mycology the ecmm/cemm mycology newsletter is mailed ... · 2 mycology newsletter - december 2007...

Great hits in MycologyThings are going well with medical mycology in Europe. We witnessed a bal-

anced, dynamic and very well organized TIMM3 in Torino, Italy. Our spe-cialty has arrived were it belongs, in the center of infectious diseases and along-side with the other specialties of clinical microbiology. It is the close cooperationwith our clinical colleagues at the EORTC IDG that brings this diversity and col-laboration in Europe. Trends in Medical Mycology has become the internationalmeeting ground for all professionals working with and against fungi and fungal in-fections. While many people still think that “The best things in life are free” it re-quires hard work, meticulous preparation and planning to run a successful meet-ing like this. I would like to thank the executive committee consisting of ClaudioViscoli, Marianna Viviani, Thierry Calandra and Maiken Cavling Arendrup, withhelp of the enthusiastic local Italian colleagues and support of the PCO CongressCare, for their efforts.

Now it is time to look ahead. Our goal should be to outperform the next time.Without doubt the upcoming TIMM4 executive committee, George Petrikkos,Emmanuel Roilides, Maiken Cavling Arendrup and Johan Maertens is eager tostart making the first arrangements for 2009 in Athens, Greece. Although our bi-annual conference is the flagship of ECMM, the Confederation is doing severalothers things which are of equal importance. Still there is an increasing demandfor well trained and well informed doctors regarding opportunistic fungal infec-tions in Europe.Therefore educational meetings are organized every other year in

Mycologynewsletter 1/2007

E C M MEuropean Confederation of Medical Mycology

C E M MConfédération Européenne de Mycologie Médicale

The ECMM/CEMM Mycology Newsletter is mailedto the members of the national societies affiliatedto the European Confederation of Medical Myco-logy (about 3000 in 24 different countries)

Contents

1 Great hits in Mycology2 ECMM Council3 Affiliated Societies5 New entry in ECMM

ECMM Working Groups06 Difend: an online registry of invasive

pulmonary mould disease06 ECMM Epidemiological Survey on

Zygomycosis in Europe07 ECMM WG on Candida Infections in

ICU Surgical Patients in Europe

Special report on 3rd Trends in Medical Mycology

9 Antifungal vaccines10 Controlling pathogenic inflammation

to fungi: the contribution of the Th17pathway

11 Recurrent vulvovaginal candidiasis12 Dermatophyte infections in Europe13 Updates on uncommon and emerging

fungal pathogens15 Update on the diagnosis on invasive

fungal infections16 Revised definitions for invasive fungal

disease17 Management of invasive fungal

infections: remarks about19 Antifungals and filamentous fungi: in

vitro or in vivo testing?20 Cryptococcal Working Group 121 How the fungal genome project may

have helped to solve one of themysteries of history

22 The ECMM Young Investigator TravelAward

23 FunNet2007. The first joint meeting ofresearch consortia on fungal pathogensin Europe

24 2nd Pan African Medical MycologySociety Conference

26 IUMS 2008 Istanbul28 ISHAM: medical mycology alive!29 Workshop on fungal sinusitis30 Microbiologic quality of coastal beach

sands

The ECMM Council at TIMM3 in Torino. From left: K. Mencl (Czech Rep.),M. Ullberg (Sweden), C. Lass-Flörl (Austria), M.C. Arendrup (Nordic Soc.),J. Meis (The Netherlands), A.Y. Sergeev (Russia), I. Surmont (Belgium),M. Schaller (Germany), S. Arikan (Turkey), M.A. Viviani (Italy), B. Dupont (France),E. Segal (Israel), E. Roilides (Greece), L. Rosado (Portugal), J. Pemán García (Spain)

(continued on page 4)

Mycology newsletter - December 20072

ECMM/CEMMMycology Newsletter

Editorial Advisory BoardJacques F. Meis Malcolm RichardsonEmmanuel RoilidesMartin SchallerMaria Anna Viviani (Editor)

Editorial officec/o Dipartimento di Sanità Pubblica,Microbiologia, VirologiaSezione di Sanità PubblicaUniversità degli Studi di MilanoVia Pascal 36, 20133 Milano, Italy

Direttore responsabileIvan Dragoni

Art Director Luigi Naro

Contributions from:Maiken Cavling Arendrup, Arun Balajee,Francesco Barchiesi, João Brandão,Jenny Bryan, Arunaloke Chakrabarti,Peter Donnelly, John Graybill,Ferry Hagen, Sybren de Hoog,Bernhard Hube, Lena Klingspor,K. June Kwon-Chung, Cornelia Lass-Flörl,Mihai Mares, Jacques F. Meis,Livio Pagano, Georgios L. Petrikkos,Luciano Polonelli, Malcolm Richardson,Luigina Romani, Alexey Y. Sergeev,Jack D. Sobel, Hester Vismer,

Maria Anna Viviani

© Copyright 2007 by European Confederation of MedicalMycology

Official Office: 105, Bld Murat75016 Paris, France

Registrazione Tribunale di Milano n. 749 del 25.11.1997

ECMM CouncilDr. Jacques F.G.M. Meis (President)Dept. of Medical Microbiology and Infectious Diseases Canisius-Wilhelmina Hospital Weg door Jonkerbos 100P.O. Box 9015NL-6500 GS Nijmegen, The NetherlandsTel +31 24 365 7514 - Fax +31 24 365 7516E-mail: [email protected]. Emmanuel Roilides (General Secretary)3rd Dept. PediatricsUniversity of ThessalonikiHippokration Hospital49 Konstantinoupoleos StreetGR-54642 Thessaloniki, GreeceTel +30 2310 892446 - Fax +30 2310 992983E-mail: [email protected]. Martin Schaller (Treasurer)Eberhard-Karls-UniversitätUniversitäts-HautklinikLiebermeisterstrasse 25D-72070 Tübingen, GermanyTel +49 7071 2984555 - Fax +49 7071 295113E-mail: [email protected]. Maria Anna Viviani (Mycology Newsletter Editor)Laboratorio di Micologia MedicaDipartimento di Sanità Pubblica,Microbiologia, VirologiaSezione di Sanità PubblicaUniversità degli Studi di MilanoVia Pascal 36I-20133 Milano, ItalyTel +39 02 503 151 44 / 45Fax +39 02 503 151 46E-mail: [email protected]. Maiken Cavling ArendrupUnit of Mycology and Parasitology - ABMPStatens Serum Institut, building 43/214CDK-2300 Copenhagen, DenmarkTel +45 32 68 32 23 - Fax +45 32 68 81 80E-mail: [email protected]. Israela Berdicevsky Department of MicrobiologyThe Bruce Rappaport Faculty of MedicineP.O. Box 9649Haifa 31096, IsraelTel +972 4 829 5293 - Fax +972 4 829 5225E-mail: [email protected]. Bertrand Dupont Hôpital NeckerMaladies infectieuses et tropicales149 rue de SevresF-75015 Paris, FranceTel +33 1 4438 1742 - Fax +33 1 4219 2622E-mail: [email protected]. Elizabeth M. Johnson HPA Mycology Reference LaboratoryHPA South West LaboratoryMyrtle Road, KingsdownUK-Bristol BS2 8EL, United KingdomE-mail: [email protected]. Todor Kantardjiev National Center for Infectious Diseases Laboratory of Mycology26, Yanko Sakazov Blvd.BG-1504 Sofia, BulgariaTel +359 2 8465520 - Fax +359 2 9433075E-mail: [email protected]: [email protected]. Lena Klingspor Dept. of Clinical Bacteriology, F72Karolinska University Laboratory, HuddingeKarolinska University Hospital S-141 86 Huddinge, Sweden

Tel +46 8 5858 7839/Beeper 3621Fax +46 8 5858 1125E-mail: [email protected]. Pentti KuuselaDivison of Clinical Microbiology/HUSLABHelsinki University Central HospitalPO Box 400 (Haartmaninkatu 3)FIN-00029 Hus, FinlandE-mail: [email protected]. Katrien LagrouKatholieke Universiteit LeuvenUZ GasthuisbergHerestraat 49 B-3000 Leuven, BelgiumTel +32 16 347073 - Fax +32 16 347931E-mail: [email protected]. Cornelia Lass-FlörlDepartment für Hygiene, Mikrobiologie undSozialmedizin, Sektion Hygiene undmedizinische Mikrobiologie,Medizinische Universität InnsbruckFritz Pregl Str. 3/III6020 Innsbruck, AustriaTel +43 512 9003 70725Fax +43 512 9003 73700E-mail: [email protected]. Mihai MaresOP 6, CP 1356, Iasi, RomaniaTel +40232 407 316 / +40722 465 789Fax +40232 407 316 / +40332 404 047E-mail: [email protected]. Karel MenclPardubice Regional Hospital, Inc.Laboratory of Medical MycologyKyjevská 44532 03 Pardubice, Czech RepublicTel +420 466 013 202 - Fax +420 466 013 202E-mail: [email protected]. Ladislav OzegovicANUBIHBistrik 771000 Sarajevo, Bosna i HercegovinaTel +387 33 206034 - Fax +387 33 206033E-mail: [email protected]. Javier Pemán GarcíaServicio de MicrobiologiaHospital Universitario La FeAvda. Campanar, 21E-46009 Valencia, SpainTel +34 96 1973333 / +34 649 093378Fax +34 96 3987375E-mail: [email protected]. Laura Rosado Institute of HealthAv. Padre Cruz1649-016 Lisboa Codex, PortugalTel +351 217.519.247 - Fax +351 217.526.400E-mail: [email protected]. Alexey Y. SergeevMalaya Bronnaya str. 20 b. 1.Moscow 103104, RussiaTel +7 095 5046506Fax +7 095 2592165E-mail: [email protected] Dr. Gyula SimonReference Laboratory of Dermato-Mycology,Semmelweis University, Faculty of Medicine,Department of Dermatology, Venereology andDermatooncologyMária u. 41H-1085-Budapest, HungaryTel +36 1 266 0465 - Fax +36 1 267 6974E-mail: [email protected]

All-Russian National Academy of Mycology President: Y.V. Sergeev Vicepresident, Head of Medical Section:S.A. Burova Secretary: A.Y. Sergeev (ECMM delegate)Treasurer: V.M. LeschenkoMembership 2007: 246Website: www.mycology.ruAssociação Portuguesa de Micologia Médica(ASPOMM)President: M. RochaVicepresident: R.M. VelhoSecretary: M.L. Rosado (ECMM delegate)Treasurer: M. GardeteMembership 2007: 50Asociación Española de Micología (AEM)Sección de Micología MédicaPresident: J. Pontón San EmeterioVicepresident: C. RubioSecretary: F.J. Cabañes SaenzTreasurer: F.L. Hernando EchevarríaPresident Medical Mycology Section:J. Pemán García (ECMM delegate)Membership 2007: 145 National meeting: Every two years.A workshop meeting (“Forum Micológico”) isscheduled the years between National MeetingsJournal: Revista Iberoamericana de MicologíaWebsite: www.reviberoammicol.com/AEMAustrian Society for Medical Mycology(ASMM)/Österreichische Gesellschaft fürMedizinische Mykologie (ÖGMM)President: B. Willinger Vicepresident: C. Lass-Flörl (ECMM delegate),H.-J. Dornbusch Secretary: W. BuzinaVicesecretary: G. Ginter-HanselmayerTreasurer: C. SpethVicetreasurer: J. RainerMembership 2007: 122National meeting: twice a yearWebsite: www.oegmm.atBritish Society for Medical Mycology (BSMM)President: E. M. Johnson (ECMM delegate)General Secretary: R.P. HobsonMeetings Secretary: G. MoranTreasurer: D.M. MacCallumMembership 2007: 302 National meeting: March 30th - April 1st, 2008,NorwichNewsletter: BSMM NewsletterWebsite: www.bsmm.orgBulgarian Mycological Society (BMS)President: T. Kantardjiev (ECMM delegate)Vicepresident: G. MateevSecretary: A. KouzmanovTreasurer: T. VelinovMembership 2007: 50National meeting: 3-6 April 2008Website: www.bam-bg.netCommittee for Medical Mycology ofCzechoslovak Society for Microbiology (CSSM)President: K. Mencl (ECMM delegate)Secretary: P. Hamal

Treasurer: J. GabrielMembership 2007: 16 Newsletter: Bulletin of CSSMDanish Society for MycopathologiaPresident: J. Stenderup (ECMM delegate)Vicepresident: B. AndersenSecretary: B. KnudsgaardTreasurer: J. Stenderup Membership 2006: 25National meeting: twice a yearNewsletter: Report from the Danish Society forMycopathology Deutschsprachige Mykologische Gesellschaft e.V. (DMykG)President: M. Ruhnke Vicepresident: O. CornelySecretary: H. Chr. Korting Treasurer: C. HiplerECMM delegate: M. SchallerMembership 2007: 478 National meeting: 4-6 September, 2008, JenaJournal: MycosesNewsletter: Mykologie Forum (4 issues/year)Website: www.dmykg.de/start2.htmlFederazione Italiana di Micopatologia Umana eAnimale (FIMUA)President: L. PaganoVicepresident: E. DifonzoSecretary: F. De BernardisTreasurer: A.M. TortoranoECMM delegate: M.A. VivianiMembership 2007: 160National meeting: November 20-22, 2008, CataniaWebsite: www.fimua.itFinnish Society for Medical MycologyPresident: R. VisakorpiVicepresident: T. PutusSecretary: L. Naire-KoivistoTreasurer: O. LindroosECMM delegate: P. KuuselaMembership 2007: 88 Newsletter: Sienet ia Terveys (Fungi and Health)Hellenic Society of Medical Mycology President: G.L. Petrikkos Vicepresident: G. SamonisSecretary: A.M. ZiouvaTreasurer: O. Nikolatou-GalitiECMM delegate: E. Roilides Membership 2007: 81Website: www.hsmm.grHungarian Dermatological SocietyMycology SectionPresident: G. Simon (ECMM delegate)Secretary: G. FeketeMembership 2005: 59Israel Society for Medical MycologyPresident: E. SegalVicepresident: I. PolacekSecretary: I. Berdicevsky (ECMM delegate)Treasurer: D. EladMembership 2007: 50 National meeting: twice a yearMycology Group of Bosnia HercegovinaPresident: L. Ozegovic (ECMM delegate)

Secretary: M. BabicMembership 2005: 19National meeting: twice a yearNetherland Society for Medical Mycology(NVMy)President: J.F.G.M. Meis (ECMM delegate)Secretary: E.P.F. YzermanTreasurer: M.H. DammerScientific Secretary: G. S. de HoogMembership 2007: 139 National meetings: 1-2 April 2008, ArnhemNewsletter: NVMy NewsletterWebsite: www.nvmy.nlNordic Society for Medical Mycology (NSMM)President: M.C. Arendrup (ECMM delegate)Vicepresident: M. RichardsonSecretary: P. Gaustad Treasurer: D.M.L. SaunteMembership 2007: 214Scientific Meeting: 22 May 2008, StockholmNewsletter: at web siteWebsite: www.nsmm.nuPolish Dermatologic Society-Mycology SectionPresident: E. BaranVicepresident: Z. Adamski, R. MaleszkaSecretary: J.C. Szepietowski (ECMM delegate)Treasurer: R. Bialynicki-BirulaMembership 2006: 98Journal: Mikologia Lekarska (MedicalMycology)Romanian Society of Medical Mycology andMycotoxicology (RSMMM)President: M. Mares (ECMM delegate)Vicepresident: B. DorofteiManaging Editor: I. AilincaiSecretary: A. StefanacheTreasurer: L. MalicMembership 2007: 56National meeting: National Meeting every twoyears and Congress every four yearsJournal: Fungi & MycotoxinsBooks: Syntheses of Medical Mycology (for Continuing Medical Education)Website: www.fungi.ro / www.journal.fungi.roSociété Belge de Mycologie Humaine etAnimale/Belgische Vereniging Voor Menselijkeen Dierlijke MycologiePresident: I. SurmontVicepresident: K. Lagrou (ECMM delegate),F. SymoensSecretary: M. Van EsbroeckTreasurer: M.-P. HayetteScientific Secretary: E. De LaereMembership 2007: 183Website: www.medmycol.beSociété Française de Mycologie MédicalePresident: B. Dupont (ECMM delegate)Vicepresident: N. Contet-Audonneau,R. Grillot, C. GuiguenSecretary: P. RouxTreasurer: A. DatryMembership 2007: 350National meetings: May 15-16, 2008, Tours;November 2008, ParisJournal: Journal de Mycologie MédicaleWebsite: www.mycolmed.chez.tiscali.frSwedish Society for Clinical MycologyPresident: J. FaergemannVicepresident: T. KaamanSecretary: L. Klingspor (ECMM delegate)Treasurer: M.L. von Rosen Membership 2006: 80National meeting: 22 May 2008, Stockholm (joint meeting with Nordic Society for MedicalMycology)Turkish Microbiological SocietyMycology SectionPresident: Ö. AngSecretary: A. AgaçfidanTreasury: D. YaylaliECMM delegate: E. TümbayMembership 2007: 150Newsletter: Bulletin of the TurkishMicrobiological Society


Dr. Jørgen StenderupDanish Society for Mycopathology17A Hjortholms AlleDK-2400 København NV, Denmark Tel +45 3860 7879 - Fax +45 9927 2666E-mail: [email protected]

Prof. Jacek C. SzepietowskiDepartment of Dermatology, Venereologyand AllergologyUniversity of Medicineul Chalubinskiego 1

PL-50-368 Wroclaw, PolandTel +48 717842288 / 717842286Fax +48 713270942E-mail: [email protected]

Prof. Emel TümbayDept. of Microbiology and ClinicalMicrobiologyEge University School of Medicine Bornova, Izmir, 35100 TurkeyTel +90 390 33 03 - Fax +90 232 3422142E-mail: [email protected]

3

ECMM Affiliated Societies(Information provided by the member Societies)

4 Mycology newsletter - December 2007

between TIMM. In the coming yearECMM will organize, in collaborationwith the Turkish National Society, twoeducational symposia during the XIIInternational Congress of Mycologypart of the International Union of Mi-crobiological Societies (IUMS) meet-ings from 5-9 August 2008 in Istanbul.If a national society, of course with sup-port of ECMM, is interested in runningsimilar Educational activities in Eu-rope in 2010 please get your proposalto the General Secretary for considera-tion. But we do not stick only to Eu-rope. ECMM has been the first organi-zation, together with ISHAM, in sup-porting African mycology since the for-mal erection of the Pan-African Med-ical Mycology Society in 2005. We havefinancially supported the first twomeetings in South Africa (2005 and2007). The next meeting of this youngneighbor society will be in the begin-ning of 2009 in Nigeria, West-Africa. Itmight be interesting for some of us toparticipate and start new collabora-tions with African colleagues.

Not everybody has the chance tovisit meetings and educational activi-ties. Therefore it is with great pleasureto notice that web-based learning andteaching in Mycology has entered Eu-rope. The British Society for MedicalMycology is running a successfulcourse in Medical Mycology based atthe University College of London. Thepresident of the British Society, Elisa-beth Johnson and the course DirectorChris Kibbler have expressed their am-bition to extend the recruiting of stu-dents to the “continent”. ECMM canonly wholeheartedly support this ac-tion of increasing the number of highlyqualified medical mycologists through-out Europe. Other news is the expan-sion of the Confederation with a newmember; the Romanian Society ofMedical Mycology and Mycotoxicolo-gy. We welcome you and hope that yougoing to feel at home in our family. Un-fortunately not all European countrieshave a representation yet in the Con-federation. If there are initiatives outthere do not hesitate to call upon theexecutive committee for help or advise.

You might have noticed thatECMM has a website in the air and youmight think that it is not a very com-

Great hits in Mycology(continued from page 1)

petitive site compared with other soci-eties. Furthermore you might say that awebsite is nowadays the digital heart ofa society. I am the first to agree withyour opinion. In view of these consider-ations the council meeting in Torinohas decided to put our website(www.ecmm.eu) under major recon-struction. Given the fact that "manyhands make the job an easier job" theConfederation installed a website com-mittee under the direction of AlexeySergeev, which will start on short noticeto accomplish a modernization and re-furbishing of our site. The plan is that itis going to contain news, links, an-nouncements, contact addresses and soon. The next year will also be a changein the organizational aspects of theECMM. Executive council membersgenerally have a 3 year term with thepossibility for re-election for another 3years. After 6 years in office both thegeneral secretary, Emmanuel Roilidesand the treasurer, Martin Schaller, willbe completing their final term in thecoming year. This means that members

of the Council Meeting will have toelect new officials at the next meetingduring IUMS in Istanbul in August. Al-though I am prepared to continue foranother term, the office of president isalso open for (re)election since my 3year term is ending. ECMM delegateseligible to vote will receive more infor-mation in due time.

Finally since TIMM4 in Athens ison track local societies should start tothink about TIMM5. Which country isable and willing to host our majormeeting in 2011? If you have plans orjust would like to inquire, contact oneof the members of the executive com-mittee.

The year 2007 runs to an end. I wishthat you achieved all your personalgoals set for this year. ECMM will flyinto a new episode and we have thingsto look forward too in 2008. Apertaquoque apertiora fieri solent.

Jacques F. MeisECMM President

New entry in ECMM

5Mycology newsletter - December 2007

The Romanian Society of MedicalMycology and Mycotoxicology(RSMMM) is a professional organi-zation recently established (2006)by microbiologists, clinicians, veteri-narians and pharmacists, in order tocombine their efforts to improvethe diagnosis and control of fungaldiseases in Romania. Now with 56active members, it also includes spe-cialists working in state- or private-ly-owned diagnostic laboratories,research institutions, universities,and students.

We exist because the lastdecades have brought greatchanges in the infectious pathology,opportunistic microorganisms – es-pecially fungi, being involved moreand more frequently in infections ofincreasing gravity; because in Ro-mania there is a discrepancy be-tween the rising trend of mycosesand the capacity to control them;because the training of medical my-cologists is made now and then andit is insufficiently organized; be-cause the Romanian resources arepoor in clinical mycology studies sonecessary to understand the aug-mentation tendency of mycotic dis-eases incidence in the general clini-cal context; because it is not knownexactly the mycoses etiologicalspectrum which occur in patientsfrom our region and there are nodata concerning the antifungal sus-ceptibility profile of implied strains;and last but not least, because weshould not ignore the essential – thefact that behind these figures there

The Romanian Society ofMedical Mycology andMycotoxicologyis the human suffering whose com-fort justifies any effort.

The mission of the Romanian So-ciety of Medical Mycology and Myco-toxicology is to improve the diagnosis,treatment and prevention of fungaldiseases in Romania. Our society pro-motes basic and applied knowledge,as well as training and education,across the main fields of medical my-cology and mycotoxicology.

The RSMMM’s executive poweris represented by Executive Coun-cil that is elected by the member-ship every four years during the As-sembly of Members. As scientificmeetings, RSMMM organize a na-tional conference every two yearsand a congress every four years.

Membership categories: activemembers (voting members entitledto all benefits, including officialpublications; reduced fees foryoung – less 30 years, and retiredcolleagues), honorary members andsupportive members. Membershipplaces the colleagues within a com-munity that benefits from participa-tion in an open, young and collabo-rative organization.

RSMMM Study Groups com-prise professionals with a commoninterest and are open to all col-leagues who wish to be involved indiscussing and resolving profession-al issues – Antifungals, Fungemia,Oral mycoses, Mycotoxins.

Fungi & Mycotoxins is the offi-cial peer-reviewed journal of theRSMMM, published twice yearly, inApril and October. Manuscriptsthat present reviews or results oforiginal basic and applied researchin all fields of medical, veterinaryand environmental mycology andmycotoxicology may be submitted.The journal is published in two vari-ants – printed and on-line(www.journal.fungi.ro).

Mihai MaresPresident of the RSMMM

Mihai Mares, RSMMM President (on theleft), and Ionut Ailincai, Managing Editor

RSMMMPO Box 6-1356, Iasi, RomaniaPhone: +40232407316 Fax: +40332404047E-mail: [email protected]: http://www.fungi.rohttp://www.journal.fungi.ro

Working Groups


Difend: an online registry ofinvasive pulmonary mould disease

Some 3 years ago an initiative was un-dertaken in the Netherlands to set up an on-line registry of invasive pulmonary moulddisease. To this end Sineke Puister of PfizerBV offered to put us into contact with Es-ther van Noort of Curavista BV, a companythat provides an independent eConsult sys-tem for patients and doctors. A registryseems deceptively easy. Build a databasethat includes demography, diagnosis, therapyand outcome, make it available on-line andthe rest is easy. However first we had to setdown the ground rules. These were to collectsufficient information whilst avoiding ques-tionnaire fatigue - this arises when theamount of data far exceeds capacity andwillingness of the participants to collect thedata. The next problem was to decide how tobuild the database. I had already developeda local database to accommodate theEORTC/MSG definitions. This provided uswith a core. The next step was to gather in-terested parties round the table. Here wewere joined by Ad Dekker of The Universi-ty Hospital of Utrecht and Geert-Jan Tim-mers of the Vrije Universiteit Amsterdam.We eventually settled on 23 questions whichwere divided into 4 chapters: Inclusion, In-take, Outcome after 6 weeks and Outcomeafter 26 weeks. Curavista BV wrote the pro-gramme and we tested it until it worked reli-ably. Importantly the anonymity of the pa-tient is guaranteed as each case entered is al-located a number and this procedure was ap-proved as being consistent with the DutchRegulations on Protecting Privacy. In theNetherlands and Belgium this allowed us toproceed with Ethics Committee approval

without having to ask for the patient’s con-sent. However it does mean that the partici-pant has to keep a record of the number inorder to be able to identify the case. If this isnot done then no case entered can be tracedback to a particular patient.

The system went live in 2004 and sincethen we have a 101 cases with follow-up for 6weeks. Only 6 were proven cases (Figure) andthe majority were classified as probable cases.The database will also allow us to look at thecontribution of CT scan and mycological in-vestigations to the diagnosis as well as to lookat outcome in relation to the underlying dis-ease and its status, the procedure used and al-so whether or not prophylaxis was given. Wewill also be able to look at the nature and du-ration of therapy.

Recently we were joined by JohanMaertens of the University Hospital of Leu-ven and Bart Span of the University HospitalMaastricht which means that there are now146 cases entered. Janos Sinko of the LazloHospital in Budapest will also be joining theproject.

Despite its success as a registry, we want-ed to offer the registry to a wider public thanhas been possible hitherto so it was decidedto seek a place within the ECMM.This wouldalso ensure independence. Although not anepidemiological survey the registry can giveus a better idea on the occurrence of invasivepulmonary mould disease than is now possi-ble. We would therefore encourage any whoare interested to test the website by contact-ing me by mail: ([email protected]).

Peter Donnelly

THE DIFEND REGISTRYWhyto obtain a better estimateof the number of pulmonarymould mycosis occurringamongst high-risk patientsWhatan electronic database forregistering pulmonarymould mycosis amongpatients at high-riskHowonline entry via a securewebsite Whocentres treating patients forhaematologicalmalignancies and thoseproviding stem celltransplantationWhenfrom 2004 onwards

ECMM Epidemiological Surveyon Zygomycosis in Europe

A very interesting meeting of the Zy-gomycosis Working Group of ECMM washeld during the TIMM in Torino. The firstanalysis of the cases was accepted at thisconference as an oral presentation. Onehundred and thirty-nine cases, from 11 coun-tries, were analyzed (Italy 45, Greece 26,Germany 20, France 15, Austria 10, Spain 9,Russia 5, Belgium 4, Finland 2, Norway 2 andUK 1). Representatives from Italy, Germany,

Austria, Spain, Belgium and Greece said thatthey will soon have more cases. In addition,two colleagues from Portugal said that theyhave cases which they want to submit. Thefirst analysis showed that haematologicalmalignancy correlated with pulmonary dis-ease and underlying diabetes mellitus corre-lated with rhinocerebral disease.

Regarding the diagnosis methods, it wasnoted that 80 (57.55%) cases were con-

Working Groups


ECMM Working Group on Candida Infections in ICU Surgical Patients in Europe

The distribution of Candidaspecies isolated from 360patients included in thestudy is the following:

57.5% C. albicans17.0% C. glabrata 13.0% C. parapsilosis

5.0% C. tropicalis 1.4% C. krusei1.1% C. lusitaniae5.0% other Candida spp.

The study started September 1st, 2006and is extended to 31st of December, 2008.The aim is to include 75 patients from eachof 18 participating countries for a total of1350 patients.

So far, patients included in the study are372 from 12 out of 18 participating countries:Italy 112 cases, Austria 63, Greece 60, Czech33, Sweden 30, Spain 22, Netherlands 15,Germany 12, France 10, Finland 6, UK(Cardiff) 5, Switzerland 4. Additional 75 pa-

tients from Denmark will be included. No re-port from Turkey, Hungary, Portugal, Nor-way and Bulgaria. Representatives fromHungary, Portugal and Norway confirmedthat they will participate in the study. Norepresentatives from Turkey or Bulgariawere present at the meeting. They will becontacted again.

Dr. N Longley (UK) presented data col-lected from representative European ICUsconcerning the use of different diagnosticprocedures and anti-infective practices, inorder to provide the background of the cur-rent survey study (Poster 216: ECMM surveyof risk factors and practice in the manage-ment of invasive yeast infections in Europeansurgical intensive care units).

Prof. A.M. Tortorano presented datafrom Italy (Oral communication 07: ECMM-FIMUA survey on invasive fungal infectionsin ICU: ad interim analysis after 12 months).

The Working Group has received an un-restricted grant from Merck Sharp &Dohme.

Preliminary data of the Working Groupwill be presented by Dr. Klingspor in Istan-bul, during the IUMS Congress; see in thebox the preliminary program of our Sympo-sium.

Lena Klingspor

IUMS 2008 IstanbulFriday 8 August 2008, h. 13.30 - 15.30 ECMM WG: Invasive fungal infections in the intensive care (Parallel Symposium 11)Chair J. Meis (NL)Co-chair L. Klingspor (SE)

J. Meis (NL) Introduction to the problem of invasive fungal infection onthe intensive care

A.M. Tortorano (IT) Candida infections in the ICU S. Arikan (TR) Filamentous fungal infections in the ICUM. Akova (TR) Risk factors and prophylaxis of fungal infections in ICU G. Samonis ( GR) Antifungal therapy of fungal infections in ICUL. Klingspor (SE) Epidemiology of candidosis in European intensive care units

The increasing use of high grade supportive care in severe and life threatening diseases,especially in intensive and neonatal care units, has created a shift in hospital populationsat risk for opportunistic fungal infections. This medical progress has led to a change in theepidemiology of invasive fungal infections. In this symposium the changing epidemiology,diagnostic approaches, prophylaxis and therapy of fungal infections in the intensive careunit will be discussed.

IUMS 2008 IstanbulFriday 8 August 2008, h. 16.00 - 18.00 ECMM WG: Zygomycosis (Parallel Symposium 11)Chair G. Petrikkos (GR)Co-chair E. Tümbay (TR)

G. Petrikkos (GR) Epidemiology of Zygomycosis in Europe E. Roilides (GR) Pathogenesis and Host Defense against Zygomycetes E. Dannaoui (FR) Conventional and Molecular Diagnostic MethodsA. Groll (DE) Pharmacology of Antifungal Agents against ZygomycosisL. Pagano (IT) Antifungal Prophylaxis and Therapy of Zygomycosis

Zygomycosis has emerged as a major cause of morbidity and mortality, mainly in patientswith haematological malignancies or diabetes, as well as in immunocompetent patients whosustain trauma or burns. Its pathogenesis is not fully understood yet, but many interestingaspects of it, including the host’s defences, have been studied. Rapid diagnosis is of para-mount importance and, in addition to conventional methods, such as direct microscopy andcultures, new molecular techniques are being investigated.Amphotericin B has been the on-ly available drug for the treatment of zygomycosis, but recently, posaconazole has also beenshown to be effective. Early diagnosis and appropriate treatment may improve the outcome.

firmed by culture (22 only culture, 58 histol-ogy and culture) and 13 (9.35%) only by his-tology. The most commonly isolated fungiwere Mucor sp.(35) and Rhizopus sp. (29).Statistical analysis showed that patients whohad received voriconazole prior to the diag-nosis of zygomycosis had a higher mortality(p=0.009), but this result needs furtheranalysis.

The study is supported by an unrestrictedgrant by Gilead.

It was decided that the study will go onuntil the end of 2007. A data review commit-tee will study the results.

More data will be presented in Istanbul,during the IUMS Congress; see in the boxthe preliminary program of our Symposium.

Georgios L. Petrikkos

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One of the premier medical mycology congresses within the Euro-pean context is the Trend in Medical Mycology conference

(TIMM). With previous Trends being held in Amsterdam and Berlin it wasTurin’s turn. A very successful and varied programme took place on 28-31October 2007. This was the largest TIMM so far with about 1200 partici-pants from 57 countries, demonstrating the increasing interest in medicalmycology.

Many new developments in all fields of medical mycology were rep-resented. Medical mycologists, microbiologists and clinicians presentedthe results of their studies. Invited international opinion leaders gavemany interesting lectures on a wide range of medical mycology topics,both old and new. Professor Antonio Cassone opened the Congress with“The E. Drouhet Lecture” on Antifungal Vaccines.

We observed, with great pleasure, a high participation from youngercolleagues and one of them, Ferry Hagen from Netherlands, received the“Young Travel Award” with an interesting paper on the molecular biolo-gy of infections caused by Cryptococcus gattii. Furthermore, it was en-couraging to see a record number of free papers and posters: there weremore than 300 contributions that covered all the aspect of mycology (mol-ecular biology, microbiology, epidemiology, antifungal treatments, etc).

During the Congress many different organisations and societies tookthe opportunity to hold committee meetings, seminars and workinggroup discussions, including the ECMM Council, the EORTC-IDGM, ameeting of the ISHAM Working Group on Malassezia, the ECMMWorking Group on Candida and candidosis in the ICU, and a meeting ofthe ECMM Zygomycosis Working Group. These informal meetings gavethe members of these various activity groups the possibility to partici-pate in productive discussions on the results of on-going studies and toplan future programs. Finally the next TIMM meeting is planned for 18-21 October 2009 in the Athens Hilton Hotel, Athens, Greece. We hopethat this progressive increase in the interest on fungal infections will en-courage an even larger participation. Visit the Congress Care(http://www.congresscare.com/index.php) web site for further details.

Livio Pagano and Malcolm Richardson

Trends in Medical Mycology Joint meeting of the 12th ECMM and 9th TIFI

The Programme and the Abstracts of theTIMM3 were published in “Journal ofChemotherapy”, vol. 19, Supplement 3,October 2007. To retrieve a copy of theSupplement 3 go to www.jchemother.itThe following is a direct link to thesupplement which you can paste onto yourbrowser:http://www.jchemother.it/cgi-bin/digisuite.exe/products?ID=134

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The E. Drohuet Lecture

Antifungal vaccines

3rd Trends in Medical Mycology

At the 3rd Trends in Medical My-cology the prestigious E. Dro-

huet Lecture, an international recogni-tion for the most distinguished re-searchers in the field, was given by Anto-nio Cassone, from the Istituto Superioredi Sanità, Rome, Italy, who intrigued theaudience of the Plenary Session 1 withthe talk “Antifungal vaccines”.

After a comprehensive review of thefrustrating challenge that the identifica-tion of suitable fungal targets may repre-sent for vaccinologists, Prof. Cassone hasproposed a revolutionary approach forprotecting immunocompromised pa-tients even against multiple mycoses (i.e.,candidiasis, aspergillosis, cryptococcosis)with a single, well-defined β-glucan-pro-tein conjugate vaccine eliciting antibod-ies exerting direct antifungal effects invitro and conferring passive transfer ofimmunity to naive animals that was pre-vented by adsorption of antibodies on β-glucan particles.

Previous attempts to produce proteinconjugate vaccines for fungi were ham-pered by the use of heterogeneous poly-saccharide preparations. To avoid anylikely contamination with other fungalcell wall antigens, laminarin from Lami-naria digitata, a well characterized β-glu-can preparation of non fungal source,was selected as specific antigen. As mostfree polysaccharides, laminarin is a poorimmunogen thus it was conjugated withthe diphteria toxoid CRM197, a proteincarrier generally used in other humanglyco-conjugate vaccines. The algal na-ture of the polysaccharide antigendemonstrates that the vaccine works byeliciting antibodies cross-reactive withmicroorganisms which belong to a differ-ent kingdom from fungi thus rejectingthe dogma that vaccines should rely onthe immune response elicited against thespecific etiologic agent of the disease.

The realization that fungicidal anti-bodies may be protective against most

major fungal pathogens inspires the par-adigm shift that, in analogy with bacteriaand viruses, antifungal vaccine efficacymay not require cellular or other arms ofthe immune system. The recognition ofβ-glucan in the cell walls of pathogenicfungi supports the previously unrecog-nized potential of cross-reactive anti-body-mediated immunity.

The novel laminarin-CRM197 conju-gate represents the original proof of con-cept that a single vaccine may be broad-ly protective against many transphyleticpathogens and deserves considerationfor future preclinical and clinical studies.

Luciano Polonelli

Antonio Cassone

Controlling pathogenicinflammation to fungi:the contribution of the Th17 pathway

3rd Trends in Medical Mycologythat is associated with defectivepathogen clearance, failure to re-solve inflammation and to initiateprotective immune responses. BothIL-17 and IL-23 inhibited thefungicidal activity and subvertedthe inflammatory program of neu-trophils even in the presence ofIFN-gamma, a finding suggestingthat the Th17 effector pathway pre-vails over the Th1 pathway. Protec-tive Th1 and nonprotecive Th17were crossregulated in experimen-tal models of mucosal candidiasisor pulmonary aspergillosis. Cros-regulation occurred at differentlevels, including the production ofdirective cytokines (such as IL-12or IL-23, for Th1 or Th17, respec-tively) by dendritic cells. TLR4 ap-peared to play a major role in con-trolling the balance between pro-


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The pathogenic role of the Th17 pathway infungal infections: Promotion of overzealousinflammation, inhibition of protective Th1responses, functional antagonism withregulatory T cells (Treg).

Inflammation is a key feature offungal infections and diseases.

The inflammatory response to fungimay serve to limit infection but anoverzealous or heightened inflam-matory response may contribute topathogenicity, as documented bythe occurrence of severe fungal in-fections in patients with immunore-constitution disease or primary im-munodeficiencies associated withhightened immune reactivity. Thesepatients may experience intractablefungal infections despite the occur-rence of pathogen-specific immuni-ty. IL-12, by initiating and maintain-ing Th1 responses, was thought tobe responsible for overreacting im-mune and autoimmune disorders.This was also the case in fungal in-fections where immunoregulationproved to be essential in fine-tuninginflammation and uncontrolledTh1/Th2 antifungal reactivity. Re-cent studies have suggested agreater diversification of the CD4+T-cell effector repertoire than thatencompassed by the Th1/Th2 para-digm. Th17 cells are now thought tobe a separate lineage of effector Thcells contributing to immune patho-genesis previously attributed to theTh1 lineage. Th17 cells, which pro-duce IL-17 preferentially, promoteneutrophil-mediated inflammationand, although linked to the resis-tance to several bacterial and para-sitic infections, correlate with dis-ease severity and immunopatholo-gy in diverse infections.

Recent evidence have shownthat is the Th17 pathway—and notthe uncontrolled Th1 response— Luigina Romani and Jean-Paul Latgé

vidual women.The management of recurrent

Candida vaginitis has progressed inthat there is now widespread ac-knowledgement that maintenanceregimens consisting of azole sup-pressive prophylaxis are highly ef-fective in controlling this condition.By control, it is meant that as long asthe azole is taken either topically ororally, at an interval that is based onthe unique pharmacokinetics of theindividual agents, clinical manifesta-tions are entirely absent and mycol-ogy is negative. This implies that pa-tients are entirely free of symptomsas long as they take the suppressiveregimen. These regimens are be-nign, entirely safe and can be takenfor months and years. The break-through attack rate while womentake these maintenance regimens isextremely low and less than sevenor eight percent. In other words, theoverwhelming majority of womenwith idiopathic recurrent Candidavaginitis caused by C. albicans canbe safely controlled by long-termazole suppressive prophylaxis. Cure,however, is not readily achieved inat least half the women with this en-tity. Identifying those women likely

Recurrentvulvovaginalcandidiasis


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Vulvovaginal candidiasis con-tinues to be a worldwide

problem with approximately 6-8%of women in their reproductiveyears suffering from recurrent boutsof vulvovaginal candidiasis(RVVC). There has been scant ad-vance in understanding the patho-genesis of RVVC in the majority ofpatients. The dominant microorgan-ism species responsible remainsCandida albicans usually highly sus-ceptible to all azoles. Less than 10percent of isolates from women suf-fering from recurrent disease arenon-albicans Candida species ofwhich the dominant species is un-doubtedly C. glabrata. The over-whelming majority of the C.albicansisolates are highly susceptible to allazoles including fluconazole and re-sistant cases are rare. In contrast,azole susceptibility is a problemwith regard to C. glabrata vaginitis.

Some progress in understandingthe pathogenesis of this complex in-fection has been made, particularlywith regard to the final recognitionof the importance of genetic hostfactors in determining host suscepti-bility. Genetic polymorphisms arenow described and may explainracial and individual susceptibilityto recurrent disease. In particular,mannose-binding lectin (MBL) con-centrations have been found to bereduced in women with idiopathicrecurrent Candida vaginitis andmay well explain susceptibility tothis infection. It should be empha-sized there is widespread recogni-tion that pathogenesis of this com-mon entity is not simply a functionof a single pathogenetic mechanismbut rather that different mecha-nisms explain susceptibility in indi-

tective and protective immune re-sponses to fungi, through its abilityto both promote (via MyD88) andinhibit (via TRIF) Th17 develop-ment. This suggests that conditionsof high-threat inflammation mayrepresent a local environmentalfactor that predispose to Th17 acti-vation in fungal infections. In thisscenario, the unrestricted fungalgrowth will result from the activa-tion of not only pathogenic Th17cells but also nonprotective Th2cells, whose activation is strictly de-pendent on fungal burden. Block-ade of IL-17/IL-23 prevented path-ogenic inflammatory responses,ameliorated infections and re-stored protective Th1 antifungal re-sistance, thus causally linking path-ogenic inflammation to Th17 devel-opment (Zelante et al., Eur J. Im-munol, 37:2695, 2007; De Luca etal., J. Immunol, 179:5999, 2007)(Figure).

The finding that IL-23 and IL-17promote inflammation while sub-verting protective antifungal immu-nity may serve to accommodate theparadoxical association of chronicinflammatory responses with in-tractable forms of fungal infectionswhere fungal persistence occurs inthe face of an ongoing inflamma-tion. Thus, the new Th17 CD4 T-cellsubset is proving to fill many gaps inour understanding of how antifun-gal immune responses are regulat-ed. The new findings on the contri-bution of the IL-23/Th17 axis pro-vide a molecular connection be-tween the failure to resolve inflam-mation and lack of antifungal im-mune resistance and point to strate-gies for immune therapy of fungalinfections and diseases that attemptto limit inflammation to stimulatean effective immune response. Im-munomodulatory therapies are nolonger just promising as adjuncts inthe management of fungal infec-tions but are strictly required to bal-ance protective immunity and in-flammatory pathology in fungal in-fections and diseases. Inhibition ofthe Th17 response may potentiallyrepresent such a novel strategy.

Luigina Romani

Jack D. Sobel

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to be controlled versus thosewomen likely to be cured, is not pos-sible at present. Both categories ofwomen have identical azole suscep-tible organisms and whether theprognosis is a function of host ver-sus microorganism factors remainsunclear. One ideally would like toachieve a patient population that isnot only free of attacks off therapy,but remains either culture negativeor if becoming culture positive, atleast attack free in the presence ofCandida colonization (which proba-bly reflects the most physiologicstate). New research is being direct-ed at identifying both yeast as wellas host characteristics responsiblefor vaginal yeast persistence.

In the meantime, control of re-current Candida vaginitis caused bynon-albicans Candida species ismore problematic with regard toC. glabrata. All the other non-albi-cans Candida species with the ex-ception of C. kruseii, which is rare,can be controlled with maintenancefluconazole enjoying an excellentprognosis on cessation of therapy.C. glabrata, however, is problematicin being less azole responsive andregimens that are most effective in-clude those containing boric acid orflucytosine. Long-term maintenanceprograms are less available. More-over, the major problem con-fronting the patients with C. glabra-ta vaginitis is identifying thosewomen in whom C. glabrata is actu-ally causing the symptoms as op-posed to symptomatic women withC. glabrata but being of low viru-lence the yeast is simply an innocentbystander.

Idiopathic recurrent Candidavaginitis has not benefited from thenew generation of availableechinocandins which are not avail-able topically or orally, as well asfrom the availability of voriconazoleand posaconazole.We are in need ofmore active broad spectrum azoleswhich can be taken orally andpreferably those with the advan-tages of a long half life. Neverthe-less, significant progress in patientmanagement has been accom-plished.

Jack D. Sobel

Dermatophyteinfections in Europe


Dermatophyte fungi almostnever cause serious damage

to human health or threaten life ofthe patient. Nether the less, der-matophyte infections still affect mil-lions, and the members of Tri-chophyton, Microsporum and Epi-dermophyton genera cause themost ubiquitous and the only truecontagious fungal infections knowntoday.

Extensive industry support forresearch on invasive fungal infec-tions in recent years has no parallelin the field of superficial mycoses.Recognizing this, ECMM andTIMM organizing committee mem-bers have agreed to hold a specialworkshop to review the currentstate of the problem. The workshopwas chaired by R. C. Summerbelland A. Y. Sergeev.

Richard Summerbell (nowworking in University of Toronto,Canada) opened the workshop witha review lecture on taxonomy, biol-ogy and virulence of dermatophytesin our current understanding. Prof.Summerbell discussed the impact ofmolecular studies on the changingconcepts of dermatophyte specieswith relevance to pathogenesis anddiagnosis of tinea infections.

Nadine Lateur (CHU SaintPierre, Bruxelles, Belgium) gave atalk about tinea capitis in modernEurope. Dr. Lateur has outlined theimportance of pan-European stud-ies in this field, giving credit forECMM epidemiological survey oftinea capitis in Europe, convened in1997-1998 by R. J. Hay. The studygathered data from 92 laboratoriesand compared figures from 1987and 1997. Growing numbers of cas-es represented by Trichophytonspecies were observed, probablyrepresenting the infections in immi-

grant communities. One of the ma-jor features of tinea capitis in Eu-rope is diversity in predominantcausative agents – zoophilic M. can-is in Eastern and Central Europe,and anthropophilic Trichophyton inthe West. Recent observations ofDr. Lateur on M. langeronii import-ed tinea capitis in Belgium weresupported with the UK data of Prof.Hay later during TIMM, during histalk on imported non-endemic fun-gal infections (Workshop on traveland geographic mycology).

Alexey Y. Sergeev (I.M. Sechen-ov Moscow Medical Academy, Rus-sia) provided an update topic ononychomycosis. Epidemiologicstudies on onychomycosis, startingfrom major pan-European indus-try-supported Achilles project(1997-1998), were continued by dif-ferent authors, contributing to themodern picture of prevalence andcausative agents. Growing inci-dence, longer duration of diseaseand varying severity may describemodern onychomycosis, thus callingfor selective approaches in treat-ment and prevention. The propor-tion of true dermatophyte cases ofonychomycosis appears to increasewhen assessed with more accuratemethods, e.g. with new RussianPCR probes, specific for T. rubrumand T. mentagrophytes.

Michalis Arabatzis (Universityof Athens, Greece), giving a talk onlaboratory diagnosis of tinea infec-tions, focused on European ad-vances in molecular techniques.Therecently published study of Dr.Ara-batzis and coworkers evaluated thepossibilities of multiplex real-timePCR, offering the identification ofseveral dermatophyte species inclinical specimens in less than 24hours. Dr. Arabatzis discussed the

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highly sensitive PCR methods asnew opportunities for laboratoryconfirmation of diagnosis for ony-chomycosis and other forms oftinea infection, and the probableemerging replacement of conven-tional diagnostic approaches.

Antonella Tosti (University ofBologna, Italy) presented an expertoutline of clinical aspects of ony-chomycosis, explaining currentchallenges and pitfalls in treatment.Good initial response to modernsystemic antifungals may continuewith disappointing long-term re-sults, possible relapses and reinfec-tion. Varying clinical presentationof fungal nail infection, featuringseveral clinical forms, different ex-tent of affected nail, and predispos-ing conditions, may contribute totherapeutic failures and recurrence.Non dermatophyte mold ony-chomycosis, presenting in new clini-cal forms, should deserve special at-tention and treatment. Combina-tion therapy and special preventivemeasures may solve the problem ofsuboptimal therapeutic efficacy insuch cases.

Alexey Y. Sergeev


Updates on uncommonand emerging fungalpathogens


Invasive fungal infections in theimmunocompromised popula-

tion continue to be an importantcause of mortality and morbidity.Several recent reports have re-vealed that there may be a shift inthe species distribution of fungicausing these infections, in particu-lar the non-fumigatus aspergilli andZygomycetes. Recognizing this, asession was organized at the TIMM2007 titled “Updates on uncommonand emerging fungal pathogens”

and was chaired by Sybren de Hoogand Kathrin Tintelnot. Four speak-ers presented updates on a diversegroup of fungi causing human infec-tion including black yeasts, non-fu-migatus aspergilli, Zygomycetes andScedosporium spp.

Montarop Sudhadham (PhD stu-dent at Centraalbureau voor Schim-melcultures, Utrecht, The Nether-lands) presented research data onecology and routes of transmissionof the black yeast Exophiala der-

From left to right:Antonella Tosti,Alexey Sergeev, Richard Summerbell, Michalis Arabatzis, and Nadine Lateur at the workshop on Dermatophyte infections in Europe.

matitidis, one of the major clinicalblack yeasts that cause occasionaldeaths in otherwise healthy patients.After an extensive search that in-cluded almost 3000 samples, it wasconcluded that the natural nichewas a focal association with frugivo-rous animals (birds, bats) in thetropics. Also man-made niches wererevealed: public steambath facilities,and railway ties in tropical climates.Two genotypes, A and B, were un-covered with Multi Locus SequenceTyping methods, which, judgingfrom absence of mutations in rapid-ly evolving genes, were of a recentorigin. Montarop’s group showedthat 2 genotypes were preponder-antly found – steambaths, GenotypeB or on creosote-treated wood suchas railway ties Genotype A. Thegenotypes thus had diverged sym-patrically after new, man-made nich-es had become available. The cre-osote-promoted genotype (A) isprevalently found in human disease,suggesting that assimilation of phe-nolic compounds might be a viru-lence factor.

Arun Balajee (Centers for Dis-ease Control and Prevention, At-lanta, USA) talked about the non-fumigatus aspergilli causing invasiveaspergillosis (IA) in solid organ andhematopoietic stem cell transplantrecipients. The talk was largelybased on data from a recently com-pleted large, multicenter fungal sur-veillance study, Transplant Associat-

14

ed Infection Surveillance Network(TRANSNET). Using molecularspecies identification tools, hergroup showed that although A. fu-migatus still remained the predomi-nant etiological agent of IA, otherunusual aspergilli - Petromyces alli-aceus, A. tubingensis, A. protuberus(for instance) were recovered forthe first time from the transplantpopulation. Importantly, the non-fu-migatus aspergilli such as A. cali-doustus and A. lentulus that were re-covered from the transplant popula-tion had high MICs to several anti-fungal drugs and A. terreus isolateshad elevated MIC to the antifungaldrug, Amphotericin B. In contrast,all of the A. fumigatus isolates hadlower in vitro MICs to most antifun-gals tested. She concluded althoughA. fumigatus caused more than halfof the IA in transplant settings, thenon-fumigatus aspergilli had higherin vitro MICs to antifungals. Howev-er, the clinical relevance of these el-evated MICs is not yet known. No-tably, this large study revealed thatalthough novel Aspergillus speciesare being reported as a cause of IA,these unusual aspergilli were rarecauses of IA.

Eric Dannaoui (Institut Pasteur,Paris, France), in his presentation on“The Zygomycetes” pointed outthat although these fungi are unusu-al causes of invasive fungal infec-tions, the outcome of such infectionswere poor given that these organ-

isms are often angioinvasive and areresistant to several of the systemicantifungals available on the market.Significant progress has been madehowever, regarding the moleculartaxonomy of these fungi, and datafrom his work showed that carbonassimilation profiles may discrimi-nate these species. Importantly, theantifungal susceptibility profile ofthe species was variable betweenthe species. Although, amphotericinB remains the most active drug,posaconazole is also active againstmost species both in vitro and in vi-vo. Dr. Dannaoui stressed the factthat clinical and microbiologicalsurveillance programs are needed tobetter understand the epidemiologyand biology of these organisms.

Jean-Philippe Bouchara (AngersUniversity Hospital, Angers,France) presented work on the Sce-dosporium spp. that causes a widevariety of infections, ranging fromlocalized infections, including in pa-tients with cystic fibrosis, to invasivepulmonary or disseminated infec-tions in the immunocompromisedpopulation. Thanks largely in partto the working group onPseudallescheria/Scedosporium in-fections, the molecular taxonomyof these fungi are becoming moreclear with clear evidence from mul-tiple locus phylogeny that theP. boydii/S. apiospermum is aspecies complex. He also showeddata that these fungi could be pre-sent in potted plants, thereforesuch plants could be possible reser-voirs of infection. Data was alsopresented showing that azole resis-tance in these fungi could be due toa constitutive overexpression ofgenes encoding efflux pumps of theABC protein family. Finally, Dr.Bouchara concluded that impor-tant advances in this field are ex-pected from the development ofgenomic, transcriptomic and pro-teomic methods.

Overall, the presentations of-fered a snapshot of these clinicallyimportant, yet unusual organisms;as such the talks were well receivedwith many discussions during andafter the session concluded.

Arun Balajee


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Arun Balajee

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Update on thediagnosis on invasivefungal infections


The early diagnosis of invasivefungal infections is still diffi-

cult but on the same time acknowl-edged to be of outmost importanceand with direct impact on outcome.Therefore, any news on this topicwas awaited with great interest atthe recent TIMM conference inTorino.

The two most common invasivefungal infections include invasivecandidiasis and invasive aspergillo-sis. For candidiasis culture remains acornerstone in the diagnosis but amajor issue is the time needed, inaverage 2 days before the culturebecomes positive and another 1-4days for species identification. Overthe recent years a number of reportson the development and perfor-mance of in situ hybridisation as atool for species identification direct-ly from the positive blood culturehave been presented. At this year’sTIMM this method was document-ed useful in a routine setting withprobes targeting the five most com-mon Candida species (SchønheyderH.,Abstract O.04).Also noteworthyare the recently introduced rapidspecies identification tests which al-low identification of C. albicans,dubliniensis, glabrata, krusei as soonas these are on agar plates (Lass-Flörl C., W13.1). New molecularstudies allow C. parapsilosis to be

divided into C. orthopsilosis andC. metapsilosis, which are proposedto replace the existing designationsof C. parapsilosis groups II and III,respectively (W13.1). Multilocus se-quence typing recognized a newspecies of Aspergillus, namelyA. lentulus, which exhibits low sus-ceptibility to multiple antifungals in vitro (Balajee A., W15).

Another diagnostic approach isthe non-culture based methods. Forinvasive aspergillosis galactoman-nan antigen detection has becomean important and acknowledgedtest. Recently, several studies haveshown that the test performed onBAL fluid appear to have increasedsensitivity, although the cut-off forGM in BAL has not been finally de-fined (van Dam A.P., O.05). AlsoGM detections in supernatants fromsliced and vortexed lung-needlebiopsies have recently been shownto further increase the sensitivity.The beta-glucan detection assays, al-though promising (Senn L.S., O.01),have not yet been widely imple-mented, probably due to the higherprice, more complicated set up andhigher risk of contamination. A po-tential advantage, however, is thedetection of not only Aspergillus butalso other moulds and yeasts (withthe exception of Zygomycetes andCryptococcus).

A number of presentations fo-cused on various in house PCR testsfor detection of invasive fungal in-fections. In this context two majorstep forwards were presented at theTIMM conference: 1) the initiativeon standardisation of in house PCRs(Donnelly P., White L., M9) and 2)

the development and pilot-evalua-tion of two new commercial PCRtests. These two include a kit for thedetection of Aspergillus & Pneumo-cystis in respiratory fluids (My-conostica) and a kit for the detec-tion of Aspergillus fumigatus & thefive most common Candida speciesin blood (Roche SeptiFast). Whilethe first one has been preliminaryinvestigated in a retrospective set upusing stored BAL fluids and withpromising results, the second is un-dergoing prospective evaluation in ahaematological population and pre-liminary results are limited but givehope for an early diagnosis (LamothF., O.02).

Finally, although the develop-ment of a number of new kits andtests is indeed very encouraging it isimportant also to focus on the dailyperformance in routine laboratoriesof clinical microbiology and mycolo-gy. Although most laboratories per-form very well according to thescores obtained at external qualityassessment programmes, recentNordic experiences with a EQAprogramme including simulatedclinical samples with zero to severalmicroorganisms indicate that wehave to focus on continued im-provement and education of thestaff in the routine laboratories(Meis J., Arendrup M.C., M15).

Thus all together this conferenceagain confirms that we are movingup the ladder towards better andmore rapid diagnosis of invasivefungal infections.

Maiken Cavling Arendrup Cornelia Lass-Flörl

Maiken Cavling Arendrup

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Group of the EORTC and the My-coses Study Group of the USA. Al-so, proven disease still requiresdemonstration of fungal element bymicroscopy or culture in tissue. Theterminology of “probable” and“possible” remains unchanged andhinges upon host factors, clinicalfeatures and mycological evidence.However what constitute a host fac-tor has been revised -fever has dis-appeared from the host factors alto-gether whilst T-cell immune sup-pressants have been added.This willhelp expand the remit of the defini-tions to other patient populations.The division of clinical features intominor and major was both cumber-some and assigned equal weight to

objectively verifiable signs on CTscan and softer symptoms such asdyspnoea. Now clinical evidenceprimarily relies on imaging evidenceof a disease process.As for mycolog-ical evidence a test for beta-D-glu-can is now included but not one forPCR as yet as this technique needsfirst to be standardised and validat-ed. The distinction between “proba-ble” and “possible” diseases is nowmuch simpler namely that

Probable IFD = Possible IFD +mycological evidence.

It was also explained why theterm “invasive fungal diseases” hadbeen adopted to emphasise that thedefinitions apply to fungal infec-tions that cause illness and not thosethat might be confined to colonisa-tion. Hence IFD should replace SFI,IFI and other variants.

The definitions can now apply toa wider group of immunocompro-mised patients than just those withcancer or who are recipients of ahaematopoietic stem cell transplant.Moreover there use should help ob-viate confusion among clinicians es-pecially now that patients with radi-ological evidence consistent with anIFD comprise effectively the onlycases of “possible” mould disease.There is no more need to modify thecriteria for trial purposes as hap-pened with the “Ambiload” study(Cornely et al, Clinical InfectiousDiseases 2007; 44:1289–97). Con-versely many of the hitherto “possi-ble” cases have been removedthereby focussing on those caseswith a reasonable likelihood of be-ing IFD for which there is no myco-logical evidence to support a diag-nosis of “probable” IFD. It will alsostill be possible to compare casesclassified under the old and the newdefinitions provided the basis forthe classification is known.

It is hoped that once publishedresearchers will be find the reviseddefinitions not only rational andclear but also useful for their re-search be it in studying the epidemi-ology of IFD, developing diagnostictests, or in designing and conductionclinical trials of agents and strate-gies.

Peter Donnelly


Revised definitionsfor invasive fungaldisease

Peter Donnelly (on the right) and Johan Maertens


The road to hell is often pavedwith good intentions.This was

also true of the revised definitionsfor invasive fungal diseases as publi-cation was planned to coincide withthis year’s TIMM. However thefates decided otherwise as the man-uscript was still “with the editor”.None the less there was a golden op-portunity to highlight why the origi-nal definitions needed revised andalso introduce the salient features ofthe revised definitions.

First there was no change in the“Brand name” EORTC/MSG asthis is not only now well known inthe literature (650+ citations since2002) but also reflects the equal par-ticipation of the Infectious Diseases

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high crude mortality rate.Infectious disease experts who

attended the leading biennial con-gress on fungal diseases were left inno doubt that earlier interventionis the key to reducing the currentsignificant mortality associatedwith fungal infection in immuno-compromised patients.

‘Antifungal prophylaxis shouldbe applied to patients at high riskfor invasive fungal infection, suchas those with haematologic malig-nancies or those who have receiveda haematopoietic stem cell trans-plant, and results of prophylaxisstudies should demonstrate mor-bidity and mortality advantages’,advised Andrew Ullman from Jo-hannes Gutenberg University ofMainz, Germany.

Evaluating clinical trials Comparing data from clinical

trials of antifungal therapy isfraught with difficulties because ofdifferences in study design, diseaseseverity, planned and actually treat-ment duration and primary end-points, according to speakers at aworkshop devoted to clinical trialmethodology.

In a review of key studies of an-tifungal prophylaxis in haemato-logical malignancy, Dr Ullman dis-cussed the problems of comparingresults from studies of patients withdifferent malignancies and severityof neutropenia. He pointed outthat, while studies had demonstrat-ed equivalence of itraconazole andfluconazole prophylaxis, and the

superiority of liposomal ampho-tericin B and voriconazole overplacebo, a survival advantage forone treatment over another wasseen in only one study, in favour ofposaconazole overfluconazole/itraconazole.

Turning to bone marrow andhaematopoietic stem cell trans-plant patients, Dr. Ullman high-lighted the difficulty of interpretingdata from studies of different treat-ment duration, ranging from 50-100days, especially when drugs arerarely delivered as planned in thestudy design. He concluded thatmany questions remain aboutwhich patients to treat, the best useof prophylactic antifungal therapy,including optimal drug levels andduration of treatment, the potentialfor resistance, and the most usefulendpoints.

In his discussion of studies offirst line and salvage therapy for as-pergillosis, Raoul Herbrecht, fromthe Hôpital de Hautepierre, Stras-bourg, France, pointed to statisticalissues, such as small numbers of pa-tients, and interpretation of non in-feriority studies as particularlychallenging when analysing results.In studies of salvage therapy, hesaid that the most critical point iswhether patients have really failedon first line treatment, and he sug-gested that stable disease shouldnot necessarily be considered treat-ment failure.

Bart-Jan Kullberg, from Rad-boud University Nijmegen MedicalCentre, in the Netherlands, urged

Management of invasive fungal infections: remarks about

Local infection rates shouldguide antifungal therapy

Staying up to date with localfungal epidemiology is becomingincreasingly important, as efforts totarget antifungal therapy at pa-tients with the highest pathological,treatment-related and hospital-ac-quired risk of infection becomemore refined.

Latest data (2001-2005) fromthe TransNet fungal surveillanceprogramme across 25 major UStransplant centres, presented byDavid Warnock, from the Centersfor Disease Control and Preven-tion, Georgia, USA, show a 12month cumulative incidence of1.64% for Aspergillus, 1.1% forCandida, 0.53% for other mouldsand 0.3% for Zygomycetes. But Dr.Warnock explained that there werelarge variations across the 15 cen-tres reporting solid organ trans-plant data and the 21 centres re-porting stem cell transplant data.

The current lack of longitudinalstudies of fungal infection world-wide is being addressed by a seriesof European surveys, preliminaryresults of which were reported atthe congress.

First year reports from 35 Ital-ian Intensive Care Units takingpart in a major European Confed-eration of Medical Mycology(ECMM) study, reported by AnnaMaria Tortorano from the Univer-sità degli Studi di Milano, Italy,have shown a total of 218 deepseated infections, 181 caused byyeasts and 37 by filamentous fungi.Candidaemia rates ranged from 3-23 (3-85) per 1000 patients, andfrom 9-26 (9-61) per 10,000 patientdays. The highest rates were relatedto the exceptional high frequencyof C.parapsilosis fungemia cases intwo centres and are indicative ofbreaks in catheter care and infec-tion control procedures. Over threequarters of yeast infections were insurgical patients, and C.albicanswas identified in 53.5% of episodes,C.parapsilosis in 16.5%, andC.glabrata in 10.5%. Crude mortal-ity in these cases was 36%, 33%and 69% respectively. C.glabratafungemia occurred mostly in oldpatients, which may explain the


Special report

researchers to stop using non-lipo-somal amphotericin B as a com-parator in studies of candidaemiaand invasive candidosis because itstoxicity is such a powerful driver ofoutcomes. He suggested that theoptimal timing of endpoints needsmore consideration and pointedout that most studies report a 70%success rate when measurementsare taken at the end of treatment,but that this falls to around 40% fordelayed endpoints, such as 6-8 or 12weeks post therapy. He proposedthat the best endpoint could be 2-4weeks after treatment.

Implementing guidelines in everyday practice

Growing experience of the val-ue of prophylactic antifungal thera-py in routine clinical practice, awayfrom the clinical trials setting, wasalso reported at the congress. Thisfollows the recent publication ofguidelines from the First EuropeanConference on Infections inLeukemia (ECIL1) which stressedthe importance of antifungal pro-phylaxis for leukaemia patients andother cancer patients undergoinghaematopoietic stem cell trans-plant (HSCT). Helmut Ostermann,from the University of MunichHospital, Germany, reported thatnone of 22 patients undergoingchemotherapy for haematologicalmalignancy had proven invasivefungal infection (IFI), following in-corporation of posaconazole anti-fungal prophylaxis, median dura-tion 21 days, into the Munich regi-men, and there were no deaths inthe group. Three patients (17%)had a probable IFI, nine patients(41%) had a possible IFI, and 10patients (45%) had no IFI.

This compared with a 7%proven IFI rate, 7% probable IFI,15% possible IFI and 43% no IFIrate in a series of 100 comparablepatients prior to August 2006, whodid not receive posaconazole pro-phylaxis. There was a 14% overallmortality rate in this series, 10%being related to fungal infection. Inthose with proven infection, themortality rate was 58%, comparedto 12%, 15% and 5% in the proba-ble, possible and no infection

groups respectively.Prof. Ostermann concluded that

incorporation of posaconazole pro-phylaxis reduced the risk of provenIFI in patients undergoingchemotherapy for haematologicalmalignancy, and was not associatedwith any deaths. The lack of effecton the probable infection rate sug-gested possible diagnostic prob-lems, he added.

How newer antifungal agents compare

A 33% overall response rate tocaspofungin as first line therapyfor invasive aspergillosis in astudy of 61 haematological pa-tients was reported by ClaudioViscoli from the University ofGenova, Italy, on behalf of theEORTC Infectious DiseasesGroup. At day 84,31% of patientswere in complete or partial re-sponse and the survival rate was54%. Prof. Viscoli commentedthat the results were comparableto those seen with other antifun-gal agents, in particular to the 59-71% survival rates seen in studieswith lipophilic amphotericin Band voriconazole. However, heagreed with delegates that the re-sponse rate had failed to reach the35% lower limit for a true re-sponse which had been set for thestudy.

Recently published results of anon-inferiority study comparingthe new echinocandin, anidulafun-gin with fluconazole in invasivecandidiasis were presented byColeman Rotstein, from McMas-ter University, Hamilton, Canada.At the end of intravenous therapy,anidulafungin was statistically su-perior to fluconazole for clinicaland micobiological response, with75.6% of patients successfullytreated with anidulafungin, com-pared with 60.2% in the flucona-zole group. Anidulafungin was al-so statistically superior at the twoweek time point, but not at sixweeks after the end of treatment.Prof. Rotstein reported that themortality rate in the anidulafun-gin group was 23% compared with31% with fluconazole and headded that, although this was not

significant, it did mean that anidu-lafungin had breached the 30%barrier.

Revised definitions should makeclinical trials easier

Revisions to the 2002EORTC/BAMSG definitions of in-vasive fungal infection are likely tobe published in the next fewmonths, and should make clinicaltrials simpler to perform and re-sults easier to interpret. Plans arealso underway to standardise andvalidate polymerase chain reaction(PCR) techniques so that these canbe included in future revisions.

Broadly welcoming the new de-finitions as a useful framework forthe diagnosis of invasive fungal in-fection, David Denning, from theUniversity of Manchester, UK, sug-gested that some patient groups, in-cluding children, would still get leftout. He predicted that antifungalprophylaxis could have an increas-ing impact on microbiological crite-ria, such as the results of bron-cheoalveolar lavage and aspirationtests, and he expressed reservationsabout the practicalities of routinegalactomannan testing. He also feltthat some weighting system was re-quired to differentiate between pa-tients with single versus multipleand repeated positive diagnostictests, and between patients withsingle versus multiple invasive fun-gal infections.

Jenny Bryan


Special report


Antifungals andfilamentous fungi: in vitro or in vivotesting?

3rd Trends in Medical MycologyAlthough there are some cor-relations between clinical

outcome and in vitro testing for Can-dida species, the same is not true forfilamentous fungi. Recently, theCLSI has developed in vitro stan-dard methods for moulds. Unfortu-nately, results of more than 200 testsfound significant inconsistencies forthe same isolate and for differentspecies among multiple expert labo-ratories. Whether these in vitro test-ing is more advantageous than ex-perimental models of infections incorrelating with clinical outcomemay be either drug or fungus specif-ic. Examples follow.

Animal data support the in vitroefficacy of triazoles, amphotericin Band candins against Aspergillus fu-migatus. Additionally, in vitro resis-tance of A.fumigatus to some drugs,mainly to itraconazole, has beenconfirmed in vivo using several ani-mal models. Also, models usingA. terreus confirmed the experiencein humans, that this species is oftenresistant to amphotericin B and sus-ceptible to caspofungin. Limited an-imal data support the efficacy ofcaspofungin against A. flavus whilethe effects of the polyene againstthis fungus are more uncertain.

Zygomycetes are susceptible in vitro and in vivo to amphotericinB, and are consistently resistant tovoriconazole in vitro, in animals, andclinically. However, they have quitevariable in vitro susceptibility toposaconazole. Animal experimentsshows that the response toposaconazole therapy varies accord-ing to the pathogen. Posaconazole isgenerally active in infections due toAbsidia corymbifera while the re-sults obtained with Rhizopus spp.varies according to the species andthe experimental procedures. In vit-ro testing of individual isolates of zy-gomycetes does not always predictin vivo or clinical responses toposaconazole. Animal data supportthe efficacy of the new triazolesagainst Scedosporium apiospermumbut not against S. prolificans which iswidely resistant to all antifungalagents, similarly to the clinical data.Other pathogens, such as Fusarium,show variation according to thespecies, to antifungal drug, and to

immune deficiency of the host.Endemic mycoses are also vari-

able. With Penicillium marneffei invitro resistance to fluconazole andsusceptibility to itraconazole areclosely mirrored in clinical experi-ence. Similarly, studies conducted inexperimental models of murinehistoplasmosis showed a quite goodcorrelation among in vitro / animalmodel and human results in re-sponse to fluconazole. In particular,mouse studies confirmed in vitro flu-conazole resistance of H. capsulatumand correlated with clinical failure.Interestingly, posaconazole showedsome potential against fluconazole-resistance isolates of H. capsulatumin experimental models of systemicinfections. However, clinical data onposaconazole efficacy in histoplas-mosis are still scarce. Finally, Coccid-ioides immitis is susceptible in vitroand in animals to most antifungaldrugs, but has an unpredictable ten-dency to clinical failure and relapses.

Why does the in vitro test corre-

late well with animal and clinical re-sults for some species and poorlywith others? There are multiple po-tential reasons, none of which areuniversally applicable. First, many ofthese organisms cause tissue infarctsby angioinvasion. Necrotic tissue isnot penetrated well by any antifun-gal. Second, pharmacokinetics andpharmacodynamics differ widelyamong drugs and among animalspecies. For example, voriconazoleclears so rapidly in mice that in vivoresults are unreliable. Third, in vitrotesting of conidia has in some handsgiven difference results from tests ofhyphae. Finally. Growth rates andnutritional requirements (i.e. zy-gomycetes for acid and iron and sug-ar) may differ widely among fila-mentous pathogens. One size doesnot fit all.

Francesco BarchiesiJohn R. Graybill

John R. GraybillFrancesco Barchiesi

Special report


� Overall picture of EuropeanC.neoformans strains and future di-rection of genotyping (M.A. Vi-viani).

The symposium was well attend-ed with lively discussions at the endof the symposium.

The most important achieve-ment of the Cryptococcal WorkingGroup 1, in addition to the sympo-sium, at TIMM3 was the meetingamong members of the workinggroup in order to arrive at a con-sensus on the issues associated withthe nomenclature and the genotyp-ing methods that can be applieduniversally. The highlights of thosediscussions are summarized as fol-lows:A. The working group has agreed to

choose nomenclature of genotype,VNI (serotype A), VNII (serotypeA), VNIII (serotype AD) andVNIV (serotype D) for C.neofor-mans and VGI (serotype B), VGII(serotype B), VGIII (serotype B)and VGIV (serotype C) for C.gat-tii that were coined by W. Meyeraccording to the M-13 PCR pat-tern. This agreement was based onthe fact that the nomenclature

correlates with the current statusof the two species concept in cryp-tococcosis etiology. The VN-VGnomenclatural system also repre-sents the global population struc-ture based on the analysis of morethan 2000 isolates.

B. The working group also agreed todesignate reference strains: In ad-dition to Meyer’s standard strainsfor each type, H99 and B-3501were suggested as the alternativereference strains of VNI andVNIV respectively since theirgenomes have been sequenced.

C. The reference strains are to be de-posited at both CBS and ATCCfor easy access by anyone interest-ed.

D. For the MLST (multilocus se-quence type), 7 genes, CAP59,GPD1, IGS1, LAC1, PLB1,SOD1, URA5, were chosen basedon the results obtained in the stud-ies by several investigators withspecial emphasis on the number ofdifferent sequence types. The 7genes can be PCR amplified usingthe same primers for all 8 majormolecular types within the twospecies of cryptococcosis agents.The database of MLST can befound at www.mlst.net. The de-tails of PCR conditions for MLSTwill be posted in the CryptococcalWorking Group 1 page in theISHAM website.

Investigators who are interestedin joining the Cryptococcal Work-ing Group 1 are encouraged to con-tact June Kwon-Chung([email protected]), thechair of the Cryptococcal WorkingGroup 1 or Malcolm Richardson([email protected]),the general secretary of ISHAM.

K. June Kwon-Chung

Cryptococcal Working Group 1The first ISHAM sponsored symposium at the TIMM3

June Kwon-Chung


ISHAM sponsored a symposiumorganized by the Cryptococcal

Working Group 1 for the TIMM3meeting in Torino. This was the firstWorking Group symposium spon-sored by ISHAM since the variousworking groups were established in2006-2007 under the umbrella ofISHAM.

The Cryptococcal WorkingGroup 1 “Genotyping of Crypto-coccus neoformans and C. gattii”was formed in 2006 in order tobring together investigators inter-ested in cryptococcal epidemiologyand population genetics and tostandardize the molecular straintyping methods that can be applieduniversally. In addition, the workinggroup aimed to foster the genotypicanalysis of cryptococcal strainsfrom the geographic regions wherecryptococcal population geneticshas been less studied such as theMiddle East, Eastern Europe, Scan-dinavia and the Far East.

The symposium of the Crypto-coccal Working Group 1 entitled“World-wide genotypic status ofthe agents of cryptococcosis: Is thecryptococcal genotype related toepidemiology?” included six pre-sentations:� Clonal population of ChineseCryptococcus neoformans strainscause infection predominantly inpatients without any apparent riskfactors (J. Kwon-Chung),� Cryptococcal genotype in theCaribbean region with special inter-est to Cuba (G. Martinez),� Genetic complexity of C.gattiifrom S.E Asia and North America(W. Meyer),� Structure of sensu lato, with spe-cial reference to C.gattii (T.Boekhout),� Developing MLST.net as a toolfor mapping the global biodiversityof Cryptococcus (M. Fisher),

Special report


Special report

Arsenic poisoning and the role of environmental mouldsOne of the plenary lectures during the recent TIMM meeting in

Turin was given by David Denning (University Hospital of SouthManchester, and the University of Manchester), entitled ‘The fun-gal genome project: where are we headed?’ The lecture covered avariety of topics including: Which fungi are sequenced? Thegenomes of Aspergilli, the avail-ability of genome resources; andthe future of genomic sequencingof fungi. Prof. Denning pointed outthat most of the 500 or so A.fumi-gatus-specific genes (relative toA.oryzae and A.nidulans) have no functional annotation. Some do,however, and the most interesting examples include two putativemembers of the ArsC-superfamily arsenate-detoxifying arsenatereductases found in bacteria.

The evolution of our understanding of arsenic poisoning and therole of environmental moulds is fascinating as it appears from the in-formation provided by prof. Denning. Previous observations corre-lating the dangers of toxic arsenic concentrations in pigments of fab-rics and wallpapers were recognised and investigated during the18th century. Documented causes of arsenical poisoning have in-cluded traditional Chinese herbal balls, Korean herbal medicine pre-scribed for haemorrhoids, kelp supplements, contact with pesticidesand rodenticides, industrial waste contaminations in water streams,beer, milk, rice, arsenic-treated pressurised lumber, cocaine and ‘sin-ister forensic events’. In the 19th century there were reports of poi-sonings associated with green pigments in fabrics and wall coverings(Scheele’s green). In 1892 Bartolomew Gosio, an Italian physician,found certain fungi could metabolize arsenic pigments producingtoxic trimethylarsine (Gosio gas).

A screen in the 1930s by Thom and Raper found A. fumigatus toone of a small number of arsenic fungi. Arsenic compounds havebeen abundant at near toxic levels in the environment since the ori-gin of life. A tragic example of this is cot deaths. Cot deaths havebeen attributed to biodeterioration of cot mattresses by extracellu-lar enzymes of Scopulariopsis brevicaulis converting preservativeplasticisers and fire retardants to arsine and phosphines.

What does this have to do with Napoleon I?During his research Bartolomew Gosio discovered that arsine

was released by the action of fungus Penicillium brevicaule on ar-senical wallpaper pigments. Reddish pigmented colours had thehighest arsenic content. The later use of white arsenic in the horse-hoof sizing used in wallpaper hanging discouraged rodent damage,but increased the dangers! Little wonder that many victims im-proved from their variegated symptoms after being sent away to thecountry for a change of scene and air. Renovation of century-oldhouses is a well-documented source of lead and arsenic poisoning. Inaddition to Pencillium species, other moulds such as A. fumigatusand A. niger have been isolated behind odorous and moist wallpa-per. The spectrum of signs and symptoms of arsenic intoxication in-clude torsade de pointes with circulatory collapse, polyneuropathywith Landry Guillain Barré syndrome, encephalopathy with seizurestates, enteritis, myelodysplastic syndrome, vasospastic events withacrocyanosis, hyperpigmented keratoses with skin neoplasia, rhab-domyolysis, renal failure to hepatic necrosis, progressing to veno-oc-clusive fibrosis.

In 1815, after being defeated by the Duke of Wellington at theBattle of Waterloo, Napoleon Bonaparte was exiled to the tiny andremote volcanic island of St Helena in the south Atlantic. Duringmost of his exile, Napoleon lived in Longwood House with a retinueof about twenty people. A number of these had a motive to murder

Napoleon. The Emperor died at Longwood House in 1821. A fewdays prior to his death Napoleon had requested that his doctormake a full examination of his body, particularly of his stomach.Thedoctors who carried out the post-mortem on Napoleon said that aperforated stomach ulcer that had turned cancerous was the maincause of his death. Initially Napoleon was buried on St Helena but

his body was later removed and re-buried in Paris at the Invalides.

In 1952 Swedish dentist StenForshufvud read the recently pub-lished account of Napoleon's deathby Merchand. Based on his knowl-

edge of toxicology, Forshufvud came to the conclusion thatNapoleon had been murdered. Fortunately, a number of Napoleon'sstaff had kept locks of the Emperor's hair, which were passed downthe generations, sometimes coming up for auction. In the 1960s thishappened and in order to prove this theory Forshufvud turned toGlasgow University forensic scientist Professor Hamilton Smith,who had developed the nuclear techniques to record very small lev-els of arsenic. Using these techniques it was shown that small quan-tities of arsenic were present in Napoleon's hair. It was possible topoison a person without detection by slowly exposing him/her tosmall quantities of arsenic. This technique was known and was de-scribed in a book that one of Napoleon’s staff,Albine de Montholon,Napolean’s supposed mistress, had with her on St Helena. For-shufvud concluded that Napoleon had been murdered by the Comtede Montholon, his head of staff and Albine’s husband.

However, in 1980, a Dr David Jones made a radio programme,broadcast by the BBC, in which he asked if anyone knew the colourof Napoleon's wallpaper on St Helena. As part of the programme,one of the stories that Dr Jones had told was one about Gosio's Dis-ease and Scheele’s green. If Napoleon's wallpaper had been green,it could possibly have contained arsenic, and this could have beenthe source of the arsenic in the hair sample. Napoleon might havebeen an early victim of Gosio's disease. Shirley Bradley who lived inNorfolk, England, had a piece of the wallpaper itself. The wallpapershowed a single star, the principal of which were green and brownalthough it is possible that the brown had faded, and had originallybeen gold. Gold and green were the Imperial colours.The green pig-ment did contain arsenic and it began to look as if Napoleon mighthave been a victim of Gosio's disease, poisoned not by the Britishauthorities, but inadvertently by the British wallpaper makers. Manyof the other people who were with Napoleon on St Helena also be-came ill and complained of the 'bad air'. Napoleon's butler did ac-tually die. Dr Jones' conclusion was that the amount of arsenic inNapoleon's wallpaper was not particularly great and consequentlythe amount of arsenic vapour in the air would not have been large,otherwise more people would have become sick or died. Althoughthe arsenic was not enough to have killed Napoleon, once he was al-ready ill with a stomach ulcer, the arsenic would have exacerbatedhis condition. Certainly some of the symptoms he complained aboutdo correspond to those of arsenic poisoning.

In conclusion As we learnt from Prof. Denning the genes found in the A.fu-

migatus genome include those conferring arsenic resistance inA.fumigatus and upregulation of arsenate reduction which maybe responsible for the hypertolerance of this fungus to arsenic.So, the intriguing question remains: did Napoleon developed ar-senic poisoning because of fungal, possibly Aspergillus, growthon the wallpaper?

Malcolm Richardson

Was Napoleon poisoned? By whom? By what?

How the fungal genome project may have helped to solve one of the mysteries of history


entitled ‘Where is the origin of theCryptococcus gattii Vancouver Islandoutbreak?’ (authors: Ferry Hagen,Eiko E. Kuramae, Marjan Bovers,Dave J.C. Gerits, Collin H.A. Ger-ritzen, Wieland Meyer and TeunBoekhout) won this important prize.This award is an extra stimulant forme, and our “Cryptococcus team”, tofurther investigate the epidemiologyand genetics behind the ongoing out-break of this pathogenic fungus.

Since 2002, our research team isworking together with several investi-gators worldwide to find the answerson several questions regarding the on-going outbreak of C.gattii on Vancou-ver Island and the mainland of BritishColumbia (Canada). The title of ourposter addresses one of the most de-bated questions in current Cryptococ-cus research. Other researchers con-cluded that this outbreak was causedby a same-sex mating between twoAustralian low virulent C.gattiistrains. We have used a plethora ofmolecular tools to prove this hypoth-esis, but came to the conclusion thatnot Australia but most likely thewarm environment of Northern SouthAmerica is the cradle of this out-break.

During the past years, it becameapparent that there was an increase incase reports describing C.gattii andatypical C.neoformans infections inEuropean citizens. This prompted usearly 2006 to start, in collaborationwith the ECMM Cryptococcus andcryptococcosis working group, an epi-demiological study to investigate thegenotypic, phenotypic and clinicalcharacteristics of these Cryptococcusstrains. This will be another project onwhich I will work during the comingyears, as well as on the finalization ofthe epidemiology of Dutch cryptococ-cosis.

Ferry Hagen

The ECMM YoungInvestigators Travel Award

Since December 2006, I am work-ing at the CBS Fungal Biodiver-

sity Centre (Utrecht, The Nether-lands) as a PhD student in the YeastResearch group headed by TeunBoekhout. Before I started with thisPhD research project, I worked forfive years in this research group as atechnician in the yeast and molecularlaboratory studying the epidemiologyof Cryptococcus neoformans in theNetherlands and the ongoing out-break of Cryptococcus gattii on Van-couver Island.

I was completely surprised by thefact that the board of ECMM award-ed me, during the Trends in MedicalMycology meeting in Torino, theYoung Investigator Travel Award. It isa great honor for me that our poster,

Ferry Hagen and Roxana Vitale, the winner of the 2000 ECMM Young Investigators Travel Award.

Ferry Hagen from CBSFungal BiodiversityCentre (Utrecht, The Netherlands), was awarded the 2007ECMM YoungInvestigators TravelAward.

Special report

Congress report


FunPath www.pathogenomics-era.net/projectsCanTrain www.cantrain.beGalar Fungail II www.galarfungail.org FungWall www.fungwall.orgEURESFUN www.chuv.ch/imul/euresfunGlycoshield www.pathogenomics-era.net/projectsKinCan www.pathogenomics-era.net/projectsManasp www.manasp.orgSignalPath http://cogeme.ex.ac.uk/signalpath/

FunNet2007Focussing and coordinatingEuropean research on humanpathogenic fungiThe first joint meeting of researchconsortia on fungal pathogens in Europe

Infections with human patho-genic fungi, in particular Candi-

da species and Aspergillus fumiga-tus, are increasing, and yet theirbiomedical significance is stillthought to be underestimated. Can-dida species frequently cause su-perficial infections of mucosa andskin. However, in hospital settings,particularly in intensive care units,these fungi are life-threatening andprevalent. Candida infections ac-count for the third most commontype of hospital-acquired infectionsin the USA, after Staphylococcusepidermidis and S.aureus infections,reaching mortality rates of morethan 50%, which are higher thanthose caused by bacterial pathogenssuch as Pseudomonas aeruginosa.Even more dramatic are mortalitiesfrom systemic infections with A.fu-migatus (up to 90%).

The biomedical importance offungal infections has recently beenrecognised by several researchgroups in Europe. Their projectsare supported by different transna-tional programmes of the Euro-pean Commission and national sci-ence foundations. Some nine Euro-pean networks focussing on molec-ular medical mycology and thetraining of young researchers havebeen established during the 6thframework programme and theERANet-PathoGenomics scheme.Delegates and PhD students ofthese networks gathered, for thefirst time, in a joint meeting (Fun-Net2007 – Fungal Pathogen Net-works) in Gosau, Austria, organ-ised by Karl Kuchler (Medical Uni-versity of Vienna). In addition tothe scientific exchange and man-agement meetings of consortia, thenetworks discussed their visionsand strategies together in a jointFunNet2007 Workshop. This Fun-Net2007 workshop was sparked byan earlier ‘White Paper on FungalPathogens’, which was written in2006 by Alistair Brown (AberdeenUniversity, UK) together with emi-nent scientists in the field.

Report on...

FunNet2007 concluded that amajor aim of fungal pathogen net-works should be to increase thequality, reliability, accuracy and ef-ficiency of both clinical diagnosesand therapy of life-threatening fun-gal diseases. It will also be crucial toelucidate pathogenicity mecha-nisms driving fungal infections, inparticular the mechanisms trigger-ing transition from commensalgrowth to parasitic and systemicdissemination. The collaborativeefforts of microbiologists, cliniciansand immunologists will be neces-sary, to shed light on host respons-es, as well as on the pathogenicmechanisms allowing for host inva-sion. Systematic approaches as wellas systems biology approaches willbe required. In addition, improvedand widely available tool boxesneed to be generated (i.e. genome-wide mutant libraries, antibodies,animal models, vaccines), as along-side methodological standardiza-tion. Also, the training of young re-searchers in the most advancedtechnologies (eg post-genomics, cellmicrobiology, immunology) thatare all relevant to medical and mol-ecular mycology is essential. Dur-ing FunNet2007, delegates from

different networks strongly high-lighted the need for interdiscipli-nary approaches, the integration ofother fungal pathogens (Crypto-coccus, Fusarium, Trichophyton),and the development of novel ani-mal infection models (includingthose enabling dissection of com-mensalism). More effective com-munication with hospitals is alsorequired, as well as biobanks withclinical isolates, and cooperationwith pharmaceutical industry andclinicians. FunNet2007 concludedthat these urgent needs have notbeen met in FP7 as yet, and theyshould be included as relevant top-ics in upcoming FP7 thematic calls.

European research networkswith research topics on humanpathogenic fungi and their internethomepages are listed below for fur-ther information. These homepageswill provide a downloadable andupdated ‘White Paper on FungalPathogen Research’ in Europe, inwhich future visions, needs andstrategies will be described in moredetail, in spring 2008.

Bernhard Hube


2nd Pan AfricanMedical MycologySociety Conference

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The second PAMMS Conference was held in Cape Town, 6-8 May 2007, at the Cape Town International Convention Centre (CTICC) and providedmedical mycologists from Africa with a unique opportunity to presenttheir latest research findings, to foster collaboration and to establishlong-term relations between scientists from Africa and abroad. Sixtyscientists, most of them from Africa, participated and included severaleminent medical mycologists from elsewhere presenting their work donein Africa. African countries that were represented included South Africa,Nigeria, Cameroon, Sudan, Egypt and Kenya, while there were alsodelegates from the USA, Australia, The Netherlands, Germany, Qatar,Saudi Arabia, India, Denmark, France and Austria present.

nancial support. These sponsor-ships also allowed the organisersto wave the registration fees of allthe speakers. Many students whoeither completed a post graduatedegree, or were in the process ofcompleting such a degree and re-siding in countries in Africa, pre-sented their research findings inoral and or poster presentations.

A wide variety of mycologicaltopics was presented. Theseranged from rare clinical cases inHIV/AIDS subjects; the evalua-tion and potential of plant ex-tracts as anti-fungal agents andtheir practical application inAfrica; the natural habitats, mole-cular analyses and epidemiology

Congress report

It was the privilege of thePAMMS 2007 Organising

Committee consisting of HesterVismer (Chairperson), EstellaBurgess/Belinda Lategan (Trea-surers) and members Sybren deHoog, Lorraine Moses, JohnRheeder, Gail Imrie and TheoLeukes, to financially support 14scientists from Africa to attendthe conference. The main sponsorof the event was the InternationalSociety for Human and AnimalMycology (ISHAM), while Euro-pean Confederation of MedicalMycology (ECMM) and theAfrica Fund for Fungal Biodiver-sity and Mycotic Infections alsosubstantially contributed to the fi-


of Cryptococcus species and theimplication of the provision of an-tiretroviral therapy in AIDS pa-tients with cryptococcosis (cur-rently in Southern Africa the im-pact and death rate of cryptococ-cosis in HIV/AIDS remains ex-tremely high); the occurrence andincidence of mycetoma in Africa,and the molecular identificationof mycetoma causing agents; der-matophytoses; barcoding of fungi,eg. black yeasts; as well as severalother topics such as sporotri-chosis, histoplasmosis, aspergillo-sis and mycotic diseases caused byless well-known fungi. As with thefirst meeting, this conferenceshowed that Africa has much tooffer in medical mycology, bothclinically and scientifically, andonce again accentuated the factthat health problems in Africa arestill enormous.

A PAMMS General Meetingwas held during the conferenceand the first official council of thesociety was elected. Dr. HesterVismer (South Africa) was elect-ed as President, Prof. Ifeoma En-weani (Nigeria) as Vice-Presi-dent, Dr. John Rheeder (SouthAfrica) as Secretary, and Prof. AlfBotha (South Africa), Dr. AbdallaAhmed (Saudi Arabia) and Dr.Ahmad Moharram (Egypt) asmembers of the council. An Inter-national Advisory Committee willbe constituted by the council indue course. A constitution for the

society was drafted by Hester Vis-mer and will be scrutinized by thecouncil and presented at the nextgeneral meeting of the PAMMSfor acceptance. The next meeting

will be held in two or three yearstime in Nigeria with Ifeoma En-weani as the chairperson.

No less then five poster awardswere presented after a panel ofsix judges evaluated the posters.Sigma Aldrich sponsored a bookprize that went to Ms. LorraineMoses for her poster entitled“Molecular analyses to determinethe reproductive mode of Fusari-um globosum”, the second posterprize of the Clinical Atlas of Clin-ical Fungi (CD), sponsored by theMedical Research Council ofSouth Africa, was awarded to Mr.Palanisamy Manikandan for hisposter on “Neocosmospora vasin-fecta keratitis”. Three one yearmembership subscriptions toISHAM was awarded to Dr.Marie-Pierre Hayette, Dr. PyuPyu Sein and Ms. EuphemiaSekati for their poster presenta-tions. The council hope to retainthis tradition at future meetingsof the PAMMS.

The abstracts of oral presenta-tions and posters of the 2ndPAMMS Conference can beviewed at www.cbs.knaw.nl. Thereis a limited number of hard copiesof the proceedings available to res-idents in Africa, which can be ob-tained for free from Hester Vismerat [email protected].

Application for membershipcan also be made to this e-mailaddress. Membership of thePAMMS is currently free, as theAfrica Fund for Fungal Biodiver-sity and Mycotic Infections(Africa Fund), initiated bySybren de Hoog and Jacques Meisof the Netherlands, will cover theinitial costs of the Society. TheAfrica Fund has limited resourcesfor training of African students inEurope; applications may be sentto [email protected].

Hester Vismer PAMMS President

Sessions at the PAMMS 2007 Conference were well attended

Mr Palanisamy Manikandan (centre)receiving his poster award from Prof Sybrende Hoog (left) and Dr Jacques Meis (right)

Ms Lorraine Moses receiving her book prizesponsored by Sigma Aldrich for the bestposter at PAMMS 2007

Congress report

IUMS 2008 ISTANBUL


Announcements

XII International Congress of MycologyLECTURES

Opening Lecture P. Crous (NL) Fungal biodiversity: the future of research Keynote Lecture B.J. Howlett (AU) Mechamisms of fungal pathogenesis in plants and animals

PLENARY SESSIONS CHAIRS

Mycotoxins and mycotoxigenic fungi A. Visconti (IT), J.F. Lesile (USA)Future directions for yeasts in food and beverage production (ICFM & ICY) . P Romano (IT), G. Fleet (AU)Fungal biofilm: the new frontier M. Ghannoum (USA), J.P. Latgé (FR)Controversies and progressions in antifungal management and susceptibility testing S. Arıkan (TR)

SYMPOSIA CHAIRS

Indoor environments in the Mediterranean countries (ICIF) O. Adan (NL), T. Warscheid (DE)Progress in the phylogeny of fungi: one gene, four genes, genomes M. Blackwell (USA) Applied fungal genomics (ICBB) J. Bennet (USA), M. Machida (JP)Facing the transition from culture collection to biological resource centre D. Smith (UK), H. Sugawara (JP)Advances in molecular phylogenetic/systematics of Penicillium & Aspergillus S. Peterson (USA), J. Varga (NL)Fungal secretome L. Lange (DK), S. Baker (USA)ISHAM WG: Black Yeasts: life on the extreme S. de Hoog (NL), L. Selbmann (IT)Food Mycology (ICFM) G. Fleet (AU), R. Samson (NL)ECMM WG: Invasive fungal infections in the intensive care J. Meis (NL), L. Klingspor (SE)Mycoses in wildlife J. Guillot (FR), A. Ilgaz (TR)ECMM WG: Zygomycosis G. Petrikkos (GR), E. Tümbay (TR)Emerging fungal plant pathogens P. Crous (NL), B.J. Howlett (AU)Advances in molecular subtyping of pathogenic fungi (ICAMD) D. Stevens (USA), S. Bretagne (FR)Fungal infections in developing countries J. Kwon-Chung (USA), T. Harrison (UK)Taxonomic development of economically important fungal genera I. Druzhinina (AT), R. Samson (NL)Yeasts and the environment (ICY) L.C. Mendonca-Hagler (BR), N. Arneborg (DK)

Programme Committee Chair Marianna Viviani (Italy), Vice-Chair Emel Tümbay (Turkey) International Advisory Board: S. Arıkan (TR), J. Bennett (USA), M. Blackwell (USA), P. Crous (NL), S. de Hoog (NL), G. Fleet (AU),M. Ghannoum (USA), J. Guillot (FR), A. Hocking (AU), J. Kwon-Chung (USA), L. Lange (DK), J. Meis (NL), L.C. Mendonca-Hagler(BR), E. Reiss (USA), E. Roilides (GR), P. Romano (IT), R. Samson (NL), J. Taylor (USA), A. Visconti (IT)

The International Union of Microbiological Soci-eties (IUMS) has three Divisions – Bacteriology andApplied Microbiology (BAM), Mycology, and Virology– which come together every three years for the organ-isation of their international congresses. In 2005, theAmerican Society for Microbiology hosted these con-gresses in San Francisco. The IUMS Congresses 2008will be hosted in Istanbul, Turkey, by the Turkish Mi-crobiological Society, the Society of Microbial Ecologyand the Society of Chemotherapy. The Mycology andthe BAM Divisions will held their meetings jointlyfrom 5 to 9 August, followed by the Virology DivisionCongress from 10 to 15 August.

The IUMS Mycology program, organised in the for-mat of plenary, symposium, and poster sessions, willcover a variety of topics, which reflects the numerousinterests of mycologists. Sessions will address taxonomyand biodiversity, medical and environmental mycology

and the impact of molecular biology, fungal resistanceto various antifungal agents and population genetics.

Generally, IUMS Congresses do not have strong at-tendance from mycology scientists, who are well at-tracted by more specific conferences. However, in theera of hyper-specialisation it is often prudent to look atyeasts or moulds in the overall context of microbiology,and see how they relate to bacteria and viruses. Thesemicroorganisms share many common bio-physiologicalcharacteristics and it should not be forgotten that innatural habitats they live together and actively interact.The IUMS Congresses provide an excellent opportuni-ty to explore the broader view and see new directions.

Although there are nominated topics for symposiumsessions, mycologists are invited to submit papers fororal presentation on any topics relevant to the Con-gress. Every effort will be made to accommodate thesein the final program.

Meetings of the Divisions of the International Union ofMicrobiological Societies 2008


Announcements

XII International Congress of Bacteriology and Applied MicrobiologyLECTURES

Opening Lecture R. Losick (USA) Surprises in how bacteria cope with uncertainty Closing Lecture P. Bork (DE) Comparative genomics Closing Lecture P. Sansonetti (FR) Pathogenicity

SATELLITE SYMPOSIUM CHAIRS

Vaccine K.P. Klugman (USA)

PLENARY SESSIONS CHAIRS

Omics and pathogenicity (Pathogenomics) P. Sansonetti (FR)Regulation of gene expression J. Helmann (USA)Chaperones, trafficking, protein secretion J. Wehland (DE)White biotechnology/Metabolic engineering H. Sahm (DE)Antibiotics /Pathogenicity J. Davies (CA)Taxonomy of prokaryotes J.T. Staley (USA), K.H. Schleifer (DE)From metabolism to metabolic networks Interactions in the microbial world (ISME) S. Kjelleberg (AU)

SYMPOSIA CHAIRS

Pathogenicity and Commensalism J. Hacker (DE)Stress/Starvation responses/Global regulatory networks C. Harwood (UK)Plant-Microbe-Interaction L. Eberl (CH)Extremophiles M. da Costa (PT)Bacterial metabolism (VAAM Session) B. Schink (GR)Nosocomial infections H. Abacıoglu (TR)Signal transduction U. Roemling (SE)Bacterial protein secretion related to health and disease J.M. van Djil (NL)Cellular microbiology J. Wehland (DE)Functional genomics/Pathogenomics C. Buchrieser (FR)Antibiotic resistance P. Courvalin (FR)Food-born bacterial infections/ Food microbiology Systematics: The objects and objectives of classification B.J. Tindall (DE)Bacterial multicellular behaviour and biofilm formation Metagenomics W. Liebl (DE)Physiological proteomics: from blueprint to real life G. Özcengiz (TR)Systems microbiology White microbiology S. Olof (SE)Anaerobic life B. Schink (DE)Emerging/reemerging bacterial infections M. Ang Küçüker (TR) Actinobacteria: an unexhausted source for biodiscovery, biotechnology and biobusiness I. Kurtboke (TR)

Programme CommitteeChair Michael Hecker (DE), Vice-Chair Mine Ang Kusuker (TR)International Advisory Board: Y. Aharonowitz (IL), J.C. Alonso (ES), K. Altendorf (DE), J. Anné (BE), A. Basustaoglu(TR), B. Berger-Bächi (CH), P. Bork (DE), S. Bron (NL), C. Buchrieser (FR), B. Bukau (DE), S.T. Cole (FR), A. Danchin(FR), J. Davies (CA), F.R. de Leo (USA), W. de Voss (NL), A.L. Demain (USA), K.M. Devine (IE), S. Foster (UK),M. Frosch (DE), Y. Fujita (JP), P. Glaser (FR), J. Hacker (DE), C.R. Harwood (UK), J. Heesemann (DE), W. Hillen (DE),U. Jakob (USA), S. Kjelleberg (AU), K.P. Klugman (USA), M. Ang Küçüker (TR), J.G. Kuenen (NL), F. Kunst (FR),H. Labischinski (DE), R. Losick (USA), M. Marahiel (DE), A.C. Matin (USA), R.P. Mellado (ES), M. Mitsuyama (JP),T. Msadek (FR), P. Neubauer (SF), Z. Yesim Özbas (TR), G. Özcengiz (TR), T. Palmer (UK), C.W. Price (USA),C. Robinson (UK), U. Römling (SE), E.Z. Ron (IL), S. Rota (TR), H. Sahm (DE), M. Sarvas (SF), U. Sauer (CH),K.H. Schleifer (DE), J. Schrenzel (CH), W. Schumann (DE), S. Seror (FR), M. Skurnik (SF), D.O. Sordelli (AR),R.L. Switzer (USA), R. Thauer (DE), K.N. Timmis (DE), J.M. van Dijl (NL), U. Völker (DE)

Deadline for submission of abstractsJanuary 31, 2008Registration deadline at reduced feeApril 1, 2008For further informationwww.iums2008.org

One of the main and most active organizationspromoting all aspects of medical and veterinary

mycology on a global scale is ISHAM (InternationalSociety of Human and Animal Mycology). Member-ship of this Society certainly is mandatory for everyambitious medical mycologist worldwide. We have setup very efficient, interactive communication tools.Our latest service is an electronic alerting system forglobal advice on urgent diagnostic and therapeuticchallenges, called ‘ISHAM-SOS!’ Interesting and ed-ucational cases will subsequently be published in‘Medical Mycology’, the society journal with an in-creasing impact factor and the spectacularly low aver-age turnaround time of only 50 days.

A major development within ISHAM is the es-tablishment of Working Groups on particularthemes. At this moment seventeen topics are cov-ered. The WGs are networks of specialists and otherresearchers interested in and working on the themesselected. Plans and news items from the WorkingGroups can be found on the ISHAM website, click athttp://www.isham.org/Groups.asp. Several have estab-lished their own websites, which you can find easilythrough the respective links. ISHAM provides facilitiesand gives financial support to their activities, a.o. in theform of sponsorship of workshops. Several workshopshave already taken place, e.g. on Aspergillus, blackyeasts, chromoblastomycosis, and on Scedosporium,while a subsequent WG meeting will be on sinusitis,

next February in India. All workshops held thus farhave proven to be incredibly successful, leading tobooks and special issues of several journals. We alsosupport some major congresses, such as AdvancesAgainst Aspergillosis (see http://www.aaa2008.org/).

If you wish to join any of ISHAM’s activities, or ifyou wish to be informed about developments in med-ical mycology, you are more than welcome as a memberof our Society.Just click http://www.isham.org/membership_form.aspfor a membership form. Subscription to ‘Medical My-cology’, discussion fora and alerting systems are includ-ed in the fee. Memberships of Working Groups are freeof charge.

Sybren de HoogISHAM President

Announcements


IUMS 2008 IstanbulISHAM Working Group On Black Yeasts: Life on the extreme(Parallel Symposium 7)

Thursday 7 August 2008, h. 16.00 - 18.00 Chair S. de Hoog (NL)Co-chair L. Selbmann (IT)

F. Lutzoni (USA) Origin of extremotolerance, in black yeasts L. Selbmann (IT) Fungal life inside rocks of Antarctic dry deserts H. Badali (NL) Agents of chromoblastomycosis: a link between extremotolerance and human pathogenicity?W. Boeger, (BR) New diseases in crabs promoted by climatic change

Black yeasts are very remarkable in their ecological preferences: they love the extreme. We are now beginning to understandthat we can uncover a wealth of diversity by using exceptional isolation methods, such as crushing bare rock, using toxins, puresulphuric acid, or high temperature – or human bodies. Some of the evolutionary lines leading to human and animal patho-genicity have our special attention. Saprobic black yeasts may suddenly express their pathogenic potential under the influenceof global change, as is demonstrated in an emerging crab disease at the Brazilian coast.

ISHAM: medical mycology alive!

Announcements

Mycology newsletter - December 2007 29

Scientific programSunday 10 February, h 8:30 am – 6:30pm

Symposium 1: Magnitude of the problem

D. Denning (UK) Prevalence of fungal sinusitis A global perspective

A. Chakrabarti (India) Prevalence of fungal sinusitisIndian perspective

A. Gupta (India) Fungal sinusitisExperience in pediatric patients

A. Fothergill (USA) Spectrum of agents causing fungal sinusitis

Symposium 2: Categorization of fungal sinusitis

H. Stammberger (AT) Controversies surrounding Terminology and Categorization

A. Das (USA) Histopathologists can categorize fungal sinusitis better

M. Richardson (FI) Role of CT in diagnosisP. Singh (India) Role of MRI in diagnosisB. Marple (USA) Definition of AFRSB.J. Ferguson (USA) Concept of EFRS J. Ponikau (USA) Role of fungi in CRS – Alternate conceptH. Kita (USA) Use of animal model

in understanding fungal sinusitis

Symposium 3: Allergic fungal sinusitis

W. Buzina (AT) Fungi - allergen or a bystander in AFRS?S. Vlaminck (BE) The finding of hyphae in sinuses,

its significanceH. Kita (USA) Novel biomarkers and newer diagnostic

techniques for fungal sinusitisE. Toskala (FI) Role of MMPs in CRS

The missing link between fungal exposure& eosinophilic inflammation

R. Vedantam (India) Increasing diagnostic yield in allergic fungal sinusitis – a surgeon’s perspective

H. Stammberger (AT) Surgical Management of EFRS B. Marple (USA) Treatment of CRS in light

of classification as EMRS J. Ponikau (USA) The role of antifungals

in the treatment of CRS

Monday 11 February, h 8:30 am – 6:30pm

Symposium 4: Colonizing fungal ballColonization of fungi in sinusesIts significance

C. Kauffmann-Lacroix (FR) Epidemiology. Do fungi discriminatepatients or do patient discriminate fungi?

Handa (India) Diagnosis and management Thungapatra (India) Genetic risk factor analysis / Microarrays

- is it the way to the future?

Symposium 5: The Invasive Disease

T. Aldeen (Qatar) Agents responsible for invasive diseaseS. Kantarcioglu (TR) Diagnosis of invasive disease N. Panda (India) Management of invasive disease

Panel Discussions: To resolve the controversies and defineeach category of fungal sinusitisH. Stammberger, W. Buzina, J. Ponikau, B. Marple, B.J. Ferguson, A. Chakrabarti

Workshop on fungal sinusitis

International Society for Human & Animal Mycologyhas formed a working group on ‘Fungal sinusitis’.The

working group with its website (http://fungalsinusitis-group.org) was launched in May 2007, with member-ship open to all the workers working actively in thefield of fungal sinusitis. The highlight of the group isthat it will serve as a meeting ground for the membersand that it serves as a portal for exchange of ideas andto keep the members abreast about the latest develop-ments taking place in the area of fungal sinusitis.

With those objectives in mind a workshop is beingorganized at Chandigarh, India during 9th-11th Febru-ary, 2008. “The City Beautiful Chandigarh”, which is lo-cated approximately 160 miles/250kms North West ofNew Delhi, is situated at the foothills (the Shivalik

mountain range) of the majestic Himalayas. The work-shop will be held at Hotel Mountview, a beautiful hotelwith country look.

Two days of intensive scientific deliberations, andsymposia are planned to cover all areas in fungal sinusi-tis. There would be no registration fees for the work-shop. However participants must have a keen interest inthe areas of fungal sinusitis. To express his or her inter-est every participant other than invited speaker mustpresent a poster in the area of fungal sinusitis. To en-courage the participation in the workshop meals, teaand snacks will be served on behalf of the organizers.

Arunaloke ChakrabartiCo-ordinator, WG on ‘Fungal sinusitis’


The quality of coastal and inland recreational wa-ters and sand are of great importance as people

use them both for bathing or water-contact sports. In1989, the Mycology group of the National Instituteof Health Dr. Ricardo Jorge worked on this subjectfor the first time, in a joint study with the PortugueseNational Directorate of Health. During the follow-ing 10 years, several local beach sands were random-ly analyzed.

Between 2000 and 2002 by invitation of the Por-tuguese Blue Flag Association, and based on thework previously done, a project involving several na-tional institutions took place, aiming to define beachsand quality parameters and associated methods:“Microbiologic Quality of Coastal Beach Sands”.During this project we split our country in 5 regionsand from each region 3 beaches were selected: Oneblue flag awarded (thus with documented goodmaintenance and water quality), one wild (with theleast possible human influence), and one with docu-mented poor water quality (as a close reference ofmicrobiological poor quality). Samples were collect-ed every 2 months for 13 months. Based on the re-sults obtained we were able to build mean valueswhich we used as standard indicators of microbio-logical quality. These have been extended to inlandbeaches through our participation a European pro-ject, ICReW (www.icrew.info), and have recentlybeen revised and asserted, based on blue flag award-ed beaches. We also found out then that wet sandanalysis is unnecessary and that water falls under theEuropean and local water directives, being moni-tored by default in order to allow public use.

Originally, fungi isolated and counted weregrouped into 4 categories, according to behaviourpatterns and pathologies, regardless of individualpositive or negative interactions within each group.The groups were: (a) Yeasts (genera Candida, Cryp-tococcus, Saccharomyces. Rhodotorula), (b) Aler-gogenic and potential pathogens (genera Aspergillus,Fusarium, Scopulariopsis, Scedosporium, Chrysospo-rium, Scytalidium), (c) Dermatophytes (genera Mi-crosporum, Epidermophyton and Trichophyton) and(d) others (other potentially pathogenic genera).Bacterial parameters are total coliforms, Escherichiacoli and intestinal enterococci.

All biological parameters have been looked intofor statistical significant positive and negative corre-lations (Spearman’s) amongst themselves andagainst physical-chemical parameters (total nitro-

gen, nitrates, nitrites, BOD5, COD, total phosphorus,phosphates, pH and turbidity), measured in the wa-ter samples and in sand washings. We could not con-sistently correlate the fungal parameters with any ofothers studied. We found hence no indicator of fun-gal quality of either sand or water with this study.Groups (b) and (d) could be regarded as similar, al-though not identical. Therefore, we have now aban-doned group (d), as a routine, bearing in mind that inits place, data on the sand origin could become rele-vant as tropical/atypical species sometimes appear(e.g. Coccidioides spp) in imported sands (commonpractice these days) and should be included in group(b), when present.

Our local blue flag organization has been supportingour work in many ways, including financially, and theworldwide integration of the sand quality criteria toaward a beach is already being discussed within the in-ternational organization (www.fee-international.org).

In 2008, Blue flag Portugal will invite all candi-date municipalities to integrate those that alreadydo a sand quality check, together with the applica-tion for the award; the argument being, of course,prevention rather then treatment.

We currently provide this service to the commu-nity and the demand has been growing every year.We analyze at least 60 beaches throughout the sum-mer (different samplings/beach). Now that the meth-ods have been sorted and are fully in place, we’replanning to extend our work internationally in orderto raise information and relevance and ultimatelycompare experiences on other climates and regions,namely within Europe, with northern Atlantic andMediterranean coasts and inland recreational watercatchments and rivers.

If you feel your organization would like to bepart of this work at an international level, pleasecontact us at [email protected].

João Brandão

Announcements

Microbiologic quality of coastal beach sands

mycology the ecmm/cemm mycology newsletter is mailed ... · 2 mycology newsletter - december 2007...

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