State of Medical Mycology at German Academic Medical Centres: A Survey of the German-Speaking Mycological Society (DMYKG) and the Paul-Ehrlich-Society for Chemotherapy (PEG).

BACKGROUND: Little is known about the infrastructure to translate advances in the management of patients at risk to develop invasive opportunistic fungal diseases. To assess the current state of Medical Mycology support in Germany, we conducted a survey among all 36 academic medical centres. METHODS: The survey consisted of a 3-pages questionnaire sent out in the first half of 2019. Information included details of infrastructure, education and teaching; consultation services and interdisciplinary conferences; research activities and participation in network groups; radiology, microbiology and pharmacology support; publication activity; and European Confederation for Medical Mycology (ECMM) Excellence Center designation, if assigned. RESULTS: Information was returned from 24 centres (67%). Thirteen institutions (54%) reported an independent infectious disease, and two a separate Medical Mycology department (8%); a Medical Mycology working group was reported for nine institutions (38%). An infectious disease consultation service was existent in 16 institutions (67%) and a multidisciplinary conference in 13 (54%). Fifteen institutions reported a separate study office with activities in infectious disease studies (63%). Laboratory capability for fungal identification and susceptibility testing was confirmed by all 24 institutions; testing of galactomannan by 23 (96%), cryptococcal antigen by 21 (88%), ß-D-Glucan by 9 (38%), and panfungal and Pneumocystis PCR by 21 and 22 (88% and 92%), respectively. Therapeutic drug monitoring of voriconazole was reported to be available in 15 (63%) institutions with a turnaround of ≤24 h during weekdays in 10 (42%). Two of the 24 University hospitals (8%) reported ECMM Diamond Excellence Status. CONCLUSIONS: The results of this survey document the continuing need to improve the availability of specialised Medical Mycology support in German academic medical centres.

The Canadian Fungal Research Network: current challenges and future opportunities.

Fungi critically impact the health and function of global ecosystems and economies. In Canada, fungal researchers often work within silos defined by subdiscipline and institutional type, complicating the collaborations necessary to understand the impacts fungi have on the environment, economy, and plant and animal health. Here, we announce the establishment of the Canadian Fungal Research Network (CanFunNet, https://fungalresearch.ca), whose mission is to strengthen and promote fungal research in Canada by facilitating dialogue among scientists. We summarize the challenges and opportunities for Canadian fungal research that were discussed at CanFunNet's inaugural meeting in 2019, and identify 4 priorities for our community: (i) increasing collaboration among scientists, (ii) studying diversity in the context of ecological disturbance, (iii) preserving culture collections in the absence of sustained funding, and (iv) leveraging diverse expertise to attract trainees. We have gathered additional information to support our recommendations, including a survey identifying underrepresentation of fungal-related courses at Canadian universities, a list of Canadian fungaria and culture collections, and a case study of a human fungal pathogen outbreak. We anticipate that these discussions will help prioritize fungal research in Canada, and we welcome all researchers to join this nationwide effort to enhance knowledge dissemination and funding advocacy.

Clinicians' challenges in managing patients with invasive fungal diseases in seven Asian countries: An Asia Fungal Working Group (AFWG) Survey.

BACKGROUND: Invasive fungal diseases (IFD) are a serious threat, but physicians in Asia lack access to many advanced diagnostics in mycology. It is likely that they face other impediments in the management of IFD. A gap analysis was performed to understand the challenges Asian physicians faced in medical mycology. METHODS: The Asia Fungal Working Group (AFWG) conducted a web-based survey on management practices for IFD among clinicians in China, India, Indonesia, Philippines, Singapore, Taiwan and Thailand. FINDINGS: Among 292 respondents, 51.7% were infectious disease (ID) specialists. Only 37% of respondents had received formal training in medical mycology. They handled only around 2-4 proven cases of each fungal infection monthly, with invasive candidiasis the most common. For laboratory support, the majority had access to direct microscopy (96%) and histopathology (87%), but galactomannan and azole levels were available to 60% and 25% of respondents, respectively. The majority (84%) used clinical parameters for treatment response monitoring, and 77% followed the Infectious Diseases Society of America guidelines. The majority (84%) did not use the services of an ID physician. Where febrile neutropenia was concerned, 74% of respondents used the empirical approach. Only 30% had an antifungal stewardship program in their hospital. Eighty percent could not use preferred antifungals because of cost. INTERPRETATION: The survey identified inadequacies in medical mycology training, non-culture diagnostics, access to antifungal drugs, and local guidelines as the major gaps in the management of IFDs in Asian countries. These gaps are targets for improvement.

The Curious Case of "Case Report" of Infections Caused by Human and Animal Fungal Pathogens: An Educational Tool, an Online Archive, or a Format in Need of Retooling.

Case reports describe the unusual occurrence and complications of diseases, diagnostic challenges, and notable therapeutic successes. Some journals have discontinued the case reports, while new case report journals have appeared in recent years. During the eightieth anniversary of Mycopathologia, it is fitting to examine the relevance of the case report since the journal continues to traverse the boundaries of basic and clinical sciences. A random sample of recent case reports and other articles were selected from Mycopathologia. Springer Nature individual article download statistics, and Google Scholar and Scopus citations numbers were compared to assess the reader access and bibliometric impact of case reports. Our analysis indicated that the case report format continues to be a vital element of publication in a cross-disciplinary journal such as Mycopathologia. Medical and veterinary case reports covering fungal pathogens are widely read as evident from their download numbers. The download numbers have a positive correlation with the completeness of the report, the topics and geographic origin of reports have a neutral influence, and the recency leads to lower downloads. There is no discernible trend between the download numbers and the citations of case reports as measured by Google Scholar and Scopus. A specially designed checklist for Mycopathologia case reports and new format MycopathologiaIMAGES are being introduced to improve the quality and relevance of case reports further.

Especialistas graduados en el Instituto Nacional de Higiene "Rafael Rangel", tutoría y trabajos especiales de grado en el área de micología médica durante el periodo 2007 ­ 2014 / Specialists graduated in the National Institute of Hygiene "Rafael Rangel", tutorship and degree theses in the area of medical mycology, period 2007 ­ 2014

El Instituto Nacional de Higiene "Rafael Rangel" (INHRR) inició las actividades académicas de la Especialización en Micología Médica en septiembre de 2007. En los primeros ocho años de actividad, el Instituto ha concluido cuatro cohortes de especialistas. El objetivo del presente trabajo fue presentar una descripción de los especialistas graduados en el INHRR, los tutores y los trabajos especiales de grado (TEG) en el área de micología médica durante el periodo 2007 ­ 2014. Para ello, se realizó una investigación documental y de tipo descriptiva, revisando los expedientes resguardados en los archivos de la Coordinación de Postgrado de la Gerencia de Docencia e Investigación del INHRR. Con este programa de postgrado, el Instituto graduó a 23 especialistas en micología médica con un elevado índice académico (17,5 puntos). La mayoría de los egresados de la especialización fueron mujeres bioanalistas egresadas de la Universidad Central de Venezuela, quienes laboraban en entes públicos al momento de iniciar el programa. El 61% de los TEG defendidos se realizaron dentro de dos de las líneas de investigación que lleva adelante el Departamento de Micología Médica del INHRR, a saber: las micosis en pacientes inmunocompetentes e inmunocomprometidos utilizando el diagnóstico convencional y la resistencia antifúngica de hongos levaduriformes. Ocho profesionales fueron los encargados de dirigir los TEG, bajo la figura de tutor: dos se destacaron por haber dirigido el 52% de los TEG y tres por ser egresados de la especialización. Solo el 38% de los tutores fueron externos al Instituto

The National Institute of Hygiene "Rafael Rangel" (INHRR) began the academic activities of the Medical Mycology Specialization in September 2007. In the first eight years, the Institute has graduated four cohorts of specialists. The aim of this work was to present a description of the specialists graduated in the INHRR, their advisors and degree theses (DT) in the field of medical mycology, during the period 2007 ­ 2014. Documentary and descriptive research were carried out; reviewing the records kept in the Postgraduate Coordination archives of the Management for Teaching and Research, INHRR. With this program, the Institute graduated 23 specialists in medical mycology with a high academic score (17.5 points). Most of the specialists were bioanalyst women graduated from the Central University of Venezuela, who worked in public entities at the beginning of the program. Sixty-one percent of the DT was conducted in two of the research lines carried out by the Department of Medical Mycology, INHRR, namely: mycoses in immunocompetent and immunocompromised patients using conventional diagnosis and antifungal resistance of yeast infections. Eight professionals supervised the DT, under the figure of tutor. Two tutors excelled for supervising 52% of the DT and three tutors for being graduates of the specialization. Only 38% of the tutors were external to the Institute

Mycological Education for Dermatologists.

Mycotic infections remain important in dermatological clinics. Therefore the mycological training curriculum needs to be reorganized starting from the beginning of dermatological education, including routine examination procedures, such as potassium hydroxide examination, culture of pathogenic fungi, histopathology, treatment guidelines, and the recent advances in medical mycology.Several mycological institutes will be selected and announced in the journal to provide support for mycological examinations and to publish important cases treated in clinics. The roles of the Japanese Society for Medical Mycology in these activities are discussed.

Manual de diagnóstico de las micosis sistemáticas / Manual of diagnosis of systematic fungal diseases

manual es brindar un material de apoyo para el diagnóstico micológico a los laboratorios del Ministerio de Salud Pública y Bienestar Social y servir de material complementario para los cursos de capacitación realizados por la sección Micología del Departamento de Bacteriología y Micología del Laboratorio Central de Salud Pública, y de esta manera fortalecer la capacidad diagnóstica de las micosis sistémicas, especialmente la Paracoccidioidomicosis, la principal micosis sistémica del Paraguay

The Mobile Team of Parasitology-Mycology, a medical entity for educational purposes to serve sick patients.

The Mobile Team of Parasitology-Mycology is a movable entity of the Parasitology-Mycology laboratory of Tours University Hospital, France. In contrast to the usual prerogatives of biomedical laboratories, the Mobile Team of Parasitology-Mycology is requested to intervene directly at bedside in various clinical departments, or even outside the hospital facility. Although its actions are of course primarily devoted to specialized diagnostic and therapeutic purposes, the Mobile Team also plays an important educational role in the medical training of undergraduate or graduate students.

Proyecto épico: formulación de unas recomendaciones educativas con metodología DELPHI para pacientes adultos críticos no neutropénicos y con candidiasis invasiva / Épico project. Development of educational recommendations using the DELPHI technique on invasive candidiasis in non-neutropenic critically ill adult patients

Antecedentes: Aunque en la última década ha mejorado el manejo de la candidiasis invasiva, todavía persisten aspectos controvertidos, en especial por lo que respecta a la estrategia diagnóstica y terapéutica. Objetivos: Identificar los conocimientos clínicos esenciales y formular unas recomendaciones con la obtención de un alto grado de consenso, necesarias en la asistencia de pacientes adultos no neutropénicos en estado crítico con candidiasis invasiva. Métodos: Se preparó una encuesta prospectiva cuyo texto se redactó en español, y se obtuvo un consenso mediante técnica DELPHI (un método de reestructuración de un proceso de comunicación con el que se obtiene un grado de consenso de los especialistas sobre el problema planteado). En primer término, se envió de forma anónima por correo electrónico a 25 especialistas nacionales de diferentes disciplinas médicas, expertos en infecciones fúngicas invasivas, de 5 sociedades científicas nacionales, incluidos intensivistas, anestesistas, microbiólogos, farmacólogos e infectólogos, que respondieron a 47 preguntas preparadas por el grupo de coordinación, tras una revisión exhaustiva de los estudios publicados durante los 5 últimos años. Los objetivos educativos contemplaron 5 categorías: epidemiología, instrumentos diagnósticos, scores, estrategias terapéuticas y de desescalada. Para ser seleccionado, el grado de acuerdo alcanzado entre los expertos del panel en cada uno de los ítems debía superar el 75%. En segundo término, después de extraer las recomendaciones de los ítems seleccionados, se celebró una reunión presencial donde se invitó a participar en una segunda ronda a más de 80 especialistas y se les solicitó la validación de las recomendaciones preseleccionadas. Resultados: En primer término, se realizó una preselección de 20 recomendaciones (epidemiología 4, scores 3, diagnóstico de laboratorio 4, tratamiento 6 y desescalada 3). Después de la segunda ronda, se validaron las 12 recomendaciones siguientes... (AU)

Background. Although there has been an improved management of invasive candidiasis in the last decade, controversial issues still remain, especially in the diagnostic and therapeutic approaches. Aims. We sought to identify the core clinical knowledge and to achieve high level agreement recommendations required to care for critically ill adult patients with invasive candidiasis. Methods. A prospective Spanish survey reaching consensus by the DELPHI technique was made. It was anonymously conducted by electronic mail in a first term to 25 national multidisciplinary experts in invasive fungal infections from five national scientific societies, including intensivists, anesthesiologists, microbiologists, pharmacologists and infectious diseases specialists, who answered to 47 questions prepared by a coordination group after a strict review of the literature in the last five years. The educational objectives spanned five categories, including epidemiology, diagnostic tools, prediction rules, and treatment and de-escalation approaches. The level of agreement achieved among the panel experts in each item should exceed 75% to be selected. In a second term, after extracting recommendations from the selected items, a face to face meeting was performed where more than 80 specialists in a second round were invited to validate the preselected recommendations. Results. In the first term, 20 recommendations were preselected (Epidemiology 4, Scores 3, Diagnostic tools 4, Treatment 6 and De-escalation approaches 3). After the second round, the following 12 were validated: (1) Epidemiology (2 recommendations): think about candidiasis in your Intensive Care Unit (ICU) and do not forget that non-Candida albicans–Candida species also exist. (2) Diagnostic tools (4 recommendations): blood cultures should be performed under suspicion every 2–3 days and, if positive, every 3 days until obtaining the first negative result. Obtain sterile fluid and tissue, if possible (direct examination of the sample is important). Use non-culture based methods as microbiological tools, whenever possible. Determination of antifungal susceptibility is mandatory. (3) Scores (1 recommendation): as screening tool, use the Candida Score and determine multicolonization in high risk patients. (4) Treatment (4 recommendations): start early. Choose echinocandins. Withdraw any central venous catheter. Fundoscopy is needed. (5) De-escalation (1 recommendation): only applied when knowing susceptibility determinations and after 3 days of clinical stability. The higher rate of agreement was achieved in the optimization of microbiological tools and the withdrawal of the catheter, whereas the lower rate corresponded to de-escalation therapy and the use of scores. Conclusions. The management of invasive candidiasis in ICU patients requires the application of a broad range of knowledge and skills that we summarize in our recommendations. These recommendations may help to identify the potential patients... (AU)

[Mycology in the 21st century: crisis and revitalization]. / La mycologie au début du 21ème siècle: crise et renouveau.

Although they are key players in the biosphere and have important roles in human industry, agriculture and health, fungi are largely understudied and, more disturbingly, often underrepresented in biology classes at all levels. Nevertheless, it is most likely that mycology will soon undergo a renewal of interest. Firstly, because fungi are becoming more prominent in human concerns, as their impact on human, animal and ecosystem health are increasing, animal and plant biologists become more aware of their importance. Moreover, mycologists have organized to make their discipline more visible and to enable large scale scientific projects, such as the global analyses of fungal phylogeny and of their genome structure, function and evolution. This, combined with the next generation of sequencing technologies, now permits an in depth and global understanding on how fungi are organized and how they function. It also enables the development of strategies that will help to fight fungi when they negatively interfere with human concerns, as in human mycosis, or to use them in industries such as in renewable energy usage.

[Strategy for educating senior dermatological residents in mycology].

To improve the ability of dermatologists to diagnose cutaneous mycoses, we have proposed a list of the minimum mycological knowledge and skills required by senior residents of dermatology. The list includes ability to select the most appropriate sampling method, knowledge of the basic method of potassium hydroxide (KOH) examination and skill in performing fungal cultures and identifying the most prevalent fungal species isolated from skin lesions. It is not possible for the Japanese Society of Medical Mycology to train every senior resident directly, and it is difficult for them to acquire sufficient expertise independently. Consequently, training and advice given by instructors in residents' home institutes is essential. A project of an advanced course for instructors, who are in charge of educating senior residents in their own institute, may be possible. Therefore, we have proposed here a list for instructors of the knowledge and skills required to educate senior residents. Employing this list should realize improved skill in dermatologists.

Nueva estrategia docente: la enseñanza de la microbiología a través de su historia / A new teaching strategy to teach microbiology through its history

Ante el nuevo reto de la implantación del Espacio Europeo de Educación Superior los métodos de estudio deben adaptarse y servirse de herramientas innovadoras. Una buena estrategia para comprender una ciencia, su metodología y objetivos, es conocer su historia. Esta estrategia se hace especialmente útil en el caso de la Microbiología por ser una disciplina joven, que se ha cimentado precisamente en la metodología que sus creadores han ido elaborando.El objetivo de este trabajo ha sido crear una herramienta de utilidad en el aprendizaje de la Microbiología. Para ello hemos tomado como punto de apoyo su historia, es decir, explicar la Microbiología mediante la descripción de los descubrimientos y hechos que contribuyeron al desarrollo de esta ciencia. Para ello se ha creado una página web con dos aplicaciones independientes que operan sobre una base de datos común.1. La primera de carácter público para los alumnos aunque con posibilidad de acceso restringido; se pueden consultar los contenidos sin posibilidad de alterarlos.2. La otra aplicación es privada, los profesores pueden administrar los contenidos, y hacer uso de diferentes herramientas que facilitan la gestión de los mismos(AU)

In the light of the challenge presented by the European Higher Education Area, study strategies will have to adapt themselves and take advantage of innovative tools provided by modern information technology. One good way of understanding a science, its methodology and objectives is by taking an interest in its history. This approach is especially useful with regard to Microbiology, which is a fairly young discipline founded upon and made cohesive by the methods devised and constantly elaborated on by its designers.The aim of this work has been to offer guidance towards learning Microbiology. To this end we have chosen as our starting point, and indeed one of the keystones of our approach, the history of the subject itself; that is to say, an explanation of Microbiology via a description of the discoveries and milestones that have contributed to the development of this science. Thus we have set up a web page with two separate applications operating on one common database.1. The first is openly available to the students, although allowing the possibility of restricted access. Its contents may be consulted but not altered.2. The second is accessible only by lecturers, who may administer its contents and resort to different tools to facilitate the management of the information available on the site(AU)

[Thirty years of the "Asociación Española de Micología"]. / La Asociación Española de Micología cumple 30 años.

Since the foundation of the "Asociación Española de Micología" thirty years ago, we have consolidated the Spanish mycological community and also witnessed remarkable changes, not only in the Spanish society but in the scientific community as a whole. As it usually happens to human beings, during this time the "Asociación Española de Micología" has matured transforming itself into a solid scientific society. However, the "Asociación Española de Micología" will have to continue its transformation to adapt to new changes. This article shows the most relevant aspects in the history of the "Asociación Española de Micología" as well as new challenges that the society might face in the future.

La Asociación Española de Micología cumple 30 años / Thirty years of the “Asociación Española de Micología”

Desde su fundación con el objetivo de unir a los micólogos de nuestro país yen sus treinta años de existencia, la Asociación Española de Micología (AEM)ha asistido a los espectaculares cambios que ha experimentado la sociedadespañola y, sobre todo, el mundo científico. De manera análoga a lo queocurre con las personas, el paso del tiempo ha permitido que la AsociaciónEspañola de Micología madure y se consolide como sociedad científica.Sin embargo, la Asociación Española de Micología tendrá que seguirevolucionando para adaptarse a los nuevos tiempos. En este trabajo serecogen los aspectos más sobresalientes de la Asociación Española deMicología a lo largo de su historia y se analizan los retos que tendrá queafrontar en el futuro(AU)

Since the foundation of the “Asociación Española de Micología” thirty yearsago, we have consolidated the Spanish mycological community and alsowitnessed remarkable changes, not only in the Spanish society but in thescientific community as a whole. As it usually happens to human beings,during this time the “Asociación Española de Micología” has maturedtransforming itself into a solid scientific society. However, the “AsociaciónEspañola de Micología” will have to continue its transformation to adapt tonew changes. This article shows the most relevant aspects in the history ofthe “Asociación Española de Micología” as well as new challenges that thesociety might face in the future(AU)