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Arturo Casadevall - One of the best experts on this subject based on the ideXlab platform.
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Fungal Diseases in the 21st Century: The Near and Far Horizons.
Pathogens & immunity, 2018Co-Authors: Arturo CasadevallAbstract:Fungal Diseases became a major medical problem in the second half of the 20th century when advances in modern medicine together with the HIV epidemic resulted in large numbers of individuals with impaired immunity. Fungal Diseases are difficult to manage because they tend to be chronic, hard to diagnose, and difficult to eradicate with antiFungal drugs. This essay considers the future of medical mycology in the 21st century, extrapolating from current trends. In the near horizon, the prevalence of Fungal Diseases is likely to increase, as there will be more hosts with impaired immunity and drug resistance will inevitably increase after selection by antiFungal drug use. We can expect progress in the development of new drugs, diagnostics, vaccines, and immunotherapies. In the far horizon, humanity may face new Fungal Diseases in association with climate change. Some current associations between chronic Diseases and Fungal infections could lead to the establishment of fungi as causative agents, which will greatly enhance their medical importance. All trends suggest that the importance of Fungal Diseases will increase in the 21st century, and enhanced human preparedness for this scourge will require more research investment in this group of infectious Diseases.
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recent progress in vaccines against Fungal Diseases
Current Opinion in Microbiology, 2012Co-Authors: Antonio Cassone, Arturo CasadevallAbstract:Diseases caused by fungi are increasingly impacting the health of the human population and now account for a large fraction of infectious disease complications in individuals with impaired immunity or breached tissue defenses. AntiFungal therapy is often of limited effectiveness in these patients, resulting into treatment failures, chronic infections and unacceptable rates of mortality, morbidity and their associated costs. Consequently there is a real medical need for new treatments and preventive measures to combat Fungal Diseases and, toward this goal, safe and efficacious vaccines would constitute major progress. After decades of complacency and neglect of this critically important field of research, remarkable progress has been made in recent years. A number of highly immunogenic and protective vaccine formulations in preclinical setting have been developed, and at least two have undergone Phase 1 clinical trials as preventive and/or therapeutic tools against candidiasis.
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immunoglobulins in defense pathogenesis and therapy of Fungal Diseases
Cell Host & Microbe, 2012Co-Authors: Arturo Casadevall, Liise Anne PirofskiAbstract:Only two decades ago antibodies to fungi were thought to have little or no role in protection against Fungal Diseases. However, subsequent research has provided convincing evidence that certain antibodies can modify the course of Fungal infection to the benefit or detriment of the host. Hybridoma technology was the breakthrough that enabled the characterization of antibodies to fungi, illuminating some of the requirements for antibody efficacy. As discussed in this review, Fungal-specific antibodies mediate protection through direct actions on Fungal cells and through classical mechanisms such as phagocytosis and complement activation. Although mechanisms of antibody-mediated protection are often species-specific, numerous Fungal antigens can be targeted to generate vaccines and therapeutic immunoglobulins. Furthermore, the study of antibody function against medically important fungi has provided fresh immunological insights into the complexity of humoral immunity that are likely to apply to other pathogens.
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Global Warming Will Bring New Fungal Diseases for Mammals
Mbio, 2010Co-Authors: Mónica García-solache, Arturo CasadevallAbstract:Fungi are major pathogens of plants, other fungi, rotifers, insects, and amphibians, but relatively few cause disease in mammals. Fungi became important human pathogens only in the late 20th century, primarily in hosts with impaired immunity as a consequence of medical interventions or HIV infection. The relatively high resistance of mammals has been attributed to a combination of a complex immune system and endothermy. Mammals maintain high body temperatures relative to environ- mental temperatures, creating a thermally restrictive ambient for the majority of fungi. According to this view, protection given by endothermy requires a temperature gradient between those of mammals and the environment. We hypothesize that global warming will increase the prevalence of Fungal Diseases in mammals by two mechanisms: (i) increasing the geographic range of currently pathogenic species and (ii) selecting for adaptive thermotolerance for species with significant pathogenic potential but currently not pathogenic by virtue of being restricted by mammalian temperatures. GLOBAL CLIMATE CHANGE
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polysaccharide containing conjugate vaccines for Fungal Diseases
Trends in Molecular Medicine, 2006Co-Authors: Arturo Casadevall, Liise Anne PirofskiAbstract:The recognition that antibodies are effective against Fungal pathogens has spawned interest in developing vaccines that elicit antibody-mediated protection. Recently, a novel polysaccharide–protein conjugate vaccine that uses the algal antigen laminarin was shown to elicit antibodies to β-glucan in Fungal cell walls and to mediate protection against both experimental candidiasis and aspergillosis. Remarkably, vaccine-induced antibodies manifested direct antiFungal effects, suggesting that vaccine efficacy might not require cellular or other components of the immune system. The description of a vaccine that could protect against various Fungal pathogens opens exciting new dimensions in the search for approaches to control Fungal Diseases.
David W. Denning - One of the best experts on this subject based on the ideXlab platform.
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Fungal Diseases in taiwan national insurance data and estimation
Journal of Fungi, 2019Co-Authors: Yushan Huang, David W. Denning, Shu Man Shih, Chao A Hsiung, Hsinyun Sun, Pao Yu Chen, Yeechun Chen, Shanchwen ChangAbstract:The burden of Fungal Diseases based on the real-world national data is limited. This study aimed to estimate the Taiwan incident cases with selected Fungal Diseases in 2013 using the National Health Insurance Research Database (NHIRD) which covered 99.6% of the 23.4 million population. Over 80,000 incident cases were found and the majority were superficial infections including vulvovaginal candidiasis (477 per 100,000 adult women) and oral candidiasis (90 cases per 100,000 population). Common potentially life-threating Fungal Diseases were Pneumocystis pneumonia (5.35 cases per 100,000 population), candidemia (3.68), aspergillosis (2.43) and cryptococcal meningitis (1.04). Of the aforementioned cases cancer patients contributed 30.2%, 42.9%, 38.6% and 22.2%, respectively. Of 22,270 HIV-infected persons in NHIRD in 2013, four common Diseases were Pneumocystis pneumonia (28.3 cases per 1000 HIV-infected patients), oral candidiasis (17.6), esophageal candidiasis (6.06) and cryptococcal meningitis (2.29). Of pulmonary aspergillosis 32.9% occurred in patients with chronic pulmonary Diseases and 26.3% had a prior diagnosis of tuberculosis. There are some notable gaps related to insurance claim data. Cutaneous, urinary tract and eye Fungal infections were not captured.
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global and multi national prevalence of Fungal Diseases estimate precision
Journal of Fungi, 2017Co-Authors: Felix Bongomin, Sara Gago, Rita O Oladele, David W. DenningAbstract:Fungal Diseases kill more than 1.5 million and affect over a billion people. However, they are still a neglected topic by public health authorities even though most deaths from Fungal Diseases are avoidable. Serious Fungal infections occur as a consequence of other health problems including asthma, AIDS, cancer, organ transplantation and corticosteroid therapies. Early accurate diagnosis allows prompt antiFungal therapy; however this is often delayed or unavailable leading to death, serious chronic illness or blindness. Recent global estimates have found 3,000,000 cases of chronic pulmonary aspergillosis, ~223,100 cases of cryptococcal meningitis complicating HIV/AIDS, ~700,000 cases of invasive candidiasis, ~500,000 cases of Pneumocystis jirovecii pneumonia, ~250,000 cases of invasive aspergillosis, ~100,000 cases of disseminated histoplasmosis, over 10,000,000 cases of Fungal asthma and ~1,000,000 cases of Fungal keratitis occur annually. Since 2013, the Leading International Fungal Education (LIFE) portal has facilitated the estimation of the burden of serious Fungal infections country by country for over 5.7 billion people (>80% of the world’s population). These studies have shown differences in the global burden between countries, within regions of the same country and between at risk populations. Here we interrogate the accuracy of these Fungal infection burden estimates in the 43 published papers within the LIFE initiative.
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An estimate of the burden of serious Fungal Diseases in Greece.
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2016Co-Authors: Maria N. Gamaletsou, David W. Denning, M. Drogari-apiranthitou, Nikolaos V. SipsasAbstract:Data on the epidemiology of serious Fungal infections in Greece are scarce. Our aim was to calculate the burden of serious Fungal Diseases in Greece. A thorough literature search for papers reporting epidemiological data on serious Fungal Diseases in Greece was performed. Where no Greek data existed, we used a structured set of assumptions to estimate Fungal disease burden, based on specific high-risk populations. Of the 10.8 million population, 85.5 % are adults and 27 % are over 60 years of age. The annual Fungal disease estimates are as follows: 142,337 Greek women get recurrent vaginal thrush (2,632 cases/100,000 females); there are 889 cases of esophageal candidiasis (8.2 cases/100,000); annual incidence of Pneumocystis pneumonia is 112 cases; chronic pulmonary aspergillosis prevalence is 386 cases; there are 20,843 patients with allergic bronchopulmonary aspergillosis and 27,744 with severe asthma with Fungal sensitization; candidaemia incidence is 541 cases (5.0/100,000); there are 81 cases of Candida peritonitis; invasive aspergillosis occurs in 1,125 patients. According to our calculations, 194,067 individuals (1.79 cases/100,000) in Greece suffer from serious Fungal Diseases each year. This is the first attempt to determine the burden of Fungal Diseases in Greece, and provides a crude estimate on its impact on public health.
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cryptococcal disease and the burden of other Fungal Diseases in uganda where are the knowledge gaps and how can we fill them
Mycoses, 2015Co-Authors: Rosalind Parkesratanshi, David W. Denning, Beatrice Achan, Richard Kwizera, Andrew Kambugu, David B MeyaAbstract:The HIV epidemic in Uganda has highlighted Cryptococcus and Candida infections as important opportunistic Fungal infections. However, the burden of other Fungal Diseases is not well described. We aimed to estimate the burden of Fungal infections in Uganda. All epidemiological papers of Fungal Diseases in Uganda were reviewed. Where there is no Ugandan data, global or East African data were used. Recurrent vaginal candidiasis is estimated to occur in 375 540 Uganda women per year; Candida in pregnant women affects up to 651,600 women per year. There are around 45,000 HIV-related oral and oesophageal candidosis cases per year. There are up to 3000 cases per year of post-TB chronic pulmonary aspergillosis. There are an estimated 40,392 people with asthma-related Fungal conditions. An estimated 1,300,000 cases of tinea capitis occur in school children yearly in Uganda. There are approximately 800 HIV-positive adults with Pneumocystis jirovecii pneumonia (PJP) annually and up to 42 000 children with PJP per year. There are an estimated 4000 cryptococcal cases annually. There are an estimated 2.5 million Fungal infections per year in Uganda. Cryptococcus and PJP cause around 28,000 deaths in adults and children per year. We propose replicating the model of research around cryptococcal disease to investigate and development management strategies for other Fungal Diseases in Uganda.
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british society for medical mycology best practice recommendations for the diagnosis of serious Fungal Diseases
Lancet Infectious Diseases, 2015Co-Authors: Silke Schelenz, Rosemary Ann Barnes, Richard C Barton, Joanne R Cleverley, Sebastian B Lucas, Christopher C Kibbler, David W. DenningAbstract:Summary Invasive Fungal Diseases are an important cause of morbidity and mortality in a wide range of patients, and early diagnosis and management are a challenge. We therefore did a review of the scientific literature to generate a series of key recommendations for the appropriate use of microbiological, histological, and radiological diagnostic methods for diagnosis of invasive Fungal Diseases. The recommendations emphasise the role of microscopy in rapid diagnosis and identification of clinically significant isolates to species level, and the need for susceptibility testing of all Aspergillus spp, if treatment is to be given. In this Review, we provide information to improve understanding of the importance of antigen detection for cryptococcal disease and invasive aspergillosis, the use of molecular (PCR) diagnostics for aspergillosis, and the crucial role of antibody detection for chronic and allergic aspergillosis. Furthermore, we consider the importance of histopathology reporting with a panel of special stains, and emphasise the need for urgent (
Brendan R. Jackson - One of the best experts on this subject based on the ideXlab platform.
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Public Awareness of Invasive Fungal Diseases — United States, 2019
MMWR. Morbidity and mortality weekly report, 2020Co-Authors: Kaitlin Benedict, Noelle-angelique M. Molinari, Brendan R. JacksonAbstract:Fungal Diseases range from minor skin and mucous membrane infections to life-threatening disseminated disease. The estimated yearly direct health care costs of Fungal Diseases exceed $7.2 billion (1). These Diseases are likely widely underdiagnosed (1,2), and improved recognition among health care providers and members of the public is essential to reduce delays in diagnoses and treatment. However, information about public awareness of Fungal Diseases is limited. To guide public health educational efforts, a nationally representative online survey was conducted to assess whether participants had ever heard of six invasive Fungal Diseases. Awareness was low and varied by disease, from 4.1% for blastomycosis to 24.6% for candidiasis. More than two thirds (68.9%) of respondents had never heard of any of the Diseases. Female sex, higher education, and increased number of prescription medications were associated with awareness. These findings can serve as a baseline to compare with future surveys; they also indicate that continued strategies to increase public awareness about Fungal Diseases are needed.
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estimation of direct healthcare costs of Fungal Diseases in the united states
Clinical Infectious Diseases, 2019Co-Authors: Kaitlin Benedict, Tom Chiller, Brendan R. Jackson, Karlyn D BeerAbstract:BACKGROUND Fungal Diseases range from relatively-minor superficial and mucosal infections to severe, life-threatening systemic infections. Delayed diagnosis and treatment can lead to poor patient outcomes and high medical costs. The overall burden of Fungal Diseases in the United States is challenging to quantify, because they are likely substantially underdiagnosed. METHODS To estimate the total, national, direct medical costs associated with Fungal Diseases from a healthcare payer perspective, we used insurance claims data from the Truven Health MarketScan 2014 Research Databases, combined with hospital discharge data from the 2014 Healthcare Cost and Utilization Project National Inpatient Sample and outpatient visit data from the 2005-2014 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. All costs were adjusted to 2017 dollars. RESULTS We estimate that Fungal Diseases cost more than $7.2 billion in 2017, including $4.5 billion from 75055 hospitalizations and $2.6 billion from 8993230 outpatient visits. Hospitalizations for Candida infections (n = 26735, total cost $1.4 billion) and Aspergillus infections (n = 14820, total cost $1.2 billion) accounted for the highest total hospitalization costs of any disease. Over half of outpatient visits were for dermatophyte infections (4981444 visits, total cost $802 million), and 3639037 visits occurred for non-invasive candidiasis (total cost $1.6 billion). CONCLUSIONS Fungal Diseases impose a considerable economic burden on the healthcare system. Our results likely underestimate their true costs, because they are underdiagnosed. More comprehensive estimates of the public health impact of these Diseases are needed to improve their recognition, prevention, diagnosis, and treatment.
F J F Herth - One of the best experts on this subject based on the ideXlab platform.
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The role of diagnostic imaging in the management of invasive Fungal Diseases--report from an interactive workshop.
Mycoses, 2011Co-Authors: D Gompelmann, C P Heussel, M Schuhmann, F J F HerthAbstract:Invasive Fungal Diseases are a significant cause of morbidity and mortality in the growing population of immunosuppressed patients. Appropriate early therapy is associated with a reduction in mortality, but relies on rapid diagnosis. Microbiological investigations are often a problem as it can take several days for a culture to mature. As a result, diagnostic imaging techniques play a larger role in the early recognition and characterisation of opportunistic Fungal Diseases. In April 2009, a 1-day interactive workshop titled 'The role of diagnostic imaging in the management of invasive Fungal Diseases' was held for specialists in haemato-oncology, pneumology and radiology. The aim of the workshop was to show the significance as well as the limitations of diagnostic imaging in the assessment of opportunistic Fungal Diseases and to provide education as to the radiological findings that aid disease evaluation.
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The role of diagnostic imaging in the management of invasive Fungal Diseases – report from an interactive workshop
Mycoses, 2010Co-Authors: D Gompelmann, C P Heussel, M Schuhmann, F J F HerthAbstract:Summary Invasive Fungal Diseases are a significant cause of morbidity and mortality in the growing population of immunosuppressed patients. Appropriate early therapy is associated with a reduction in mortality, but relies on rapid diagnosis. Microbiological investigations are often a problem as it can take several days for a culture to mature. As a result, diagnostic imaging techniques play a larger role in the early recognition and characterisation of opportunistic Fungal Diseases. In April 2009, a 1-day interactive workshop titled ‘The role of diagnostic imaging in the management of invasive Fungal Diseases’ was held for specialists in haemato-oncology, pneumology and radiology. The aim of the workshop was to show the significance as well as the limitations of diagnostic imaging in the assessment of opportunistic Fungal Diseases and to provide education as to the radiological findings that aid disease evaluation.
Kaitlin Benedict - One of the best experts on this subject based on the ideXlab platform.
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Public Awareness of Invasive Fungal Diseases — United States, 2019
MMWR. Morbidity and mortality weekly report, 2020Co-Authors: Kaitlin Benedict, Noelle-angelique M. Molinari, Brendan R. JacksonAbstract:Fungal Diseases range from minor skin and mucous membrane infections to life-threatening disseminated disease. The estimated yearly direct health care costs of Fungal Diseases exceed $7.2 billion (1). These Diseases are likely widely underdiagnosed (1,2), and improved recognition among health care providers and members of the public is essential to reduce delays in diagnoses and treatment. However, information about public awareness of Fungal Diseases is limited. To guide public health educational efforts, a nationally representative online survey was conducted to assess whether participants had ever heard of six invasive Fungal Diseases. Awareness was low and varied by disease, from 4.1% for blastomycosis to 24.6% for candidiasis. More than two thirds (68.9%) of respondents had never heard of any of the Diseases. Female sex, higher education, and increased number of prescription medications were associated with awareness. These findings can serve as a baseline to compare with future surveys; they also indicate that continued strategies to increase public awareness about Fungal Diseases are needed.
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estimation of direct healthcare costs of Fungal Diseases in the united states
Clinical Infectious Diseases, 2019Co-Authors: Kaitlin Benedict, Tom Chiller, Brendan R. Jackson, Karlyn D BeerAbstract:BACKGROUND Fungal Diseases range from relatively-minor superficial and mucosal infections to severe, life-threatening systemic infections. Delayed diagnosis and treatment can lead to poor patient outcomes and high medical costs. The overall burden of Fungal Diseases in the United States is challenging to quantify, because they are likely substantially underdiagnosed. METHODS To estimate the total, national, direct medical costs associated with Fungal Diseases from a healthcare payer perspective, we used insurance claims data from the Truven Health MarketScan 2014 Research Databases, combined with hospital discharge data from the 2014 Healthcare Cost and Utilization Project National Inpatient Sample and outpatient visit data from the 2005-2014 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. All costs were adjusted to 2017 dollars. RESULTS We estimate that Fungal Diseases cost more than $7.2 billion in 2017, including $4.5 billion from 75055 hospitalizations and $2.6 billion from 8993230 outpatient visits. Hospitalizations for Candida infections (n = 26735, total cost $1.4 billion) and Aspergillus infections (n = 14820, total cost $1.2 billion) accounted for the highest total hospitalization costs of any disease. Over half of outpatient visits were for dermatophyte infections (4981444 visits, total cost $802 million), and 3639037 visits occurred for non-invasive candidiasis (total cost $1.6 billion). CONCLUSIONS Fungal Diseases impose a considerable economic burden on the healthcare system. Our results likely underestimate their true costs, because they are underdiagnosed. More comprehensive estimates of the public health impact of these Diseases are needed to improve their recognition, prevention, diagnosis, and treatment.
