Chronic pulmonary aspergillosis (CPA) complicates treated pulmonary tuberculosis (TB), with high ... more Chronic pulmonary aspergillosis (CPA) complicates treated pulmonary tuberculosis (TB), with high 5-year mortality. We measured CPA prevalence in this group.398 Ugandans with treated pulmonary TB underwent clinical assessment, chest radiography andAspergillus-specific IgG measurement. 285 were resurveyed 2 years later, including computed tomography of the thorax in 73 with suspected CPA. CPA was diagnosed in patients without active TB who had raisedAspergillus-specific IgG, radiological features of CPA and chronic cough or haemoptysis.Author-defined CPA was present in 14 (4.9%, 95% CI 2.8–7.9%) resurvey patients. CPA was significantly more common in those with chest radiography cavitation (26%versus0.8%; p<0.001), but possibly less frequent in HIV co-infected patients (3%versus6.7%; p=0.177). The annual rate of new CPA development between surveys was 6.5% in those with chest radiography cavitation and 0.2% in those without (p<0.001). Absence of cavitation and pleural thickening...
Journal of fungi (Basel, Switzerland), Jan 21, 2018
Data with respect to the epidemiological situation of fungal diseases in Colombia is scarce. Thus... more Data with respect to the epidemiological situation of fungal diseases in Colombia is scarce. Thus, the aim of this study is to estimate the burden of fungal infections. A population projection for 2017 from the Colombian Department for National Statistics was used, as well as official information from the Ministry of Health and National Institute of Health. A bibliographical search for Colombian data on mycotic diseases and population at risk (chronic obstructive pulmonary disease, HIV infection/AIDS, cancer, and transplant patients) was done. The Colombian population for 2017 was estimated at 49,291,609 inhabitants, and the estimated number of fungal infections for Colombia in 2017 was between 753,523 and 757,928, with nearly 600,000 cases of candidiasis, 130,000 cases of aspergillosis, and 16,000 cases of opportunistic infection in HIV, affecting around 1.5% of the population. In conclusion, fungal infections represent an important burden of disease for the Colombian population. D...
A 25-year-old woman presented with unilateral red eye and visual blur, and was found to have panu... more A 25-year-old woman presented with unilateral red eye and visual blur, and was found to have panuveitis with an inflammatory white mass at the macula, initially presumed to be Toxoplasma retinitis. After failure to respond, she underwent vitrectomy, which produced Candida albicans. Despite intraocular and systemic antifungal treatment, she lost all vision in that eye. Two years later, she developed unilateral hip osteomyelitis leading to total hip replacement and also revealing Candida infection. By clinical exome sequencing, she was then found to have caspase recruitment domain 9 (CARD9) deficiency, an autosomal recessive disorder that causes a specific susceptibility to candidal infections. She remains otherwise well but on lifelong fluconazole prophylaxis.
Background and Rationale: IL-17A has been implicated in airway inflammation of severe asthma, but... more Background and Rationale: IL-17A has been implicated in airway inflammation of severe asthma, but its role in SAFS and ABPA is uncertain. Objectives: We investigated IL-17 in BAL and peripheral blood mononuclear cells (PBMCs) in asthmatic subjects with ABPA, SAFS, severe asthma, mild asthma compared to healthy subjects. We also investigated the relationship between IL-17A and asthma severity or blood neutrophils. Methods: Airway lymphocytes and PBMCs were characterized by flow cytometry to determine the numbers of CD4+ Th17 cells: CD4 (APC-Cy7), IL-17A (PerCP-CY5.5). Asthma severity, blood neutrophils and lung function were evaluated. Results: There were 59 patients analysed (ABPA=16, SAFS=16, severe asthma=10, mild asthma=6, NH=11), males 31 (52.5%), age 49 yrs (19-75), BMI (27.7, sd=5.5). Patients with severe asthma had significantly higher CD4+ IL-17 expressing cells in both BAL and PBMCs compared to non-severe groups ( p =0.01, 0.001 respectively). There was no significant difference between ABPA and SAFS. The %CD4+ IL-17 expressing cells correlated positively with serum neutrophil counts in non-sensitised SA in both BAL and PBMCs ( p =0.015 and 0.007 respectively), but not in other subject groups. BAL fungal culture positivity correlated positively with the number 1L-17A+cells (r=0.9, p =0.004) and the severity of asthma (r=1.89, p=0.012). Conclusion: Our data suggests that both airway and PBMC IL-17 expressing caells are higher in severe asthma and correlates with FEV1,airway fungal burden and blood neutrophilia.
Twelve laboratories evaluated candidate material for an Aspergillus DNA calibrator. The DNA mater... more Twelve laboratories evaluated candidate material for an Aspergillus DNA calibrator. The DNA material was quantified using limiting-dilution analysis; the mean concentration was determined to be 1.73 × 10 10 units/ml. The calibrator can be used to standardize aspergillosis diagnostic assays which detect and/or quantify nucleic acid.
EDITOR,—David Wilks and colleagues defend their book vigorously—and so they should, as it has muc... more EDITOR,—David Wilks and colleagues defend their book vigorously—and so they should, as it has much to commend it, as I pointed out in my review. The drug doses they quote are based on the British National Formulary and manufacturers' datasheets, but unfortunately some of these are out of date or simply incorrect. Take the recommendation that a patient with a creatinine …
Chronic pulmonary aspergillosis (CPA) complicates treated pulmonary tuberculosis (TB), with high ... more Chronic pulmonary aspergillosis (CPA) complicates treated pulmonary tuberculosis (TB), with high 5-year mortality. We measured CPA prevalence in this group.398 Ugandans with treated pulmonary TB underwent clinical assessment, chest radiography andAspergillus-specific IgG measurement. 285 were resurveyed 2 years later, including computed tomography of the thorax in 73 with suspected CPA. CPA was diagnosed in patients without active TB who had raisedAspergillus-specific IgG, radiological features of CPA and chronic cough or haemoptysis.Author-defined CPA was present in 14 (4.9%, 95% CI 2.8–7.9%) resurvey patients. CPA was significantly more common in those with chest radiography cavitation (26%versus0.8%; p<0.001), but possibly less frequent in HIV co-infected patients (3%versus6.7%; p=0.177). The annual rate of new CPA development between surveys was 6.5% in those with chest radiography cavitation and 0.2% in those without (p<0.001). Absence of cavitation and pleural thickening...
Journal of fungi (Basel, Switzerland), Jan 21, 2018
Data with respect to the epidemiological situation of fungal diseases in Colombia is scarce. Thus... more Data with respect to the epidemiological situation of fungal diseases in Colombia is scarce. Thus, the aim of this study is to estimate the burden of fungal infections. A population projection for 2017 from the Colombian Department for National Statistics was used, as well as official information from the Ministry of Health and National Institute of Health. A bibliographical search for Colombian data on mycotic diseases and population at risk (chronic obstructive pulmonary disease, HIV infection/AIDS, cancer, and transplant patients) was done. The Colombian population for 2017 was estimated at 49,291,609 inhabitants, and the estimated number of fungal infections for Colombia in 2017 was between 753,523 and 757,928, with nearly 600,000 cases of candidiasis, 130,000 cases of aspergillosis, and 16,000 cases of opportunistic infection in HIV, affecting around 1.5% of the population. In conclusion, fungal infections represent an important burden of disease for the Colombian population. D...
A 25-year-old woman presented with unilateral red eye and visual blur, and was found to have panu... more A 25-year-old woman presented with unilateral red eye and visual blur, and was found to have panuveitis with an inflammatory white mass at the macula, initially presumed to be Toxoplasma retinitis. After failure to respond, she underwent vitrectomy, which produced Candida albicans. Despite intraocular and systemic antifungal treatment, she lost all vision in that eye. Two years later, she developed unilateral hip osteomyelitis leading to total hip replacement and also revealing Candida infection. By clinical exome sequencing, she was then found to have caspase recruitment domain 9 (CARD9) deficiency, an autosomal recessive disorder that causes a specific susceptibility to candidal infections. She remains otherwise well but on lifelong fluconazole prophylaxis.
Background and Rationale: IL-17A has been implicated in airway inflammation of severe asthma, but... more Background and Rationale: IL-17A has been implicated in airway inflammation of severe asthma, but its role in SAFS and ABPA is uncertain. Objectives: We investigated IL-17 in BAL and peripheral blood mononuclear cells (PBMCs) in asthmatic subjects with ABPA, SAFS, severe asthma, mild asthma compared to healthy subjects. We also investigated the relationship between IL-17A and asthma severity or blood neutrophils. Methods: Airway lymphocytes and PBMCs were characterized by flow cytometry to determine the numbers of CD4+ Th17 cells: CD4 (APC-Cy7), IL-17A (PerCP-CY5.5). Asthma severity, blood neutrophils and lung function were evaluated. Results: There were 59 patients analysed (ABPA=16, SAFS=16, severe asthma=10, mild asthma=6, NH=11), males 31 (52.5%), age 49 yrs (19-75), BMI (27.7, sd=5.5). Patients with severe asthma had significantly higher CD4+ IL-17 expressing cells in both BAL and PBMCs compared to non-severe groups ( p =0.01, 0.001 respectively). There was no significant difference between ABPA and SAFS. The %CD4+ IL-17 expressing cells correlated positively with serum neutrophil counts in non-sensitised SA in both BAL and PBMCs ( p =0.015 and 0.007 respectively), but not in other subject groups. BAL fungal culture positivity correlated positively with the number 1L-17A+cells (r=0.9, p =0.004) and the severity of asthma (r=1.89, p=0.012). Conclusion: Our data suggests that both airway and PBMC IL-17 expressing caells are higher in severe asthma and correlates with FEV1,airway fungal burden and blood neutrophilia.
Twelve laboratories evaluated candidate material for an Aspergillus DNA calibrator. The DNA mater... more Twelve laboratories evaluated candidate material for an Aspergillus DNA calibrator. The DNA material was quantified using limiting-dilution analysis; the mean concentration was determined to be 1.73 × 10 10 units/ml. The calibrator can be used to standardize aspergillosis diagnostic assays which detect and/or quantify nucleic acid.
EDITOR,—David Wilks and colleagues defend their book vigorously—and so they should, as it has muc... more EDITOR,—David Wilks and colleagues defend their book vigorously—and so they should, as it has much to commend it, as I pointed out in my review. The drug doses they quote are based on the British National Formulary and manufacturers' datasheets, but unfortunately some of these are out of date or simply incorrect. Take the recommendation that a patient with a creatinine …
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