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]
The importance of detecting cancer early
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Our focus at the National Aspergillosis Centre is to raise awareness and support those with aspergillosis. Still, it is vital as an NHS organisation that we raise awareness of other conditions because, sadly, a diagnosis of aspergillosis does not make you impervious to everything else, and a chronic illness has the potential to mask the symptoms of other conditions like cancer.
The ever-growing pressure on the NHS, increased waiting times, a growing reluctance amongst many to seek medical attention, and a lack of understanding of the common symptoms of many cancers are all factors that can lead to an extended diagnostic interval, which in turn reduces treatment options. Therefore, earlier recognition of symptoms by patients is crucial in mitigating other factors that delay diagnosis.
It is important to note that not all alarm symptoms are cancer. Still, cancer incidence and mortality projections estimate that 1 in 2 people in the UK will be diagnosed with cancer in their lifetime(1), so last week at our monthly patient meeting, we talked about cancer and the most common symptoms. Inspired by the incredible work of the late Dame Deborah James on raising awareness and breaking down the taboo attached to bowel cancer, we have compiled the content from that talk into one article.
What is Cancer?
Cancer starts in our cells.
Usually, we have just the right number of each type of cell. This is because cells produce signals to control how much and how often the cells divide.
If any of these signals are faulty or missing, cells might start to grow and multiply too much and form a lump called a tumour.
Cancer Research UK, 2022
Cancer Statistics
- Every two minutes, someone in the UK is diagnosed with cancer.
- Breast, prostate, lung and bowel cancers together accounted for over half (53%) of all new cancer cases in the UK in 2016-2018.
- Half (50%) of people diagnosed with cancer in England and Wales survive their disease for ten years or more (2010-11).
- Cancer is the cause of 27-28% of all deaths in England in a typical year.
Experts believe abdominal cancers - throat, stomach, bowel, pancreatic, ovarian - and urological cancers - prostate, kidney and bladder - are the most likely to go unrecognised.
The above chart shows cancer diagnoses by stage for some cancers in 2019 (the most current data). The stage of cancer relates to the size of the tumour and how far it has spread. Diagnosis at a later stage is related to lower survival.
Breast Cancer - Symptoms
- A lump or thickening in the breast which is different to the rest of the breast tissue
- Continuous breast pain in one part of the breast or armpit
- One breast becomes larger or lower/higher than the other breast
- Changes to the nipple - turning inward or changes shape or position
- Puckering or dimpling to the breast
- Swelling under the armpit or around the collarbone
- A rash on or around the nipple
- Discharge from one or both nipples
For more information visit:
https://www.breastcanceruk.org.uk/
https://www.cancerresearchuk.org/about-cancer/breast-cancer
Kidney Cancer - Symptoms
- Blood in the urine
- Low back pain on one side not through injury
- A lump on the side or lower back
- Fatigue
- Loss of appetite
- Unexplained weight loss
- Fever that is not caused by an infection and that doesn't go away
For more information visit:
https://www.nhs.uk/conditions/kidney-cancer/symptoms/
https://www.cancerresearchuk.org/about-cancer/kidney-cancer/symptoms
Lung cancer
The symptoms of lung cancer can be particularly hard to differentiate for patients with aspergillosis. It is important to report any new symptoms, such as a change to a long-term cough, weight loss and chest pain to your GP or specialist consultant.
Symptoms
- A persistent cough that doesn't go away after 2/3 weeks
- A change in your long-term cough
- Increased and persistent breathlessness
- Coughing up blood
- An ache or pain in the chest or shoulder
- Repeated or persistent chest infection
- Loss of appetite
- Fatigue
- Weight loss
- Hoarsness
For more information visit:
https://www.nhs.uk/conditions/lung-cancer
https://www.cancerresearchuk.org/about-cancer/lung-cancer
Ovarian Cancer - Symptoms
- Persistent bloating
- Feeling full quickly
- Loss of appetite
- Changes in bowel habits
- Unexplained weight loss
- Pelvic or abdominal pain
- Needing to wee more frequently
- Fatigue
For more information visit:
https://www.nhs.uk/conditions/ovarian-cancer/
Pancreatic Cancer
Some of the symptoms of pancreatic cancer can closely resemble those of bowel conditions such as irritable bowel. See your GP if your symptoms change, get worse, or do not feel normal for you.
Symptoms
- Yellowing to the whites of your eyes or skin (jaundice)
- Itchy skin, darker pee and paler poo than usual
- Loss of appetite
- Fatigue
- Fever
Other symptoms can affect your digestion, such as:
- Nausea and vomiting
- Changes in bowel habits
- Stomach and/or back pain
- Indigestion
- Bloating
For more information visit:
https://www.nhs.uk/conditions/pancreatic-cancer
https://www.cancerresearchuk.org/about-cancer/pancreatic-cancer
https://www.pancreaticcancer.org.uk/
Prostate Cancer - Symptoms
- Urinating more frequently, often during the night (nocturia)
- Increased urgency to urinate
- Urine hesitancy (difficulty starting to urinate)
- Difficulty in passing urine
- Weak flow
- Feeling that your bladder has not emptied fully
- Blood in urine or semen
For more information visit:
https://www.nhs.uk/conditions/prostate-cancer
https://www.cancerresearchuk.org/about-cancer/prostate-cancer
Skin Cancer
Patients who are on antifungal medication are at an increased risk of developing skin cancer, therefore it is important to understand the symptoms and take adequate precautions with sun exposure to reduce the risk.
Symptoms
There are three main types of skin cancer:
- Malignant Melanoma
- Basal Cell Carcinoma (BCC)
- Squamous Cell Carcinoma (SCC)
Broadly, the signs are (shown in the image below):
BCC
- Flat, raised or dome-shaped spot
- Pearly or skin-coloured
SCC
- Raised, crusty or scaly
- Sometimes ulcerated
Melanoma
- An abnormal mole that is asymmetrical, irregular and has multiple colours
For more information visit:
https://www.cancerresearchuk.org/about-cancer/skin-cancer
https://www.nhs.uk/conditions/melanoma-skin-cancer/
https://www.nhs.uk/conditions/non-melanoma-skin-cancer/
Throat Cancer
Throat cancer is a general term that means cancer that starts in the throat, however, Doctors don't generally use it. This is because there are different types of cancer which can affect the area of the throat.
More information can be found here: https://www.macmillan.org.uk/cancer-information-and-support/head-and-neck-cancer/throat-cancer
General symptoms
- Sore throat
- Ear pain
- Lump in the neck
- Difficulty swallowing
- Change in your voice
- Unexplained weight loss
- A cough
- Shortness of breath
- A feeling of something stuck in the throat
For more information visit:
https://www.nhs.uk/conditions/head-and-neck-cancer/
Bladder Cancer - Symptoms
- Increased urination
- Urgency to urinate
- A burning sensation when passing urine
- Pelvic pain
- Flank pain
- Abdominal pain
- Unexplained weight loss
- Leg swelling
For more information visit:
https://www.nhs.uk/conditions/bladder-cancer/
https://www.cancerresearchuk.org/about-cancer/bladder-cancer
Bowel Cancer - Symptoms
- Bleeding from the bottom and/or blood in poo
- A persistent and unexplained change in bowel habit
- Unexplained weight loss
- Fatigue
- A pain or lump in the stomach
For more information visit:
https://www.bowelcanceruk.org.uk/about-bowel-cancer/
https://www.cancerresearchuk.org/about-cancer/bowel-cancer
(1)Smittenaar CR, Petersen KA, Stewart K, Moitt N. Cancer incidence and mortality projections in the UK until 2035. Br J Cancer 2016 Oct 25;115(9):1147-1155
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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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Drug Induced Photosensitivity
What is drug-induced photosensitivity?
Photosensitivity is the abnormal or heightened reaction of the skin when exposed to ultraviolet (UV) radiation from the sun. This leads to skin that has been exposed to the sun without protection becoming burnt, and in turn, this can increase the risk of developing skin cancer.
There are several medical conditions like lupus, psoriasis and rosacea that can increase a person's sensitivity to ultraviolet light. A more comprehensive list of known conditions can be found here.
Drug-induced photosensitivity is the most common type of skin-related adverse drug reaction and can occur as a result of topical and oral medications. Reactions happen when a component of the medication combines with UV radiation during sun exposure, causing a phototoxic reaction that appears as severe sunburn, identified by swelling, itchiness, profuse redness and in the worst cases, blistering and oozing.
Patients taking antifungal medications, in particular, Voriconazole and Itraconazole (the former being more widely known for causing reactions), are often aware of the increased risks of photosensitivity; however, these are not the only drugs that can induce an abnormal response to UV exposure. Other drugs that have been reported to cause photosensitivity are:
- NSAIDs (Ibuprofen (oral and topical), naproxen, aspirin)
- Cardiovascular medication (furosemide, ramipril, amlodipine, nifedipine, amiodarone, clopidogrel – just a few)
- Statins (simvastatin)
- Psychotropic drugs (olanzapine, clozapine, fluoxetine, citalopram, sertraline – just a few)
- Antibacterial medications (ciprofloxacin, tetracycline, doxycycline)
It is essential to note that the above list is not exhaustive, and reported reactions range from rare to frequent. If you think a medication other than your antifungal is causing a reaction to the sun, speak to your pharmacist or GP.
How to protect yourself
In most cases, patients can't stop taking the medication that can predispose them to photosensitivity. Staying out of the sun isn't always possible either - quality of life is always an important consideration; therefore, extra care should be taken to protect their skin while outside.
There are two types of protection:
- Chemical
- Physical
Chemical protection is in the form of sunscreen and sunblock. However, it is important to remember that sunscreen and sunblock are not the same. Sunscreen is the most common type of sun protection, and it works by filtering the sun's UV rays, but some still get through. Sunblock reflects the rays away from the skin and prevents them from penetrating it. When buying sunscreen, look for a sun protection factor (SPF) of 30 or above to protect against UVB and at least a UVA protection rating of 4 stars.
Physical protection
- NHS guidance advises staying in the shade when the sun is strongest, which in the UK is between 11am and 3pm from March to October
- Use a sunshade or umbrella
- A wide-brimmed hat that shades the face, neck and ears
- Long-sleeved tops, trousers and skirts made of close-weave fabrics that stop sunlight from penetrating
- Sunglasses with wraparound lenses and wide arms that conform to the British Standard
- UV protective clothing
Links to further information