Diagnostic challenges of fungal disease in Wales

Ayling-Smith, Jonathan 2023. Diagnostic challenges of fungal disease in Wales. MD Thesis, Cardiff University. Item availability restricted.

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Abstract

Invasive and serious fungal diseases carry a high degree of morbidity and mortality. Despite the seriousness of these conditions, no national fungal disease registry exists. In this thesis, the incidence and prevalence of fungal disease in Wales was estimated through a literature review exploring the expected burden of the most common or most serious pathogens in atrisk populations. Local laboratory reporting was also utilised to retrospectively analyse Wales’s local incidence data. The discrepancy between the expected incidence of pneumocystosis and the high number of laboratory-confirmed cases prompted a more comprehensive review. Aside from HIV, in which mortality was low, there was no significant difference in mortality between the various aetiologies of immunosuppression responsible for contracting pneumocystosis. Microbiological investigation of fungal pathogens is difficult. Biomarker and culture techniques are applied to samples such as bronchoalveolar lavage which can be problematic to obtain. The SPutum Induction Trial For Improved Respiratory Evaluation (SPITFIRE) was designed and implemented to investigate the opportunity to use sputum induction as a novel method of obtaining deep respiratory samples in an unwell, immunocompromised haematology cohort. The data suggests this to be an acceptable procedure for both operator and patient and produces microbiologically similar results to deep respiratory samples obtained at bronchoscopy. There is evidence of concordance with bronchoscopy in diagnosing fungal disease. It is a challenge to correctly interpret the significance of a positive result. Exophiala dermatitidis is frequently isolated from patients with cystic fibrosis but its impact on lung function was unknown. Following a retrospective case-controlled review, it was demonstrated that E.dermatitidis isolation is associated with a more rapid lung function decline than in the same individuals pre-isolation and compared to control. A healthcare environment-focussed patient-patient transmission model was also postulated. This thesis highlights multiple diagnostic challenges in fungal disease and proposes Waleswide approaches to address them.

Item Type:	Thesis (MD)
Date Type:	Completion
Status:	Unpublished
Schools:	Medicine
Date of First Compliant Deposit:	14 March 2024
Last Modified:	14 Mar 2024 13:14
URI:	https://orca.cardiff.ac.uk/id/eprint/167253

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