Infection prevention
undergoing chemotherapy. Prof. Denning went to discuss Terbinafine
resistant ringworm. Dermatophytes affect 20–25% of the world’s population. Trichophyton rubrum and T
. mentagrophytes complex are
the most widely distributed cause of skin superficial infections. However, we have seen the emergence of a new species, T
. indotineae,
which is very inflammatory and terbinafine resistant. The new species, which has emanated from India, it is much more virulent. “It is a very difficult infection and is now the commonest presentation in India,” said Prof. Denning. The UKHSA needs to start testing for Dermatophytes, he asserted.
Climate change There has already been a change in fungal disease related to climate change, according research highlighted by Prof. Denning.9
4. Loughlin L, Hellyer TP, White PL, McAuley DF, Conway Morris A, Posso RB, Richardson MD, Denning DW, Simpson AJ, McMullan R. Pulmonary Aspergillosis in Patients with Suspected Ventilator-associated Pneumonia in UK ICUs. Am J Respir Crit Care Med. 2020 Oct 15;202(8):1125-1132. doi: 10.1164/rccm.202002- 0355OC. PMID: 32609533; PMCID: PMC7560800.
5. Tejerina EE, Abril E, Padilla R, Rodríguez Ruíz C, Ballen A, Frutos-Vivar F, Lorente JÁ, Esteban A. Invasive aspergillosis in critically ill patients: An autopsy study. Mycoses. 2019 Aug;62(8):673- 679. doi: 10.1111/myc.12927. Epub 2019 Jun 9. PMID: 31177621.
Azole resistance in A. fumigatus, across the Netherlands, has been linked to the spraying of tulip bulbs.
Fungus
is being impacted by temperature increases, extreme weather events, forest fires, homes damaged by flooding, as well as changes in land use and urbanisation. Examples of changing epidemiology of pathogenic fungi, linked to global heating and severe weather, include: 1. Expansion of geographical ranges of Histoplasma.
2. Increased virulence of Histoplasma at higher soil temperatures.
3. Strong link of cases of paracoccidiodomycosis in S. America with El Nino weather events.
4. Wide dispersal of resistant fungi, such as Aspergillus from SE Asia and China.
Resistance Resistance in Aspergillus spp. is also growing, Prof. Denning pointed out. For example, data shows there is increasing Azole resistance in A. fumigatus across the Netherlands, reaching almost 10%.10
infections are both increasing and increasingly recognised; diagnosed antifungal resistance is common and needs to be tested for; while climate change will bring additional changes with flooding, extreme weather, and importations. Ultimately, vulnerable patients need protection, especially in hospital. Prof. Denning ended his presentation by sharing some useful resources for further learning, which are available at:
www.aspergillus.org.uk and www.
fungaleducation.org Alongside the Infection Prevention and Control
Conference, Knowlex also hosted three other essential conferences dedicated to advancing healthcare through infection prevention, patient safety, and innovation. These included: the Let’s Talk Sepsis Conference; IPC in a Mental Health Setting Conference; and the Decontamination and Sterilisation Conference. To view these sessions online, and find out more about future events, visit:
https://knowlex.co.uk/
CSJ This resistance has been linked to
the spraying of tulip bulbs with Azole fungicides. Composting of bulbs on tulip farms has been a significant issue which has meant that Azole resistance is now endemic in the soil. Surveillance of Triazole-resistant Aspergillus fumigatus in UK residential garden soils also shows 14% resistance to Azoles.11
The issue in
Vietnam is especially concerning, as a study found that Azole-resistant Aspergillus fumigatus is highly prevalent in the environment – with a reported 95% resistance.12
Prof. Denning
pointed out that when it comes to national guidance on how to protect patients from the risk of Aspergillosis in hospitals, there is a lot of uncertainty and variation, while some countries have no guidance at all.13 In conclusion, he said that there may be a
need to review the current UK guidelines – drawing on global guidance. Serious fungal
References 1. Jaggi TK, Agarwal R, Tiew PY, Shah A, Lydon EC, Hage CA, Waterer GW, Langelier CR, Delhaes L, Chotirmall SH. Fungal lung disease. Eur Respir J. 2024 Nov 28;64(5):2400803. doi: 10.1183/13993003.00803-2024. PMID: 39362667; PMCID: PMC11602666.
2. Hammond EE, McDonald CS, Vestbo J, Denning DW. The global impact of Aspergillus infection on COPD. BMC Pulm Med. 2020 Sep 11;20(1):241. doi: 10.1186/s12890-020-01259-8. PMID: 32912168; PMCID: PMC7488557.
3. Guinea J, Torres-Narbona M, Gijón P, Muñoz P, Pozo F, Peláez T, de Miguel J, Bouza E. Pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: incidence, risk factors, and outcome. Clin Microbiol Infect. 2010 Jul;16(7):870-7. doi: 10.1111/j.1469- 0691.2009.03015.x. Epub 2009 Nov 10. PMID: 19906275.
6. Rhodes J, Fisher MC. Global epidemiology of emerging Candida
auris.Curr Opin Microbiol. 2019 Dec;52:84-89. doi: 10.1016/j. mib.2019.05.008. Epub 2019 Jul 3. PMID: 31279224.
6. Rossato L, Simionatto S, Serafini MR, Alves IA. New Technologies to Diagnose and Treat a Multidrug-Resistant Candida auris: A Patent Review. Mycopathologia. 2022 Dec;187(5-6):535- 546. doi: 10.1007/s11046-022-00669-y. Epub 2022 Oct 4. PMID: 36194378; PMCID: PMC9529600.
7. Moin S, Farooqi J, Rattani S, Nasir N, Zaka S, Jabeen K. C. auris and non-C. auris candidemia in hospitalized adult and pediatric COVID-19 patients; single center data from Pakistan. Med Mycol. 2021 Dec 3;59(12):1238-1242. doi: 10.1093/ mmy/myab057. PMID: 34625790.
8. van Rhijn N, Bromley M. The Consequences of Our Changing Environment on Life Threatening and Debilitating Fungal Diseases in Humans. J Fungi (Basel). 2021 May 7;7(5):367. doi: 10.3390/ jof7050367. PMID: 34067211; PMCID: PMC8151111.
9. Buil JB, Snelders E, Denardi LB, Melchers WJG, Verweij PE. Trends in Azole Resistance in Aspergillus fumigatus, the Netherlands, 1994- 2016. Emerg Infect Dis. 2019 Jan;25(1):176-178. doi: 10.3201/eid2501.171925. PMID: 30561296; PMCID: PMC6302600.
10. Shelton JMG, et al. Citizen Science Surveillance of Triazole-Resistant Aspergillus fumigatus in United Kingdom Residential Garden Soils. Appl Environ Microbiol. 2022 Feb 22;88(4):e0206121. doi: 10.1128/AEM.02061-21. Epub 2022 Jan 5. PMID: 34986003; PMCID: PMC8862786.
11. Duong TN, et al. Azole-resistant Aspergillus fumigatus is highly prevalent in the environment of Vietnam, with marked variability by land use type. Environ Microbiol. 2021 Dec;23(12):7632-7642. doi: 10.1111/1462- 2920.15660. Epub 2021 Jul 16. PMID: 34232541.
12. Bamber S, Haiduven D, Denning DW. Survey of current national and international guidance to reduce risk of aspergillosis in hospitals. J Hosp Infect. 2025 May;159:124-139. doi: 10.1016/j. jhin.2025.02.015. Epub 2025 Mar 8. PMID: 40064445.
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