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.

CRYPTOCOCCAL SCREENING TRAINING PROGRAM GOES TO KANO

The CDC- sponsored MMSN Cryptococcal screening training program for healthcare providers in Nigeria has been delivered this past week in Bayero University Teaching Hospital, Kano. This brings the number of centres that have received the free training to four. We hope this will greatly reduce the number of cryptococcal meningitis-related mortalities in the country.

Cross section of participants at the training event in Kano

Onyge-what now?!

If you miss this year’s ISHAM Congress, you would have to wait till 2021 to attend the next one! That’s because the congress holds every three years. It  provides clinicians, scientists and students an exciting opportunity to meet at an international forum dedicated solely to the study of medical mycology.

This year’s congress holds from 30th June to July 4th but the pre-congress workshops have already kicked off.

MMSN president, Dr Oladele made a presentation and also chaired a session at the workshop Onygenales.

Onyga-what-did-you-say?

Onygenales. The ascomycete order Onygenales is important to medical mycologists because it includes the sexual stages of the true fungal pathogens of humans and animals (i.e the dermatophytes and the dimorphic fungi capable of causing diseases in an otherwise healthy host).

The order includes three families of medically relevant fungi, namely: Arthrodermataceae including dermatophytes; Onygenaceae including the dimorphic fungi; and Gymnoascaceae.

Some of the pioneer research of the MMSN centred around histoplasmosis.

Now you know why Onygenales is of interest to us!

 

MMSN president, Dr Rita Oladele presenting at the pre-congress workshop in Amsterdam.

CRYPTOCOCCAL MENINGITIS PATIENTS MAY RECEIVE ANTIDEPRESSANT AS PART OF TREATMENT IN FUTURE

Cryptococcal meningitis (CM) is associated with a high rate of mortality among people living with HIV/AIDS. Despite the use of antiretroviral therapy, which has greatly reduced the incidence of CM globally, the death toll from this fungal infection continues to be high in sub-Saharan Africa. Estimates show that Nigeria has the highest burden of CM worldwide.

Setraline, an anti-depressant drug has shown great promise as an anti-cryptococcal agent. According to a study conducted by Zhai et al and published in the journal Antimicrobial agents and chemotherapy, setraline is potently fungicidal against Cryptococcus isolates in vitro, acts synergistically with fluconazole in vitro and , in a murine model, a combination of straline and fluconazole is more effective than either drug alone due to their strong synergy in vivo.1 Treviño-Rangel et al 2, likewise demonstrated the efficacy of setraline against Cryptococcus both in vitro and in vivo in a murine model.

Rhein et al went further to test the safety and microbiological efficacy of adjunctive setraline in HIV-infected patients with CM in Uganda.3 Their study, published in the Lancet demonstrated participants who received  sertraline had faster cryptococcal CSF clearance and a lower incidence of immune reconstitution inflammatory syndrome and relapse than that reported in the past. They concluded that this inexpensive and off-patent oral medication is a promising adjunctive antifungal therapy.

  1. Zhai et al. http://aac.asm.org/content/56/7/3758.full
  2. Treviño-Rangel, RJ, Villanueva-Lozano, H, Hernandez-Rodriguez, P et al. https://academic.oup.com/mmy/article/54/3/280/2579224
  3. Rhein et al https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)00074-8/fulltext