR MEDICAL MYCOLOGY EDUCATION

It is a well known that invasive fungal infections often remain undiagnosed because both doctors and laboratory workers have poor knowledge of these diseases.

This often leads to very low index of suspicion amongst the former and failed diagnosis amongst the latter even when the disease is suspected.

This often results in high levels of morbidity and mortality.

Medical mycology is often poorly taught in medical schools because there are few trainsers with the requisite knowledge.

The growing number of opportunities for learning about fungi, their diagnosis and management is thus timely and relevant, especially in developing countries.

Here are the links to currently available free online courses for budding medical mycologists:

  1. Antifungal stewardship course on the open online learning platform, Futureline courtesy of the British Society for Antimicrobial Chemotherapy, BSAC (started May 20th and schedule to last for 3 weeks)
  2. A microscopy training course in 4 key modules courtesy of the Fungal infection trust, Leading International Fungal Education ( LIFE) and the University of Manchester.

Is coccidioidomycosis endemic in Africa? An unusual finding from Nigeria.

Coccidioidomycosis, also known as valley fever, is one of the classical endemic mycosis. It is an infection caused by Coccidioides. This fungus is known to live in soil in the southwestern United states and parts of Mexico and Central and South America. Thus coccidioidomycosis is thought to occur only in the Western hemisphere.

But is this really so? A recent case report in the Annals of Tropical Pathology proves contrary to this long-held belief. The authors reported a case of cutaneous coccidioidomycosis in a 28 year old HIV positive woman in Borno state, North-eastern Nigeria. The patient had never traveled to areas of known endemicity for the disease. The diagnosis was made on histopathology said to show the characteristic spherules and the patient was treated with fluconazole.

While the case is unusual, it calls for greater surveillance and epidemiological research. Another endemic mycosis, classical histoplasmosis, which was once thought to be confined to the Ohio and Misissippi valley areas of USA, has been increasingly diagnosed in many countries in other continents and is considered a neglected disease in Africa. Coccidioidomycosis might be no different.

 

BLAZING A TRAIL AT THE 14TH ANNUAL FUNGAL UPDATE IN LONDON

This year’s Fungal Update Meeting is ongoing (15th and 16th, March, 2019) at the QE2 conference centre, London, UK.

The meeting, now in its 14th year, is the largest mycosis focused specialist meeting in the UK.

MMSN president, Dr Rita Oladele, in her usual trailblazing style, picked up a prize for best abstract following her presentation on ‘Standardisation of Aspergillus IgG in Nigerians’. Co-awardees were Toine Mercer and Nicole Pagani. The prizes were sponsored by Journal of Fungi, an open access journal sponsored by MDPI.

Here is to future outstanding achievements to MMSN and all her members. Cheers!

COUNTRYWIDE CRYPTOCOCCAL SCREENING AND MANAGEMENT TRAINING FOR HEALTHCARE WORKERS- NOVEMBER UPDATE

November was an eventful month for the MMSN Cryptococcal screening and management training team as they delivered the training in three tertiary centres in Nigeria. The team, made up of president, Dr Rita Oladele and member, Dr Akase toured the South-south, south-east and Northern parts of Nigeria to ensure that health care workers in Benin, Calabar and Sokoto received the gospel of screening for cryptococcal disease in the setting of HIV/AIDS.

The spate of training events took off at University of Benin Teaching Hospital (UBTH) on November 12th.

 

Participants at the UBTH training event   

 November 17th found the dynamic duo at the Usmanu Danfodiyo Teaching Hospital (UDUTH) Sokoto. Despite it being a Saturday, participants turned out in their numbers to receive the training which included an overview of cryptococcal meningitis, clinical manifestations and drug management/ interaction

By the 26th of November, doctors, nurses and other health workers involved in HIV care in Calabar were fortunate to receive the message as the team headed back down south to the University of Calabar under the convenership of the Chief Medical Director, Professor Thomas Akang.

Cross-section of participants at UCTH training event.

All events featured hands-on practical sessions on how to perform a lumbar puncture, measure CSF opening pressure, and how to use the cryptococcal antigen lateral flow assay.

Participants at the Benin training trying out manometry using the mannequin

 

Dr Osaigbovo, consultant clinical microbiologist, UBTH demonstrating how to use the cryptococcal lateral flow assay to participants.

Participants were awarded training certificates and MMSN donated a pack of 50 test strips to each participating centre.

It is hoped that the series of trainings which has traversed the length and breadth of Nigeria will bring about greater awareness and detection of more cases of cryptococcal meningitis in the HIV populace. MMSN is also advocating for screening to detect asymptomatic cases as these are easier and cheaper to treat.

FUNGUS AWARENESS WEEK.

Fungal Disease Awareness Week was October 1–5, 2018 in the United States of America. CDC and partners organized this week to highlight the importance of recognizing serious fungal diseases early enough in the course of a patient’s illness to provide life-saving treatment.

Some fungal diseases go undiagnosed and cause serious infections in people around the world, leading to illness and death.

Increased awareness about fungal diseases is one of the most important ways to improve early recognition and reduce delays in diagnosis and treatment.

A key clue to when a sick person may have a fungal infection is that he or she is being treated with medications for other types of infection but does not get better.

I think we need to observe a week of awareness in Nigeria too. Candidaemia is not being detected in our hospitals. A key study conducted in three tuberculosis treatment sites showed that 8.7% of people thought to have TB treatment failure and smear negative TB actually had chronic pulmonary aspergillosis. The death toll from fungal diseases will remain high and undetected until doctors learn to think fungus. In turn, this awareness will only be maintained and reinforced when we get better diagnostic facilities in place.

CRYPTOCOCCAL SCREENING TRAIN LANDS IN ABUJA

MMSN is passionate about raising awareness and ensuring that physicians countrywide have a low threshold for thinking fungal disease, especially in immunocompromised patients. Cryptococcal meningitis is one of such diseases. It is estimated to that close to 30000 cases occur in Nigeria every year.

The Society therefore took the training to the Federal capital in Abuja. Facilitating were Dr Rita Oladele, MMSN president, Dr Uwaezuoke, member MMSN and Dr. Badamasi. In attendance were the DG of National Agency for the Control of AIDS (NACA). The training was a huge success.

 

ADVOCACY IN SPREADING THE FUNGAL INFECTION MESSAGE

Fungal infections are notorious for piggybacking on other diseases. For this reason, they affect diverse patient groups spread over different domains.

Anyone bent on reducing the scourge of invasive fungal infections would invariably have to be an advocate and take the message to Respiratory physicians, intensivists, surgeons, ophthalmologists and virtually any specialty you can think of.

This is why it is so gratifying to learn that The National Aspergillocis Centre, University of Manchester were in attendance at The European Respiratory Society International Congress which held in Paris France from September 15-19. Dr Akan Otu, vice president of MMSN was part of this team.

It behoves on members to take the message to their respective institutions and professional bodies. This way the message will truly spread and take effect.

National Aspergillosis Centre, UoM delegate to the ERS International Congress in Paris. Dr Akan Otu and Professor David Denning flank the group on the left and right respectively.