Training an immune system to recognise & help eliminate invasive aspergillosis
[et_pb_section fb_built="1" admin_label="section" _builder_version="4.16" global_colors_info="{}" theme_builder_area="post_content"][et_pb_row admin_label="row" _builder_version="4.16" background_size="initial" background_position="top_left" background_repeat="repeat" global_colors_info="{}" theme_builder_area="post_content" custom_margin="8px|auto|8px|auto|true|false"][et_pb_column type="4_4" _builder_version="4.16" custom_padding="|||" global_colors_info="{}" custom_padding__hover="|||" theme_builder_area="post_content"][et_pb_text admin_label="Text" _builder_version="4.16" background_size="initial" background_position="top_left" background_repeat="repeat" global_colors_info="{}" theme_builder_area="post_content"]Treating aspergillosis, in this case, acute invasive aspergillosis, with antifungal medication has its limitations. They tend to be quite toxic and have to be used carefully by experienced medical practitioners. When treating a severely immunocompromised person infected with Aspergillus (which is the main group of people that get the acute invasive form of this disease) mortality rates can exceed 50% in patient groups being treated for leukemia. It is easy to see that we need to develop better treatments and different treatment strategies.
A German research group at the University of Wurtzburg, led by Jurgan Loffler and Michael Hudacek has adopted a completely different approach to treating aspergillosis, instead of developing antifungal medication they have opted to 'train' the immune system of immunocompromised patients to recognise and attack the infection better in the hope that this will improve mortality.
This technology has been copied from cancer research, where we know that some cancers escape attack from the host's immune system and this allows cancer to grow. Researchers are successfully 'retraining' the host's immune system to attack the cancer cells more effectively.
The group took cells from a mouse's immune system (T-cells) that normally attack infecting microbes in order to eliminate infections and boosted their ability to find Aspergillus fumigatus, which is the main pathogen that causes aspergillosis. These cells were then given to mice infected with Aspergillus a mouse model system intended to simulate acute invasive aspergillosis in human patients.
The result was that of those mice that had invasive pulmonary aspergillosis and had no treatment, 33% remained alive whereas for those mice that were treated with the booster T-cells (CAR-T) 80% survived.
This result shows much promise for the treatment of aspergillosis. These experimental results need to be repeated in a human host but it is clear that this approach could form the basis for an entirely new way to treat aspergillosis, including the chronic forms of aspergillosis such as chronic pulmonary aspergillosis (CPA) and maybe even allergic bronchopulmonary aspergillosis (ABPA).
Full paper published here[/et_pb_text][/et_pb_column][/et_pb_row][/et_pb_section]
ISHAM Award for Prof Malcolm Richardson
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Founded in 1954, the International Society for Human and Animal Mycology (ISHAM) is a large worldwide organisation that represents and supports all doctors and researchers that have an interest in Medical Mycology - which includes aspergillosis as well as all fungal disease.
Fungal diseases are generally not given the attention that they deserve from medical authorities so it is vital that diagnostics and research are supported internationally, especially where health services, so the work of ISHAM is particularly valuable.
The immense contribution of medical mycology diagnostics specialist and former Director of the Mycology Reference Centre Manchester Prof Malcolm Richardson to the work of ISHAM has been recognised at the recent ISHAM conference in New Delhi, September 2022.[/et_pb_text][/et_pb_column][/et_pb_row][/et_pb_section]
Mycology Reference Centre Manchester Director (retired) Prof Malcolm Richardson Honoured
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The British Society for Medical Myology (BSMM) has a long and distinguished history in the advancement of education and the promotion of research in all branches of medical and veterinary mycology over the last 69 years (www.bsmm.org), so it is a great honour to be elected to be its President. Prof Richardson follows an illustrious list of fellow medical mycologists who have served as President of BSMM since 1964.
Professor Malcolm Richardson built and ran the highly specialised mycology laboratories at the Mycology Reference Centre Manchester since its inception alongside the National Aspergillosis Centre at the Manchester University NHS FT in 2009 until his retirement in 2020, and still serves the centre as its Consultant Clinical Scientist in Medical Mycology. He has an extensive list of publications, positions and achievements - for more details click here.
Prof Richardson commented "I feel very honoured to be elected as President, having been a BSMM member for 50 years", and it is particularly fitting that the Presidency comes to Manchester as the annual scientific meeting of the BSMM is to take place in the city in May 2023.
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Why does someone with chronic disease feel so tired?
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Ashley explains how fatigue affects your psychological wellbeing, and how to manage thoughts and feelings.
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Most people with a chronic illness will be all too familiar with how tired it makes them feel. Fatigue is a prominent and debilitating symptom of aspergillosis and recent research is starting to show why this is.
We are often asked why someone with aspergillosis feels so tired and up till now our usual answer would be that when your immune system is working hard it tires you out much like if you had run a km or two that day – the effort needed is similar and you are exhausted. Recent research gives us a slightly different picture. As your body responds to an infection one of the things that your immune system can do is to directly put you to sleep to help your recovery!
Molecules called cytokines are produced in response to inflammation (eg infection) and one of their functions is to stimulate drowsiness and sleep. Furthermore once asleep your immune system really gets to work on the infection – focusing your energy on fighting the infection, and promoting fever.
We are aware that some medications make good sleep difficult/impossible at times and anxiety plays its part too. If you mention this to your GP you may get a referral to one of the many NHS Sleep clinics in the UK who can help problems with getting asleep/staying asleep https://www.nhs.uk/…/Sleep-Medicine/LocationSearch/1888
Hints and tips for getting a good sleep
Hints and tips on how to manage the psychological impact of fatigue
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Fungal Infection Trust
[et_pb_section fb_built="1" admin_label="section" _builder_version="4.16" global_colors_info="{}" theme_builder_area="post_content" custom_padding="8px||8px||true|false"][et_pb_row admin_label="row" _builder_version="4.16" background_size="initial" background_position="top_left" background_repeat="repeat" global_colors_info="{}" theme_builder_area="post_content"][et_pb_column type="4_4" _builder_version="4.16" custom_padding="|||" global_colors_info="{}" custom_padding__hover="|||" theme_builder_area="post_content"][et_pb_text admin_label="Text" _builder_version="4.16" background_size="initial" background_position="top_left" background_repeat="repeat" global_colors_info="{}" theme_builder_area="post_content"]The Fungal Infection Trust (FIT) has supported the National Aspergillosis Centre for decades, enabling many of our patient support websites and support groups to run smoothly.
If you receive support from the National Aspergillosis Centre and its resources please help FIT support us by donating.
FIT is a small UK charity run by volunteers that minimise costs so that over 95% of all donations go into its support of people who have aspergillosis.
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Aspergillosis and Fatigue
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People who have chronic respiratory illness frequently state that one of the main symptoms that they find difficult to cope with is perhaps one that doesn’t leap to mind as a major problem for most of us who do not have a chronic illness – fatigue.
Time and time again people who have aspergillosis mention how exhausted it makes them feel, and here at the National Aspergillosis Centre we have determined that fatigue is a major component of chronic pulmonary aspergillosis (CPA – see Al-Shair et. al. 2016) and that the impact of aspergillosis on a patients quality of life correlated well with the level of fatigue suffered.
There are many possible causes of fatigue in the chronically ill: it could partly be a result of the energy that the immune system of a patient puts into fighting off the infection, it could partly be a consequence of some of the medication taken by people who are chronically ill and possibly even the result of undiagnosed health problems such as anaemia, hypothyroidism, low cortisol or infection (e.g. long COVID).
Because of the many possibilities that cause fatigue, your first step in trying to improve the situation is to go and see your doctor who can check for all common causes of fatigue. Once you have established that there are no other possible hidden causes you might read through this article on fatigue produced by NHS Scotland containing lots of food for thought and suggestions to improve your fatigue.
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Singing for lung health
[et_pb_section fb_built="1" admin_label="section" _builder_version="4.16" global_colors_info="{}" theme_builder_area="post_content" custom_padding="11px||11px||true|false"][et_pb_row admin_label="row" _builder_version="4.16" background_size="initial" background_position="top_left" background_repeat="repeat" global_colors_info="{}" theme_builder_area="post_content"][et_pb_column type="4_4" _builder_version="4.16" custom_padding="|||" global_colors_info="{}" custom_padding__hover="|||" theme_builder_area="post_content"][et_pb_text admin_label="Text" _builder_version="4.16" background_size="initial" background_position="top_left" background_repeat="repeat" global_colors_info="{}" theme_builder_area="post_content"]The breath control needed to sing can also help people who have lung disease breathe better and can help lift mood too which is vitally important for our health and quality of life.
Want to try therapeutic singing?
You may be lucky and find a lung health group locally, however, you don't have to leave your home to benefit (sessions are run on Zoom), AND you don't have to be a patient either as the groups are also open to carers.
The Asthma & Lung Health charity has published a page giving some useful information on how you can find a singing group in your area.[/et_pb_text][/et_pb_column][/et_pb_row][/et_pb_section]
Monkeypox outbreak
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What is Monkeypox?
How is monkeypox spread?
Symptoms
- fever
- headache
- muscle aches
- backache
- swollen lymph nodes
- shivering
- exhaustion
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NAC Physio Mairead runs the Manchester Marathon for the Fungal Infection Trust
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Adrenal insufficiency
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Cortisol and aldosterone are important hormones our bodies need in order to stay healthy, fit and active. They are produced by the adrenal glands which are sited at the top of each of our kidneys. Sometimes our adrenal glands may not be able to produce enough cortisol and aldosterone, for example when the glands are mistakenly attacked and destroyed by a person’s immune system – this is Addison’s disease (see also addisonsdisease.org.uk). The lost hormones can be replaced by medication from an endocrinologist and the patient can live a normal life. This form of adrenal insufficiency is not a feature of aspergillosis.
Unfortunately, people who take corticosteroid medication (e.g. prednisolone) for longer periods of time (more than 2-3 weeks) can also find that they have low levels of cortisol as their corticosteroid medication can suppress the production of their own cortisol, especially if high doses are taken.
Once the corticosteroid medication is stopped your adrenal glands will usually re-activate but it may take some time which is why your doctor will tell you to slowly taper down your dose of corticosteroid carefully over several weeks, to allow your adrenal glands to recover.
What has this got to do with aspergillosis?
People with chronic forms of aspergillosis & asthma can find themselves taking corticosteroid medication for quite long periods of time in order to control their breathlessness and allow comfortable breathing. Consequently, they may find that they have to take care when reducing their dose of corticosteroid and proceed gradually to allow their own natural cortisol production to resume safely. Reducing too quickly can cause a range of symptoms including fatigue, fainting, nausea, fever, dizziness.
These are powerful drugs and must be handled with care so if you have any concerns contact your GP without delay.
Other medication you may be taking to treat aspergillosis has also rarely been associated with causing adrenal insufficiency e.g. some azole antifungal medication, so it is worthwhile to remain vigilant for relevant symptoms (see list above). However, note that symptoms such as fatigue are very common in someone with aspergillosis.
For other details on taking corticosteroid medication see the steroids page
Steroid Emergency Card
The NHS has issued a recommendation that all patients who are steroid dependant (i.e. should not abruptly stop corticosteroid medication) carry a Steroid Emergency Card to inform health practitioners that you need daily steroid medication in the event you are taken into hospital and are unable to communicate.
Information on obtaining a card can be found here.
NOTE patients attending the National Aspergillosis Centre in Manchester can collect a card at pharmacy
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