NAC Comms team becomes NAC CARES team

“So, what do you do?” What a difficult question! The communications team at the National Aspergillosis Centre have been mulling this one over a lot recently and have decided that they need to make things clearer.

They have been known as ‘the comms team’ for a long time. But what does that really mean? How can they explain what they really do? They have broken it down into five main areas and have become NAC CARES.

NAC CARES
NAC CARES: Community Awareness Research Education Support

This is what they want to communicate about the National Aspergillosis Centre.

Community

NAC is at the centre of a community. That community is made up of people with aspergillosis, their families and carers, clinicians, researchers, academics and allied health care professionals. We work with the Aspergillosis Trust, the Mycology Reference Centre Manchester and the Manchester Fungal Infection Group. We’re available to consult with staff from any other hospital if they need specialist advice about aspergillosis. Together we are fighting against aspergillosis.

Awareness

We strive to raise awareness of aspergillosis. We champion World Aspergillosis Day. We provide research and clinical resources for academics and health care professionals. We provide free information to patients.

Research

NAC has an extensive clinical research portfolio including azole resistance, optimising diagnostics, clinical outcomes and quality of life, genetic basis of disease and immunity.

Education

We provide information to patients about aspergillosis. We also provide diagnostic and clinical training to health care professionals and technical staff through a variety of online learning resources.

Support

NAC is a friendly place to visit both on and offline. Our staff are helpful and knowledgeable. As well as clinical care, we support people with aspergillosis and their families by hosting face to face and online support groups.

NAC CARES!

The first letter of each of these areas spells out the word ‘cares’. And that’s exactly what we do. So, your NAC comms team will now be known as your NAC CARES team.

Graham Atherton, NAC CARES team lead, said “This is a real step change for us in terms of communicating our function to the people who use our service.”

What are the risk factors for Chronic Pulmonary Aspergillosis returning once antifungal therapy has been stopped?

Chronic pulmonary aspergillosis (CPA) can be a scary disease. People can be on antifungal drugs for a very long time, sometimes indefinitely. This can be worrying. Is it ever possible to come off antifungal drugs? Will the fungus ever go away? If the drugs are stopped, might the fungus come back again?

A recent research paper from the National Aspergillosis Centre has attempted to find some answers.

The researchers wanted to know how many people with CPA relapsed once their antifungal treatment was stopped. They also wanted to know what the risk factors for relapse might be. Understanding these risk factors might help to manage the disease better and might tell us which patients are at a low risk of relapse. This means that for these patients, treatment could be stopped earlier and so antifungal resistance, toxicity and cost could be reduced.

The scientists looked at people with aspergillosis who were treated at the National Aspergillosis Centre between 2009 and 2017. They identified at 102 people whose antifungal treatment (mainly voriconazole) was stopped during this period.

In 21% of people, CPA came back (21 out of 102 people). The key risk factors for relapse were the involvement of both lungs and, to a lesser extent, the presence of an aspergilloma.

In a different study of patients with CPA who were mainly treated with itraconazole, presence of disease in more than one lobe on CT scan, younger age and longer duration of treatment to achieve remission were associated with a higher risk of relapse.

Even though the authors found that CPA came back for 21% of people in this study, the chance of relapse is a very difficult thing to predict. Many people with CPA have other conditions which affect their health such as bacterial infections, non-tuberculous mycobacterial infections or COPD. Doctors might look at information from scans, microbiology or blood test results to help inform them as to whether relapse is likely, or they might rely on whether a person seems to be ‘getting worse’ clinically.

That said, this study showed that where both lungs are affected and an aspergilloma is present, the likelihood of relapse is increased, although it should be noted that antifungals were stopped mainly because of side effects or resistance development, and not because of achieving remission of disease.

The full paper is available on the Aspergillus Website.

This is a figure from the research paper showing that people with bilateral aspergillosis (i.e. aspergillosis involving both lungs) are more likely to relapse that people with aspergillosis involving one lung (unilateral disease). The green line is for both lungs, the blue line is for one lung.
This is a figure from the research paper showing that people with bilateral aspergillosis (i.e. aspergillosis involving both lungs) are more likely to relapse that people with aspergillosis involving one lung (unilateral disease). The green line is for both lungs, the blue line is for one lung.

World Aspergillosis Day 2020

World Aspergillosis Day 2020 is almost here! The big day is February 27th and here’s a few ideas of ways that you can support the occasion and help to raise awareness of aspergillosis.

Submit your selfie!

The Aspergillosis Trust are asking people to show their support by downloading a selfie card, taking a selfie with it, and uploading it to their ‘Selfie Hall of Fame‘. Please get involved and show your support!

Add a WAD2020 graphic to your email signature.

We have produced a signature graphic for you to use on emails. Feel free to save your favourite colour version and share it far and wide!

Show your support for WAD2020 on your social media profile pictures.

You can support the campaign to raise awareness of aspergillosis by adding our twibbon to your profile picture. Twibbon will create a new profile picture for you containing the WAD2020 logo. Download this image and upload it to Twitter. Voila!

For Facebook it’s much simpler! Just add our frame!

Show your support for WAD2020 on your social media profile pictures.

You can support the campaign to raise awareness of aspergillosis by adding our twibbon to your Twitter profile picture. Simply visit https://twibbon.com/support/world-aspergillosis-day-2020 and add the twibbon to your profile picture in. Twibbon will then create a new profile picture for you containing the WAD2020 logo. Download this image and upload it to Twitter. Voila!

For Facebook it’s much simpler! Just add our frame!

Use our social media header images for LinkedIn, Twitter and Facebook.

Please take a look and download and choose your favourite colours.

Display our poster in your office or in a window at home

Print out and display our WAD2020 poster.

Host a coffee morning to raise awareness

On February 27th at 10am The National Aspergillosis Centre will be hosting a virtual coffee morning whilst at AAAM2020. We’ll be talking online to patients, researchers and clinicians. We invite you to run your own events at home and at work. So why not gather your friends, family or colleagues, make a brew, enjoy a slice of cake and tweet about taking a moment out of your day to raise awareness using the hashtag #worldaspergillosisday2020

Here’s a few assets to download to decorate your home or office. There’s bunting, cake labels and invitations!

WAD2020 Coffee Morning Assets

Hope on the horizon: Novel antifungal treatments in development

A review published recently describes the new antifungals that are in the pipeline that offer hope for the future.

The new drugs described in the review have novel mechanisms of action to overcome resistance, and some offer new formulations providing distinct advantages over current therapies to improve safety profiles and reduce interactions. For example, Rezafungin has shown activity against Aspergillus species and has reduced liver toxicity, better penetration and less risk of resistance.

A summary of the mechanism of action, spectrum of activity and expected benefits is provided in the paper which you can find on the Aspergillus Website. The authors have also produced a great illustration of the new antifungals and their activity so that the remaining gaps can easily be seen. Aspergillus species have been highlighted by the blue box.

It is very encouraging to see that several of the compounds have potent activity against Aspergillus species and that Ibrexafungerp, a compound affecting the fungal cell wall, has activity against several Aspergillus species and is in phase 3 clinical trials.

The potential benefits of this drug include:

  • Oral and IV formulation
  • Active against resistant strains
  • Better penetration (IAC)
  • Minimal drug-drug interactions

In addition, olorofim, VL2397 and ABA all have potent activity against Aspergillus species and are in various stages of clinical trial. All in all, there is real hope on the horizon

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Aspergillus – Pseudomonas interactions; a match made in heaven or hell?

In the last years clinicians and researchers have realised that the interactions between microorganisms in polymicrobial infections (when a single patient is colonised/infected with two or more pathogens) are relevant for the progression of the disease. Contacts between pathogens can affect their fitness (how well they can grow inside us) and also impact on the response of our immune system. However, the research into this novel and extremely complex area is still in its infancy and we need to gain much more information before being able to understand what is going on in each specific condition. It is suspected that in some interactions the microorganisms may compete with each other, which is usually good for us. However, in other types of interactions the pathogens may help each other, which is of course detrimental for the patients. In the case of Aspergillus – Pseudomonas interaction it is still not completely clear which is taking place, a positive or a negative interaction.

Pseudomonas (mainly the species Pseudomonas aeruginosa) is a common bacterial pathogen and Aspergillus (mainly the species Aspergillus fumigatus) is the most common fungal pathogen of the human respiratory tract. Both organisms are able to grow in the lungs of immunosuppressed individuals and also of patients with certain underlying diseases, such as bronchiectasis, chronic obstructive pulmonary disease (COPD), hospital acquired pneumonia and cystic fibrosis. Since the awareness of the importance of polymicrobial infections is quite recent, there are not many reports of the incidence of co-infection with these two pathogens yet. One of the few, from the end of 2018, reported a prevalence of co-infection in cystic fibrosis patients of 15.8% (1). That means that almost sixteen percent of all cystic fibrosis patients may be co-infected with both Pseudomonas and Aspergillus… This is of course not trivial!

 Several studies carried out in various laboratories around the world would suggest that the interaction between Aspergillus and Pseudomonas is of competitive nature. That would indicate that they weaken each other during co-infection, which could mean good news for patients. However, there are also results, including some clinical evidence, that suggest the opposite, the pathogens could be helping each other in the human lungs. What seems clear is that having both pathogens is not good for the patients (2). Therefore, we need to understand how these microbes interact during co-infection to be able to decide which course of action is best, should we treat against both or only one? Which one first, or both at the same time?

To address these questions my research group, in the Manchester Fungal Infection Group, is trying to understand the specific interactions that take place between Aspergillus fumigatus and Pseudomonas aeruginosa under conditions that are similar to co-infection of the human lung.

We want to discover which interactions are the important ones. This will help us understand what is going on during co-infection and we can then use this knowledge to improve the management and treatment of patients.

Dr Jorge Amich | MRC Career Development Fellow

Manchester Fungal Infection Group (MFIG)

1. Zhao J, Cheng W, He X, Liu Y.2018. The co-colonization prevalence of Pseudomonas aeruginosa and Aspergillus fumigatus in cystic fibrosis: A systematic review and meta-analysis. Microb Pathog 125:122-128.

2. Reece E, Segurado R, Jackson A, McClean S, Renwick J, Greally P.2017. Co-colonisation with Aspergillus fumigatus and Pseudomonas aeruginosa is associated with poorer health in cystic fibrosis patients: an Irish registry analysis. BMC Pulm Med 17:70.

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