Support Meeting for              Aspergillosis Patients                              LED BY GRAHAM ATHERTON               ...
Programme 1pm Introduction & future 1:30 Livingstone Chishimba 2:30 Tea & Coffee 3:00 Close
Quick Contact Last week showed the need for me to be able to contact  people who hope to attend via a reliable direct met...
Local Patients Support Group London meeting was blighted by illness but have an interest    group of 9 to support future ...
AwarenessFacebook80 members so far (69 friends)Several ‘pages’ Aspergillosis Support:  www.facebook.com/groups/aspergillu...
Awareness Mouldy buildings    Writing guidelines    Facebook page (awareness)    Awareness campaigns    www.facebook....
Student competitionsAim: Building awareness amongst younger people & parents Art & music Original compositions £1200 pr...
eBooks written by Patients2 now available – both via download from Amazon  (www.amazon.co.uk)   The Lady with the Aspergil...
Aspergillosis Study Day For all professions allied to medicine – nurses,  physio’s to improve knowledge & awareness 70 p...
Next Meeting (June) Centre Manager (Chris Harris) & Specialist Nurse (Deb Kennedy) will talk about the new home service a...
Thank You“The best chance we have of beating this illness is to                  work together”    Living with it, Working...
Patient meeting       -Q &A Dr Livingstone ChishimbaUniversity Hospital of South        Manchester
Patient   doctor
Doctor   Patient
Q4• Does climate make any difference?
Helpful fungi:•   Most of us use fungi every day without knowing it.•   We eat mushrooms and Quorn (a vegetarian fungal pr...
Helpful fungi:•   We get some important drugs from fungi such as the    antibiotic penicillin and cyclosporin A - a drug t...
Importance of fungi:•   Without fungi we would not have•    bread, beer, wine or antibiotics, but more importantly without...
The life cycle of AspergillusSpores inhaled           GerminationMass of hyphae         Hyphal elongation(plateau phase)  ...
Hospital demolitionHansen et al. JHI 2008; 70: 259-264.
Source of Aspergillus
Exposure in the garden
Heavy excavation!  Nihtinen et al. 2007 BMT
Allergy Aspergillosis * acute allergic reaction (bronchospasm, …) * allergic sinusitis * allergic bronchopulmonary aspergi...
ABPA and severe asthma                  www.emphysema-copd.co.uk
Chronic Pulmonary Aspergillosis (CPA)           Underlying diseases       • Classical tuberculosis * ~20%       • Atypical...
Chronic pulmonary aspergillosis                           www.aspergillus.org.uk
Chronic cavitary aspergillosis in a patient with old TBC
Aspergilloma
Aspergillosis3/ Invasive     * invasive pulmonary aspergillosis     * tracheobronchitis     * sinusitis     * cerebral asp...
FUNGAL KERATITIS
Treatment• Treat or not to treat?-   – Various consideration   – Risk benefit ratio• Antifungals• Surgical• Rx complicatio...
Patient   doctor
Patient meeting     -Q &A
Frequency, dose, duration of             itraconazole• It seems that some people on the aspergillus  site are using Sporan...
Frequency, dose, duration of             itraconazole• Indication in ABPA is treatment and not  prevention• Not to be used...
Some claim 200mg/day. Any experience          with this situation?• BD, od• 100-200mg/day/BD depending on• Wt, tolerabilit...
Q2a. Does the mould clear from my lungs in the  summer months and grows again once the damp               weather starts?•...
Q2b• Why do I always have a croaky throat and feel  like there is gunk sitting in my throat just  stuck there?• Is that fr...
Q2b: croaky throat & feeling of gunk        sitting in my throat• Croaky throat may arise from various factors:  fungal or...
Should I be on anti-fungal medicine (the   registrar said not) or is this only for severe                      cases?• Tre...
Objective of treatment•   Reduce symptoms•   improve QOL,•   improve lung faction,•   prevent or reduce disease decline.  ...
Q2c• I have read a few things on forums where people feel  they were misdiagnosed with pneumonia when it  was actually the...
Different diseases as pneumonia•   Fungal disease•   Cancer•   Fluid•   Lymphoma•   Systemic dieases: WG, MPA etc•   But  ...
ABPA as non-resolving pneumonia        Chishimba L , Journal of asthma, March 2002
Mould as cancerChishimba L , Journal of asthma, March 2002
Q2d. Do steroids/antibiotics cause mould             to grow more?• Neither steroids nor antibiotics cause mould  to grow ...
Are there things that I can eat/drink to help myself or        anything that can make things worse?• Only balanced nutriti...
Q3• What is the current thinking about people with ABPA  taking some sort of anti-fungal (like itraconazole) for  life ver...
Q3• anti-fungal (like itraconazole) for life in ABPA   – Not always necessary   – May be necessary in frequent relapses.• ...
Q4• In addition to being allergic to aspergillus  fumigatus, I am also allergic to other molds.• I began allergy shots in ...
Q6: ABPA and VitD• Is there any research showing a relationship  between ABPA and vitamin D levels in the  blood? In the p...
Q6: ABPA and VitD• Strong link between Vit D deficiecy and lung  disaese• Causal –effect relationship not well  understood...
Q7• It has always been rumored not to eat fungi  related foods (i.e. mushrooms, soy sauce,  yeast based products [breads, ...
Sources of information• National Aspergillosis Centre (  www.nationalaspergillosiscentre.org.uk)  Fungal Research Trust (w...
Thanks for your attention• Any questions?
Livingstone Chishimba Q & A session with National Aspergillosis Centre patients support meeting - May 2012
Livingstone Chishimba Q & A session with National Aspergillosis Centre patients support meeting - May 2012
Livingstone Chishimba Q & A session with National Aspergillosis Centre patients support meeting - May 2012
Livingstone Chishimba Q & A session with National Aspergillosis Centre patients support meeting - May 2012
Livingstone Chishimba Q & A session with National Aspergillosis Centre patients support meeting - May 2012
Livingstone Chishimba Q & A session with National Aspergillosis Centre patients support meeting - May 2012
Livingstone Chishimba Q & A session with National Aspergillosis Centre patients support meeting - May 2012
Livingstone Chishimba Q & A session with National Aspergillosis Centre patients support meeting - May 2012
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Livingstone Chishimba Q & A session with National Aspergillosis Centre patients support meeting - May 2012

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Dr Livingstone Chishimba is a specialist aspergillosis doctor working at the National Aspergillosis Centre, Manchester, UK.

This is the second session he has run discussing & answering questions from our patients and those who are members of our support groups online
http://uk.groups.yahoo.com/group/AspergillusSupport/

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  • Team work
  • Team work
  • Lecture notes: Objective: Fungi are used in many different types of food production. Quorn (a vegetarian protein) is made by fermenting the fungus Fusarium venenatum in vats producing the mycoprotein commonly eaten by vegetarians. An example of a major ‘commodity’ chemical manufactured by fungal ( Aspergillus niger ) fer m entation is citric acid. Its production was introduced in 1923 in the US, decimating Italian citric acid production (lemons). It is a major commodity - approximately 1 million tons made per annum. It is used as a taste enhancer, a chelating agent and a natural acidulant. Why do we need Nitrogen? It is a necessary component of all proteins and nucleic acids. Animals can not break the covalent N2 bond to release free N.
  • Lecture notes: Apart from penicillin, the most important antibiotics from fungi are the cephalosporins (beta-lactams with similar mode of action to penicillin, but with less allergenicity) and griseofulvin (from Penicillium griseofulvum and related species) which is used to treat athlete's foot and related fungal infections of the skin. Lovastatin a cholesterol lowering drug is produced by Aspergillus terreus.
  • Lecture notes: Objective: Some fungi are essential for nutrient recycling and providing plant nutrition. Not all fungi are this useful – some can cause deadly diseases and are therefore pathogens. For example: Aspergillus fumigatus can cause pneumonia in patients with leukaemia and AIDS; Candida can cause bloodstream infections in intensive care patients; Cryptococcus neoformans can cause meningitis in AIDS patients. All these infections are increasing in frequency because treatment of AIDS and cancer are more effective and hence patients at risk survive longer.
  • Short movie clips showing germination of spores and growth of hyphae can be viewed on this website at the following link: http://www.aspergillus.man.ac.uk/secure/educationsection/movies/af65hyphae.html
  • Severe aspergillus keratitis in patient from Pakistan
  • Candida growing on the ocular surface of an immunocompromised patient without corneal involvement.In fact FK is exceptional in such patients.
  • Sequence of slides showing ocular surface change which unusually predisposed to severe fusarium keratitis in an elderly woman.Successful treatment involved full thickness corneal transplantation shown 2 weeks and than 2 years after surgery
  • Team work
  • Chishimba L , Journal of asthma, March 2002
  • Livingstone Chishimba Q & A session with National Aspergillosis Centre patients support meeting - May 2012

    1. 1. Support Meeting for Aspergillosis Patients LED BY GRAHAM ATHERTON SUPPORTED BY MARIE KIRWAN, GEORGINA POWELL & DEBBIE KENNEDY NAC CENTRE MANAGER CHRIS HARRIS QUESTIONS & ANSWERS, LIVINGSTONE CHISHIMBA (ASPERGILLOSIS DOCTOR) NATIONAL ASPERGILLOSIS CENTRE UHSM MANCHESTERFungal Research Trust
    2. 2. Programme 1pm Introduction & future 1:30 Livingstone Chishimba 2:30 Tea & Coffee 3:00 Close
    3. 3. Quick Contact Last week showed the need for me to be able to contact people who hope to attend via a reliable direct method – newsletters and contact via online groups didn’t work Give me your mobile numbers and I can text everyone easily – instant and up to date
    4. 4. Local Patients Support Group London meeting was blighted by illness but have an interest group of 9 to support future efforts 1 patients attended Identified Brompton Hospital as a ‘target’ for support* Identified a specialist nurse to help out by attending www.facebook.com/groups/ALSGLondon/*Brompton now agreed to display information about support group
    5. 5. AwarenessFacebook80 members so far (69 friends)Several ‘pages’ Aspergillosis Support: www.facebook.com/groups/aspergillussupport/ Local groups:  Liverpool: www.facebook.com/groups/ALSGLiverpool/  West Midlands: www.facebook.com/groups/ALSGWestMidlands/  London: www.facebook.com/groups/ALSGLondon/
    6. 6. Awareness Mouldy buildings  Writing guidelines  Facebook page (awareness)  Awareness campaigns  www.facebook.com/groups/363940156983477/  Revised patients notes www.aspergillus.org.uk/newpatients/dampbuilding.php
    7. 7. Student competitionsAim: Building awareness amongst younger people & parents Art & music Original compositions £1200 prize (school & individual share) Theme is ‘funky fungi’ UPDATE: 3-400 entries – will be judged over the summer  www. projectlifecompetition.org
    8. 8. eBooks written by Patients2 now available – both via download from Amazon (www.amazon.co.uk) The Lady with the Aspergillus (£1.94 all Proceeds to Fungal Research Trust) by Julie Michael A Fly on the Ward (£1.94) by Michael Chapman
    9. 9. Aspergillosis Study Day For all professions allied to medicine – nurses, physio’s to improve knowledge & awareness 70 people attended full day course organised by Goergina – seemed very successful Feedback analysed?? Georgina… Hope to repeat?...
    10. 10. Next Meeting (June) Centre Manager (Chris Harris) & Specialist Nurse (Deb Kennedy) will talk about the new home service available to some of our patients – who we can offer this to, how it will be delivered.
    11. 11. Thank You“The best chance we have of beating this illness is to work together” Living with it, Working with it, Treating it Fungal Research Trust
    12. 12. Patient meeting -Q &A Dr Livingstone ChishimbaUniversity Hospital of South Manchester
    13. 13. Patient doctor
    14. 14. Doctor Patient
    15. 15. Q4• Does climate make any difference?
    16. 16. Helpful fungi:• Most of us use fungi every day without knowing it.• We eat mushrooms and Quorn (a vegetarian fungal protein), but we also prepare many other foods using fungi.• The yeast Saccharomyces cerevisiae is used to ferment sugar to alcohol and carbon dioxide – the process used to make beer and wine and also to make bread rise.• The fungi Aspergillus oryzae and Aspergillus sojae are used in the production of the oriental foods soy sauce and miso.• We also use fungi to produce flavourings, vitamins and enzymes and to mature many cheeses.• Fungi play an essential role in both the Nitrogen and Carbon cycle by breaking down dead organic material.
    17. 17. Helpful fungi:• We get some important drugs from fungi such as the antibiotic penicillin and cyclosporin A - a drug that stops organ rejection after transplantation.• Research scientists use several fungi to investigate basic functions that occur in all cells because they are simple and easy to grow; some cancer research is done using fungi.• Fungi are responsible for breaking down dead organic matter which allows nutrients to be cycled through the ecosystem.
    18. 18. Importance of fungi:• Without fungi we would not have• bread, beer, wine or antibiotics, but more importantly without the nutrient recycling and plant nutrition provided by fungi - we probably could not survive at all.
    19. 19. The life cycle of AspergillusSpores inhaled GerminationMass of hyphae Hyphal elongation(plateau phase) and branching
    20. 20. Hospital demolitionHansen et al. JHI 2008; 70: 259-264.
    21. 21. Source of Aspergillus
    22. 22. Exposure in the garden
    23. 23. Heavy excavation! Nihtinen et al. 2007 BMT
    24. 24. Allergy Aspergillosis * acute allergic reaction (bronchospasm, …) * allergic sinusitis * allergic bronchopulmonary aspergillose (ABPA)•Asthmatic bronchitis
    25. 25. ABPA and severe asthma www.emphysema-copd.co.uk
    26. 26. Chronic Pulmonary Aspergillosis (CPA) Underlying diseases • Classical tuberculosis * ~20% • Atypical tuberculosis * • Allergic bronchopulmonary aspergillosis * • Lung cancer survivor * • Pneumothorax * • COPD/emphysema * • Sarcoidosis (stage II/III) * • Rheumatoid arthritis • Thoracic surgery • Asthma • Chest radiotherapy • None* Common Smith, ISHAM 2009
    27. 27. Chronic pulmonary aspergillosis www.aspergillus.org.uk
    28. 28. Chronic cavitary aspergillosis in a patient with old TBC
    29. 29. Aspergilloma
    30. 30. Aspergillosis3/ Invasive * invasive pulmonary aspergillosis * tracheobronchitis * sinusitis * cerebral aspergillosis * skin aspergillosis * osteomyelitis (bones)
    31. 31. FUNGAL KERATITIS
    32. 32. Treatment• Treat or not to treat?- – Various consideration – Risk benefit ratio• Antifungals• Surgical• Rx complications – keratitis• Symptomatic Rx – haemoptysis• Rx underlying disease• Environmental control
    33. 33. Patient doctor
    34. 34. Patient meeting -Q &A
    35. 35. Frequency, dose, duration of itraconazole• It seems that some people on the aspergillus site are using Sporanox every day/year as in order to prevent eruption of ABPA.• Some claims 200mg/day. Any experience with this situation?
    36. 36. Frequency, dose, duration of itraconazole• Indication in ABPA is treatment and not prevention• Not to be used for prevention if no disease even if – Family history or exposure to moulds• May be needed in those with relapses even without symptoms.
    37. 37. Some claim 200mg/day. Any experience with this situation?• BD, od• 100-200mg/day/BD depending on• Wt, tolerability & ability to metabolise meds
    38. 38. Q2a. Does the mould clear from my lungs in the summer months and grows again once the damp weather starts?• Not necessarily but increased exposure to mould may occur during damp weather.• Damp weather may also be associated with worsening of underlying/associated conditions – Asthma – COPD – bronchiectasis
    39. 39. Q2b• Why do I always have a croaky throat and feel like there is gunk sitting in my throat just stuck there?• Is that from medication or to do with the fungus?
    40. 40. Q2b: croaky throat & feeling of gunk sitting in my throat• Croaky throat may arise from various factors: fungal or non-fungal – Throat inflammation – Sputum – Secretions – Viral infections – Underlying/co-existing disease• Not necessary from medications.• If concerned speak to your GP
    41. 41. Should I be on anti-fungal medicine (the registrar said not) or is this only for severe cases?• Treat or not to treat? – Various consideration – Risk benefit ratio – Definitive diagnosis ( not doubt). – Previous experience with anti-fungals
    42. 42. Objective of treatment• Reduce symptoms• improve QOL,• improve lung faction,• prevent or reduce disease decline. – Stable or assymptomatic cases do not warrant treatment. – Anti-fungals like other drugs have side effects. – Benefit should outweigh risk• Definitive diagnosis ( not doubt).
    43. 43. Q2c• I have read a few things on forums where people feel they were misdiagnosed with pneumonia when it was actually the mould - wondering if this is the case with me?
    44. 44. Different diseases as pneumonia• Fungal disease• Cancer• Fluid• Lymphoma• Systemic dieases: WG, MPA etc• But – Pneumonia is the commonest and usually first thought – Doctors will always consider differential diagnosis – Other diagnosis may not be straight foward – Contact your doctor or alternative medical advice if concerned.
    45. 45. ABPA as non-resolving pneumonia Chishimba L , Journal of asthma, March 2002
    46. 46. Mould as cancerChishimba L , Journal of asthma, March 2002
    47. 47. Q2d. Do steroids/antibiotics cause mould to grow more?• Neither steroids nor antibiotics cause mould to grow but excessive steroids – Suppress body immunity and predispose to fungal colonisation, spread and complications • IA • ↑Frequency of infection • Candiasis: oral or genital etc • Aspergilloma in COPD patients (ICS)- Dr Wouter Meersseman, Belgium grp, ERS 2011, Amsterdam.
    48. 48. Are there things that I can eat/drink to help myself or anything that can make things worse?• Only balanced nutritious diet important for your body.• Avoid none nutritious food.• Always avoid alcohol.
    49. 49. Q3• What is the current thinking about people with ABPA taking some sort of anti-fungal (like itraconazole) for life versus taking an anti-fungal only for some period of time during flare ups?• Could one develop resistance to the anti-fungal over time?
    50. 50. Q3• anti-fungal (like itraconazole) for life in ABPA – Not always necessary – May be necessary in frequent relapses.• anti-fungal only for some period of time during flare ups? – Not advisable, – resistance, – infective and of no use
    51. 51. Q4• In addition to being allergic to aspergillus fumigatus, I am also allergic to other molds.• I began allergy shots in 2009 and my doctor did not include aspergillus fumigatus in my shots, but he did include the other molds.• Would it be better not to have any mold antigen in my shots?
    52. 52. Q6: ABPA and VitD• Is there any research showing a relationship between ABPA and vitamin D levels in the blood? In the past, each time I had an ABPA flare up, my blood test showed that I was deficient in vitamin D. I now take 5000 IU of vitamin D3 and am now in the normal range and have not had a flare up in almost two years.
    53. 53. Q6: ABPA and VitD• Strong link between Vit D deficiecy and lung disaese• Causal –effect relationship not well understood.• Studies underway at NAC.• Paper: Chishimba L, thorax 2010. Vitamin D and the lung.
    54. 54. Q7• It has always been rumored not to eat fungi related foods (i.e. mushrooms, soy sauce, yeast based products [breads, beer, etc.]). Is there any "science" behind this? What nutrition counseling does the patient receive when they receive the diagnosis of a fungal related disorder?• Do you recommend any vitamin and/or supplements and is there regular testing of levels of things like vitamin D, B-12, etc.
    55. 55. Sources of information• National Aspergillosis Centre ( www.nationalaspergillosiscentre.org.uk) Fungal Research Trust (www.fungalresearchtrust.org) Aspergillus website (www.aspergillus.org.uk) Aspergillus Blog ( http://www.aspergillusblog.blogspot.com/) Aspergillus Trust (www.aspergillustrust.org) Aspergillosis (www.aspergillosis.org) Aspergilloma (www.aspergilloma.co.uk www.aspergilloma.org www.aspergilloma.org.uk) SAFS (www.safs.org.uk)
    56. 56. Thanks for your attention• Any questions?

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