SUNDAY 22 OCTOBER 2023

Summary
Silke Schelenz obtained her MD in 1993 from the Free University of Berlin, Germany. She studied for her PhD and MSc at the University of London and is now a consultant microbiologist at Kings College University Hospital London and strategic clinical lead for infection Sciences Synnovis. Silke is the chair of UK Clinical Mycology Network/PHE, ECMM Fellow, a Department of Health NHSE specialty advisor and member of the SAC at the RCPath representing Medical Mycology.
Her main interest is on invasive mycoses in the immunocompromised host. Silke’s research has focused on the role of soluble pattern recognition receptors in the innate immune response to fungi. Her clinical research interest is on improving fungal diagnostic tools, effectiveness of antifungal stewardship, outbreak management of MDR Candida and the utility of novel antifungal agents in clinical practice.

Biography
Lewis White is consultant clinical scientist and leads the Public Health Wales Mycology Regional Reference Unit. He is a fellow of the European Confederation of Medical Mycologists and the Royal College of Pathologists, and leads the laboratory working party of the Fungal PCR initiative. Lewis is Education Secretary for the ESCMID Fungal Infection study group, Meeting Secretary for the British Society for Medical Mycology and the Vice President of the Welsh Microbiological Association. His research interests include evaluating novel fungal diagnostics and assessing diagnostic-driven and risk stratification approaches to managing invasive fungal disease, including the critically-ill COVID19 patient. He has published extensively in the field of medical mycology including international guidelines on defining and managing fungal disease.

Diagnostics
Professor P. Lewis White¹ FECMM, FRCPath
2 Public Health Wales Microbiology, and Cardiff University Centre for Trials research, Cardiff, United Kingdom

Overview:
This presentation will provide an update on advances and novel developments in medical mycology, focusing on both the pathogen (novel formats (new GM-EIA and lateral flow tests), new data and novel tests (e.g. Digital PCR) and the host (e.g. genomics) to provide personalized diagnostic strategies. It will also present diagnostic algorithms containing multiple different diagnostic tests for some of the main fungal pathogens in an attempt to highlight the pros and cons of multicomponent data.

Thomas J. Walsh, MD, PhD (hon), FIDSA, FAAM, FECMM, serves as Founding Director of the Center for Innovative Therapeutics and Diagnostics, the Henry Schueler Foundation Scholar in Mucormycosis, Adjunct Professor of Pathology of Johns Hopkins University School of Medicine, and Adjunct Professor of Medicine, Microbiology and Immunology of the University of Maryland School of Medicine, as well as Visiting Professor in Infectious Diseases and Medical Mycology, Aristotle University School of Medicine, and Visiting Professor, National and Kapodistrian University of Athens School of Medicine. Following graduation from Johns Hopkins University School of Medicine, and completing 10 years of post-doctoral training, leading to board certification in Medicine, Infectious Diseases, and Oncology, Dr. Walsh became the Chief of the Immunocompromised Host Section in the Pediatric Oncology Branch at the National Cancer Institute, where he founded a translational and clinical research program dedicated to the pharmacotherapeutics, immunopharmacology, and molecular detection of invasive fungal diseases in immunocompromised pediatric and adult patients. He was then recruited to serve as Professor of Medicine, Pediatrics, Microbiology & Immunology and the Founding Director of the first Weill Cornell/New York Presbyterian Hospital Transplantation-Oncology Infectious Diseases Program. As the author of more than 1,100 publications and investigator for more than 100 clinical studies, he and his colleagues have laid translational research foundations for major advances in diagnosis, host defenses, treatment, and prevention of invasive mycoses in immunocompromised pediatric and adult patients. Dr. Walsh has mentored more than 200 physicians, and scientists, and taught Medical Mycology, Pharmacology, and Immunology to more than medical 8,000 medical students. Finally, he has devoted his life to caring for pediatric and adult patients with severe life-threatening fungal diseases worldwide (www.missionfromtheheart.org).

Biography Chioma Aneke
Dr Chioma Aneke is a postdoctoral researcher in Seyedmousavi’s laboratory, Mycology Research section of the Department of Laboratory Medicine, Clinical Center in the National Institutes of Health, Bethesda campus, Maryland, USA. She is a Nigerian and grew up in Nsukka, Nigeria, Africa. She obtained her DVM and Master’s degree from the Faculty of Veterinary Medicine, University of Nigeria, Nsukka where she is also Senior Lecturer. She then obtained her PhD in Medical Mycology from the University of Bari, Italy supervised by Prof. Claudia Cafarchia. She has won lots of travel and research training grants which includes the TIMM-9 in Nice, France, ISHAM 2022, Charles University, Prague international grant. She is a reviewer of the Medical Mycology and Acta Tropica journals. As fun fact, she loves traveling, reading articles, and hiking with family. Above all, she loves eating pizza di Barese (pizza from Bari).

Biography Karl Dichtl
2023 Habilitation for Hygiene, Microbiology and Environmental Medicine
2022 Deputy head of diagnostics (Diagnostic and Research Institute for Hygiene, Microbiology and Environmental Medicine, Medical University of Graz)
2018 – 2021 Specialist for Microbiology, virology and epidemiology of infectious diseases / Senior physician (Max von Pettenkofer-Institute for Hygiene and Microbiology, Ludwig Maximilian University of Munich)
2017 Principle investigator (Junior research group at the Max von Pettenkofer-Institute, LMU Munich) for Clinical and diagnostic mycology and Biology and antigenicity of the fungal cell wall
2014 Doctorate
2013 – 2018 Resident physician and postdoctoral researcher at the Max von Pettenkofer-Institute, LMU Munich
2012 Resident physician at the Institute for Microbiology, Hygiene and Immunology, Technical University of Munich (TUM)

Rapid test for diagnosis of fungal infection
Chioma Aneke^{1, 2
1}Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
²Department of Veterinary Pathology and Microbiology, University of Nigeria, Nsukka, Enugu State, Nigeria

Fungal infections are a serious threat to public health especially since the advent of human immunodeficiency virus/AIDS epidemics, SARS-CoV-2 pandemic and other typical immunosuppressive conditions. Rapid and accurate diagnosis of these infections is crucial for an effective treatment which ultimately minimize morbidity and mortality.

In this presentation, we aim to present an overview of the rapid tests used for diagnosis of fungal infections based on our experience and available literature reviewed from the past 60 months. Current diagnosis of these infections relies on direct microscopy, cytology, histology, culture, novel PCR-based sequencing and serology.

Regarding fungal culture, it is a time-consuming procedure, while direct microscopy of potassium hydroxide (KOH) mounts suffers from low sensitivity. Fluorescence microscopy presents a higher sensitivity for fungal detection compared with KOH and can be used as a rapid screening tool. PCR-based sequencing is faster and more sensitive compared with culture. Besides, all the conventional approaches rely heavily on personnel with high levels of expertise in fungal identification and detection, and this is practically not possible in every setting.

However, several newer diagnostic procedures have been developed as alternatives to these conventional microbiological methods, diagnostic test tools such as the Matrix-Assisted Laser Desorption/Ionization – Time of Flight, Light Cycler PCR technique, T2 Candida panel assay, Film Array, RPA-Cas12a-fluorescence, lateral flow assays, microfluidic chip technology, new generation biosensors, nanotechnology-based tools, artificial intelligence-based models and others, allows the rapid detection of fungal pathogens from clinical specimens and determines resistance markers with a turnaround time of only a few hours.

On the other hand, many of these new assays require more validation data on larger patient cohorts through well-designed multicenter studies.  Thus, these new approaches cannot replace the conventional methods and need to be combined in order to obtain a more accurate diagnosis. Therefore, the audience is invited to share their experience with novel assays for the rapid diagnosis of these fungal pathogens to enable a lively discussion and exchange of opinions.

Summary Karl Dichtl
Timely diagnosis of invasive fungal infection (IFI) is pivotal for the outcome. However, culture-based mycology is time-intensive and flawed by long turnaround time for many fungal pathogens. Over the recent years, rapid tests for IFI have expanded our diagnostic armamentarium. Those assays include point of care (PoC) tests and also laboratory tests suitable for immediate testing of single samples. Thus, those rapid tests represent a welcome addition to our diagnostic tools, but must be used thoughtfully to ensure valid results and avoid inadequate diagnostics.

Biography Aleksandra Barac
Infectious diseases specialist, PhD in clinical mycology, Assistant Professor and Senior Researcher at Clinic For Infectious and tropical diseases, University Clinical Center of Serbia.

Biography Georgia Vrioni
Georgia Vrioni is currently Professor in the Department of Microbiology at the Medical School, University of Athens, Greece. Her main fields of interest and research are molecular microbiology, antimicrobial resistance mechanisms in Gram negative bacteria and fungi, and detection and identification of fungal, bacterial and viral pathogens in clinical samples. She is the scientific supervisor: (a) Mycology Unit and (b) Quality Control Unit of Microbiological Analysis in Microbiology Department, Medical School, University of Athens (Head Prof. A. Tsakris). She has been member of the Organizing Committee of various Congresses, Workshops and Seminar. She has been invited speaker in more than 150 Seminars, Congresses, Scientific Meetings, Symposia, Workshops and Courses. She has active participation in the Advisory Board of Hellenic Society for Microbiology since 2007 and of the Hellenic Society of Medical Mycology since 2008. She has 95 full publications in SCI journals (PubMed, December 2022) with 2.018 citations covered by Scopus, h- index 27 and 2.932 citations covered by Google Scholar, h-index 30 and i10-index 45 (December 2022), more than 350 abstracts presented in International and Hellenic Congresses and 72 full publications in Hellenic Scientific Journals.

Biography Monika Slavin
Monica Slavin leads a National Centre of Research Excellence in Infections in Cancer and Transplantation at University of Melbourne, Australia. She is Director of the Department of Infectious Diseases at Peter MacCallum Cancer Centre and of the Immunocompromised Host Infection Service at Royal Melbourne Hospital in Melbourne, Australia. She is Professor of Infection in Cancer and Transplantation at the University of Melbourne. Her research is in diagnosis and management of infections in the immunocompromised host with a particular interest in fungal infection.

Biography Tihana Bicanic
Dr Tihana Bicanic is a Reader and Consultant in Infectious Diseases at St. George’s University of London. Her research focusses on evolution, impact and mitigation of antifungal resistance in Cryptococcus and Candida. She has performed clinical trials in cryptococcal meningitis in Africa, as well as translational work linking Cryptococcal virulence phenotype and genomics to clinical presentation and outcome. She is currently Chief Investigator on two UK multi-centre studies: aspergillosis complicating severe influenza and COVID19 infection (AspiFlu) and Candida resistance in the ICU (CandiRes).

Cryptococcosis in people without HIV infection
Julien Coussement , Sharon SCA Chen and Monica A. Slavin

Cryptococcosis in Australia and New Zealand occurs predominantly in patients without HIV infection. A recent  study of cryptococcosis in Australian and New Zealand hospitals found that 90% of cases were HIV-negative with the marked predominance of HIV-negative cases evident in both Cryptococcus neoformans and C. gattii cases.  Infections in this population are becoming more frequent.  Whilst known immunocompromising conditions such as cancer or organ transplantation are common in this population, underlying immunocompromising conditions such as inflammatory conditions and the emergence of risk groups associated with modern therapies such as ibrutinib and fingolimod will be discussed.  Features of presentation and diagnosis specific to the population without HIV will be discussed, including the relationship between serum CRAG titres and central nervous system involvement.  Diagnostic issues such as a falsely negative CSF Biofire test and the incidental detection of infection on routine scanning in cancer and trauma patients will be discussed.  Overall 1-year mortality, the factors associated with poor outcomes and treatment recommendations will be presented.  This presentation will emphasise that a high level of awareness is warranted to diagnose cryptococcosis in patients without HIV.

Biography Robina Aerts
Robina Aerts is an MD currently working at the University Hospitals in Leuven. She is performing clinical research at the Catholic University in Leuven on infections in the immunocompromised host. She has a special interest in infectious complications and supportive care in hematology patients.

Biography Nina Khanna

Nina Khanna is Associate Professor of Infectious Diseases at the University and University Hospital Basel, Switzerland. She is a senior staff physician responsible for transplant infectious diseases at the University Hospital of Basel. She is research group leader of the Infection Biology Laboratory at the Department of Biomedicine. Her research focuses on understanding immune responses and the treatment of difficult-to-treat infections, with a particular interest in fungal and viral infections in the immunocompromised host.

Summary Robina Aerts
Corticosteroids act in several places in the immune system. This may lead to disruption of signaling via the toll-like receptor, a decrease in the function of CD4+ T cells, disruption of dendritic cell function and a reduction of immune globulin production. All of this could increase the host’s risk of opportunistic infections, and therefore of invasive mould infections. But what is the actual mechanism? And when do we have to be concerned? At what dose or duration the risk really is significant?

Summary Nina Khanna

Corticosteroids are often used in patients with immunocompromised conditions. They are a risk factor for the development of invasive fungal infection (IFI), including invasive Candida infections. Nowadays, corticosteroids may be needed to control an underlying disease even if an invasive fungal infection occurs. It is usually a major clinical dilemma whether and to what extent to discontinue them. This presentation will address systemic corticosteroids as a risk factor for invasive Candida infections, the impact of systemic corticosteroids on mortality and whether and to what extent their use should be discontinued.

Biography Amir Seyedmousavi

Dr. Amir Seyedmousavi is a Senior Staff-Clinical Microbiology Laboratory Director and Faculty member of CPEP Microbiology Fellowship Program at the Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA. In this role, he works as a Consultant Clinical Microbiologist for Infectious Disease Diagnostic Testing and Hospital Epidemiology Service. He also serves as Director of Mycology and Parasitology sections.

He obtained a VMD degree from University of Tehran, Iran, followed by a PhD (cum laude) in Medical Mycology. Then he moved to Netherlands and received a second PhD in Medical Microbiology and Antimicrobial Resistance and completed his Clinical Microbiology Postdoctoral Training and Research at Radboud University Medical Center in Nijmegen. He also conducted postdoctoral research on molecular taxonomy and fungal phylogenetics at Westerdijk Fungal Biodiversity Institute-KNAW in Utrecht, The Netherlands and completed a three-year advanced research fellowship at Molecular Microbiology Section of Laboratory of Clinical Immunology and Microbiology at National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA. He was also previously appointed as an Assistant and Associate Professor of Medical Microbiology/Mycology in Iran.

The scientific work in Dr. Seyedmousavi research laboratory focuses on molecular diversity, comparative genomic analysis, epidemiology, infection biology and evolution of antifungal drug resistance of pathogenic opportunistic fungi of human and animal origin. He is also interested in optimization of antifungal therapies through application of pharmacokinetic and pharmacodynamic principles. Another important area is to study new diagnostic technologies such as targeted next-generation sequencing for direct identification of fungi in clinical specimens, and to develop point-of-care testing for detection of fungal infections.

He has published over 150 research papers and several book chapters and has delivered over 100 invited lectures. He is co-editor of the textbook Emerging and Epizootic Fungal Infections. He is one of the founding members and coordinator of ‘ISHAM Fungal Diagnostics’ and ‘ISHAM Veterinary Mycology and One Health’ working groups.

Dr. Seyedmousavi serves as editor for ‘Medical Mycology’ and ‘Medical Mycology Case Reports’ the official journals of International Society for Human & Animal Mycology. He is also an associate editor for ‘IMA Fungus’ and serves on the editorial board of Journal of Clinical Microbiology, and several other peer reviewed journals.

He received several prestigious awards including NIH Clinical Center CEO Award in recognition of implementing Candida auris screening for Clinical Center patients. He is also the recipient of the Educational Trust Award from the Journal of Comparative Pathology, due to his significant scientific contributions to the field of Medical Mycology and One Health antimicrobial resistance.

Biography Malgorzata Mikulska

Malgorzata Mikulska is Associate Professor of Infectious Diseases at the University of Genova (Department of Health Sciences, DISSAL) since 2015, and full time Infectious Diseases Consultant at the Division of Infectious Diseases, IRCCSS Ospedale Policlinico San Martino in Genova, Italy.

She obtained her medical degree at Warsaw Medical University, Poland, subsequently recognized in 2005 by the University of Genova. She completed her specialty training in Infectious Diseases at the University of Genova and obtained PhD degree at Università Cattolica di Roma, Italy.

She is an author or co-author of over 200 documents, mostly indexed in international medical journals, with H-index of 44. She is also a co-author of 10 book chapters, including the one of Prophylaxis and Empirical Therapy of Infections in Cancer Patients in “Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases”, 9th Edition. By John E. Bennett, Raphael Dolin, Martin J. Blaser. Elsevier 2020.

Her principal areas of expertise are infections in the immunocompromised patients, in particular in patients with haematological disorders and allogeneic haematopoietic stem cell transplant (HSCT) recipients, and diagnosis and treatment of invasive fungal infections.

She is an active member of the following scientific societies:
• Infectious Diseases Working Party (IDWP) of EBMT (The European Group for Blood and Marrow Transplantation), Secretary for years 2016-2020
• European Conference on Infections in Leukemia (ECIL) group since 2009
• European Society of Clinical Microbiology and Infectious Diseases (ESCMID)
o Infectious Diseases Member of Professional Affaires Committee (PAS) of ESCMID
o ESCMID Study Group for Infections in Compromised Hosts (ESGICH)
o ESCMID Fungal Infection Study Group Study Group (EFISG)
• Academy Committee of ECMM (European Confederation of Medical Mycology) and ECCM Fellow since 2016
• Immunocompromised Host Society (ICHS) – member of the International Council
• Italian society of Infectious diseases and Tropical Medicine (SIMIT)
• Italian Federation of Human and animal Mycopathology (FIMUA) since 2008

Abstract

Standardization of fungal diagnostics is fundamental since quantitative results for some of the most important IFD, such as invasive aspergillosis, is fundamental for correct diagnosis and patient management. The implementation of rapid tests in different populations will be discussed.

Moreover, point-of-care tests in other IFD, including cryptococcosis and endemic mycosis, can contribute significantly to early and accurate diagnosis and improvement in patients, but standardization of the results might be challenging.

Biography
Professor of clinical mycology at Radboud University Medical Centre.

Summary

Reliable surveillance data regarding Aspergillus diseases are generally lacking, including data on antifungal resistance. The most straightforward approach is to perform pathogen surveillance, to determine the frequency of resistance in cultures isolates. A challenge is that many laboratories do not routinely perform in vitro susceptibility testing of molds. Agar-based screening might help to detect Aspergillus fumigatus colonies that are azole-resistant. A limitation of pathogen surveillance is that the clinical significance of the culture remains unknown. Furthermore, culture-negative cases will not be identified. Therefore, Aspergillus disease provides more meaningful data, but also comes with challenges. Medical information is needed to be able to determine if Aspergillus disease is present, requiring ethical approval and capacity to search through the patients medical files. Classification according to consensus definitions is also required, which may also be challenging. Nevertheless, it is important to design international surveillance protocols as fungal resistance is increasing and surveillance data are important to monitor trends within and between countries. Several initiatives have been initiated to set up international surveillance programs. For Aspergillus a One Health approach is required given the dominance of environmental resistance selection.

Biography

Pr Alexandre Alanio is an M.D., Ph.D., expert in medical mycology and medical parasitology. He is currently Professor at Université Paris Cité (Saint-Louis Hospital, Paris, France), heading the mycology-parasitology laboratory at Saint-Louis hospital, Head of the translational mycology group (Department of Mycology) at Institut Pasteur and Deputy director of the French National Reference Center for Mycoses and Antifungals.
He received his M.D. from Paris V university medical and its Ph.D. from Paris VII University. He owns more than 150 international publications and 5 international patents. He is currently teaching at the Université Paris Cité for medical students and Master and PhD students, and at the Medical Mycology Course of the Institut Pasteur.
He is leading a group at Institut Pasteur focusing on the heterogeneity of fungal populations focusing specifically on dormancy and persistence in Cryptococcus neoformans and in pathophysiology of invasive fungal infections. He aims at bridging medical mycology with basic research on the pathophysiology of invasive fungal infections and translating new biological tools (bench) into diagnostic test for fungal and parasitic infections (bedside).
On the bedside, he is actively working on the development of new molecular diagnostic tools for pneumocystosis, histoplasmosis, mucormycosis, aspergillosis, and other mold infections. He is also interested in the molecular epidemiology of antifungal resistance in clinically relevant fungi, in particular Aspergillus fumigatus or Candida glabrata. He published the ECIL-5 recommendation for the diagnosis of pneumocystosis in hematology patients and is part of the ISHAM Aspergillus resistance working group. He is member of ECCMID, ISHAM and ASM and is currently editor of Microbiology spectrum (ASM) and mBio (ASM), and Medical Mycology and Journal of Clinical Microbiology.

Abstract 

Invasive candidiasis is a quite pleiomorphic type of invasive fungal disease (IFD). Among invasive candidiasis, candidemia is one of the easiest and most important in numbers IFD to be epidemiologically surveyed in various countries. At least on positive blood culture obtained from peripheral blood or from the catheter classify in candidemia. Nationwide program already exists for years sometimes allowing a long-term analysis of the various species involved and the emergence of acquired antifungal resistance. I will discuss the different programs running worldwide and the major scientific facts coming from these surveillance programs.

Biography 
Professor of Medicine, Federal University of São Paulo, Brazil.
President Elect, International Society of Human and Animal Mycology (ISHAM).

Biography
Human clinical investigation on infectious disease and the lung Experimental and medical research on the treatment of aspergillosis Experimental and medical research on Nebulised antifungal treatment for Aspergillus Infection.

Biography

Biologist, PhD, data enthusiast. Working at the University Hospital of Cologne, Department of Internal Medicine. My research interests include the epidemiology of rare fungal infections and new therapeutic strategies to improve clinical management of patients with infections caused by emerging fungal pathogens.

Abstract

This presentation explores the role of consensus-driven management strategies in optimizing outcomes of patients with chronic pulmonary aspergillosis (CPA). Through research and clinical experiences consensus recommendations are formed and constantly improved to provide a comprehensive framework for diagnosis, treatment, and follow-up care. Chronic pulmonary aspergillosis poses unique diagnostic and therapeutic challenges, so we will be discussing the significance of consensus approaches in guiding the management of CPA.

Attendees will gain insights into the evolving landscape of CPA management, as well as the impact of consensus-driven protocols on patient care. The presentation aims to foster a deeper understanding of the disease, highlight the importance of interdisciplinary collaboration, and encourage innovative approaches to improve the lives of those living with CPA.

Biography
Dr Ritesh Agarwal is currently working as a Professor in the Department of Pulmonary Medicine at the Postgraduate Institute of Medical Education and Research, Chandigarh, India.
His primary research area is allergic bronchopulmonary aspergillosis. He also maintains a keen interest in pulmonary mucormycosis and chronic pulmonary aspergillosis.

Biography
Dr. Feys is an MD specializing in internal medicine and currently performing PhD-research in the team of prof. Joost Wauters at KU Leuven and University Hospitals Leuven in Belgium. His research focuses on the pathophysiology and clinical characteristics of viral-associated pulmonary aspergillosis in critically ill patients. For this work, he mainly resorts to patient samples for multi-omics based research in collaboration with renowned groups throughout Europe. This has led to publications in leading journals in the field, such as The Lancet Respiratory Medicine, Clinical Infectious Diseases and Intensive Care Medicine.

Aspergillus host interactions in viral-associated pulmonary aspergillosis
Until recently, invasive pulmonary aspergillosis was thought to primarily (if not only) occur in severely immunocompromised patients. The observation that influenza- and COVID-19-associated pulmonary aspergillosis (IAPA and CAPA) frequently affects critically ill patients with severe viral pneumonia, even those who are not immunocompromised, has shifted this view. We will dive into the rapidly expanding knowledge on the pathophysiology of IAPA and CAPA, and how this may translate into better prognostic, diagnostic and therapeutic strategies for these often lethal superinfections.

Biography
Dr. Ibrahim received his Ph.D. degree in Microbial Physiology from Loughborough University of Technology, UK and completed post-doctoral training in Infectious Diseases in the laboratory at Harbor-UCLA Medical Center. His studies focus on researching the molecular pathogenesis of fungal and bacterial infections as it relates to adhesin, invasion and toxin-mediated host cell damage. The goal of his research is to develop novel immunotherapeutic strategies including vaccines and antibodies targeting multidrug resistant infections (including the emerging Candida auris). Dr. Ibrahim laboratory is also heavily invested in the development of several new antifungal agents.

Mechanisms of mucormycosis infection in COVID-19 patients
COVID-19-Associated Mucormycosis (CAM) has been widely reported across the globe with the sub-Indian peninsula particularly hardly hit. The disease carries an overall mortality of ~50% and can reach almost 100% in severely immunosuppressed patients and those with disseminated disease or brain involvement.  We will review the recent advances made in understanding the pathogenesis of the disease and the possible connection to COVID-19 pandemic. We will also cover recent novel antibody therapies targeting the fungal invasin CotH3 and mucoricin toxin fungal adhesins and toxins.

Biography
Joost Wauters (MD, PhD) studied civil engineering and medicine, and specialized in internal medicine, emergency and intensive care medicine. Since 2011, he is full staff member at the Medical Intensive Care Unit (UZLeuven) and is Associate Professor at the Faculty of Medicine (KULeuven). His main research activities are about severe infections in critically ill patients and he is leading a translational research group on influenza- and COVID-associated pulmonary aspergillosis (IAPA/CAPA). He is principal investigator of several international multicenter studies, international speaker on ECCMID, IDweek and TIMM and he is member of several national (SIZ) and international scientific societies (ESCMID, ISICEM).

Biography

Laura Ferreras-Antolin is a Paediatric Infectious Diseases consultant at St. George’s University Hospital NHS Foundation Trust in London. She is also a Senior Clinical Research Fellow at the MRC Centre for Medical Mycology at the University of Exeter. She is a junior member of the European Paediatric Mycology Network (EPMyN) board; the deputy lead of the Fungal Infection Scientific Content Area within PENTA Child Health and part of the Paediatric group on Invasive Fungal Infections (Spanish Society of Paediatric Infectious Disease). Her main research interests are the epidemiology of invasive fungal infections in the paediatric population, fungal diagnostics and antifungal stewardship.

Abstract

Invasive infection by Candida species remains an important cause of neonatal nosocomial infections and it is associated with significant morbidity and mortality in neonates. While the general incidence rates of neonatal invasive candidiasis (NIC) vary between 0.5% and 2%; high-risk neonates, meaning those with gestational age <28 weeks and/or birth weight < 1000 grams, present higher incidence rates (7-9%).  Most of this data has been reported in high-income countries (HICs) and although the burden of NIC in low-middle income countries (LMICs) has been poorly described, this is likely to be higher and it presents pronounced variability between regions.

A few studies have also revealed a different profile of those neonates affected with NIC in LMICs compared to those from HICs. Higher proportions of older and larger neonates have been reported, differing from the high-risk neonate profile in HICs. Mortality outcomes in LMICs, despite significant variability and limited data, are worse; with reported mortality rates as high as 50%.

Microbiological data of NIC from HICs has pointed C. albicans as the leading pathogen isolated, followed by C. parapsilosis; with both species exhibiting low resistance rates to fluconazole (<5%).  However, a shift in the epidemiology of NIC has been reported in LMICs, with higher rates of non-albicans Candida isolates, as well as decreased susceptibility to fluconazole among non-albicans Candida isolates in some areas.

Only through a comprehensive understanding of the burden of NIC not only in HICs but also in LMICs, as well as the disease profile and outcomes in these settings; targeted future research and optimised treatment guidelines can be proposed.

Biography
Zoi Dorothea Pana is a Specialist in Pediatrics, Assistant Professor of the Medical School at the European University in Cyprus. Zoi holds a Scholar Fellowship Training in Hospital Epidemiology, Infection Control and Antimicrobial Stewardship at the Johns Hopkins Hospital (Baltimore, USA). Her research activities focus on Fungal Disease Epidemiology and Rare Fungal infections. Zoi is Member of several European Committees and Expert Groups in infectious Diseases and has participated in several clinical studies/trials with focus on fungal disease in pediatrics (IPFN, ESPID, ECMM/ISHAM, EHA, ECIL8- Pediatric Guidelines, C4C, PENTA, EPMyN, FungiScope®). Zoi is Member of the ECMM Guidelines Working Group (2014 ESCMID-ECMM European Guidelines on the diagnosis and management of hyalohyphomycosis, 2019 Mucormycosis ECMM MSG Global Guideline and currently she is currently working on the ECMM Candida and One Health ECMM Aspergillus guidelines. During the last 10 years, she has more than 15 peer-reviewed publications in the field of mycology, including invited systemic reviews and meta-analysis studies and she was recently appointed as Editorial Board Member of the Mycoses Journal.

Antifungal Resistance In Pediatrics
According to the latest WHO report emerging fungal infections pose an important public health threat and are often an under-recognized component of antimicrobial resistance (AMR), an emerging crisis worldwide, known also as the “silent pandemic”. Under the umbrella of ONE HEATH and across a period of profound global environmental change and expanding at-risk populations, WHO prioritizes critical, high and medium priority pathogenic fungi that are evolving resistance to the licensed systemic antifungal drug armamentarium. With this presentation we would like to update our knowledge on the fungal AMR surveillance, on the main mechanisms of antifungal resistance in the pediatric population and explore the similarities and differences between bacterial and fungal resistance to antimicrobial control. In addition, we would like to update the research and innovation topics that are needed for risk reduction strategies aimed at minimizing the emergence of resistance in pathogenic fungi in children.

Biography

I am assistant professor of Pediatric Infectious Diseases at the 3rd Department of Paediatrics in Aristotle University of Thessaloniki, Greece. I have finished my MD studies in the Aristotle University Medical School, Thessaloniki Greece (2002) and then completed post-graduate studies (MSc) in Medical Research Methodology (2005). In 2008, I had a training fellowship at the Division of Infectious Diseases, Children’s Hospital of Philadelphia (CHOP), in USA (participation in infection control and antimicrobial stewardship programs).
In 2016, I had a training fellowship in European Centers for Disease Control and Prevention (ECDC), and worked on surveillance of Hospital acquired Infections (HAIs) in children at European level. Thereafter, I have served as a scientific expert in several ECDC projects (including prudent use of antibiotics in Europe, Joint Inter-agency Antimicrobial Consumption and Resistance Analysis in Europe as well as outcome indicators for surveillance of antimicrobial resistance and consumption).
My main interest is in epidemiology of health-care associated infections as well as antimicrobial and antifungal stewardship. I participate in a multicenter study on antifungal use in pediatric and neonatal patients in Europe (CALYPSO study). I am member of the national hub for clinical trials in neonates and children (conect4children). I have participated in organizing joint ESCMID and ESPID Postgraduate Education Courses and currently I am member of the ESPID Committee of Education.

Abstract

Invasive fungal infections (IFIs) are associated with significant morbidity and mortality, especially in immunocompromised and critically ill neonatal and pediatric patients. The challenges in establishing a definite diagnosis of IFIs, the lack of consensus in defining high-risk populations, and the variability of pharmacokinetics in children have led to the overuse or misuse of antifungals in pediatrics.

Inappropriate use of antifungals entails a substantial risk of toxicity and interactions, along with the emergence of resistance. In this presentation we will review current antifungal prescription patterns in neonates and children and address opportunities for improvement. In addition, antifungal stewardship (AFS) programs are currently developed in many pediatric departments and we will discuss on how we can  implement antifungal stewardship activities in our institution, considering the unique needs of pediatric and neonatal populations.

Biography
Paul obtained his PhD in 1991 working with Geoff Turner on the genetics of Aspergillus nidulans. Since then has worked on fungal plant pathology at the Sainsbury lab in Norwich UK and at Long Ashton Research Station in Bristol before seeing the light and joining the medical mycology community in 2005. His work has mostly comprised genomics based studies on mycobiomes, AMR and virulence in fungi and finding ways to apply the scale and resolving power of genomics to speciate fungi and detect AMR.

Summary
Fungi are an unappreciated group of organisms that mostly look pretty much the same to other microbiologists. Even experienced mycologists can struggle with identification and as time passes and more and more species and species complexes are crammed into the space that previously comprised a single species it is increasingly difficult to identify fungal species. Added to this drug resistance is increasing and it is becoming clear that fungi are seldom found in isolation but rather in communities of organisms.

In this talk the range of methods used in the MRCM diagnostics labs will be discussed and the advantages and disadvantages of new techniques based on next generation sequencing will be covered.

Biography

Hospital Practitioner in Saint Louis Hospital, APHP, Paris, Department of Tropical Medicine Infectious Diseases

Main field of expertise: Infections in immunocompromised patients

MD in infectious diseases in Paris and Ph. D. in Epidemiology, on Fungal Infections in Patients living with HIV

Member of ECMM and St Louis Infectious Diseases Department is an ECMM diamond excellence center since 2019
-Member of ESCMID+ EFISG + l’EHA-SWG Infections in Hematology + SPILF (French Society of Infectious diseases) and the G2I (French Immunodepression and Infection Group of SPILF)

Biography
Dr. Spec‘s research is in fungal infections, particularly in immunocompromised patients, including those with transplants. His research focuses on Cryptococcus, Histoplasma, Candida, Aspergillus and other invasive molds. Dr. Spec also runs the division’s clinic focusing on invasive fungal infections, where he takes care of both immunocompromised and immunocompetent patients with fungal infections, which he considers the best and most rewarding part of his job.

Biography
Dimitrios P. Kontoyiannis is the Robert C Hickey Chair in Clinical Care Deputy Head, Division of Internal Medicine in the Division of Internal Medicine at MD Anderson Cancer Center in Houston, TX. Dr. Kontoyiannis has authored over 630 peer-reviewed manuscripts and has given over 350 lectures in national/ international conferences and academic institutions. He is considered the leading mycology expert world-wide (expertscape.com) with an H index of 113 and over 55000 citations. His research group is credited for many and sustained contributions to clinical, translational and experimental mycology. He is the past president elect of Immunocompromised Host Society (2016-2018). He is the leader of the European Confederation of Medical Mycology (ECMM) Diamond Excellence in Mycology Center at MD Anderson Cancer Center, the only US center to receive such designation by ECMM.

Biography
Professor Cornelia Lass-Flörl is internationally renowned in the field of medical microbiology. Professor Lass-Flörl’s teaching and clinical service responsibilities focus on the diagnosis of fungal infections in severely immunocompromised patients, with special interests in the epidemiology, diagnosis, prevention, and therapy of fungal infections. In addition, Professor Lass-Flörl’s work includes antifungal susceptibility testing and the interaction of fungi and platelets, all of which have culminated in her authorship of several journal articles, abstracts, and book chapters on her research. In 2020 and 2022 she was listed as “highly cited researcher worldwide” (Clarivate). Professor Lass-Flörl is an esteemed member of the sub-committee on Antifungal Susceptibility Testing of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the European Committee for Antimicrobial Susceptibility Testing (EUCAST) and was Chair of the Executive Board of the European Fungal Infection Study Group (EFISG).

News Excellence Centre – Austria
Cornelia Lass-Flörl

The tasks of the Institute of Hygiene and Medical Microbiology of Innsbruck Medical University comprise research, teaching, laboratory diagnosis of infectious diseases, and hospital hygiene as well as technical hygiene. HMM is one of the largest microbiology diagnostic laboratories in Austria, with an average sample throughput of 250 000 samples per year. In January 2018 the institute was designated as an ECMM Excellence Center Diamond Status. Research activities cover fungal pathogenicity and virulence factors, molecular mechanisms of hostpathogen-interaction including the complement system, basic immunological research, resistance detection and antifungal susceptibility testing.

Presently, the research focus lies on rare fungi and their antifungal susceptibility profile (RaMo-study) against conventional and novel antifungal drugs. Up to now, we have collected 449 various molds from 39 participating centres.

Biography
Eelco is currently head of section Mycology at Canisius-Wilhelmina Hospital (CWZ) in Nijmegen, the Netherlands. His center is part of the Radboudumc-CWZ Center of Expertise for Mycology, is an ECMM Diamond Status Excellence Center, as well as the National Expertise Center for Rare (ECZA) and Invasive Mycoses (RIVM). His training as MD was in parallel with an MSc in Clinical Research. For his subsequent PhD trajectory, Eelco was employed as a Postdoctoral Research Fellow at the E.L. Steele Lab for Tumor Biology, Harvard Medical School, Boston, USA. This was concurrently his PhD trajectory for Utrecht University, the Netherlands. In 2017, Eelco successfully defended his PhD dissertation and started his training as a Clinical Microbiologist soon after, with special interest in Mycology. The CWZ research group focusses on clinical and translational research in Mycology, with emphasis on severe fungal infections, surveillance, infection prevention and molecular diagnostics.

Biography
Priv.-Doz. Dr. Philipp Köhler is a consultant at the Department I of Internal Medicine at the University Hospital of Cologne, Cologne, Germany. He received his medical degree from Medical Faculty of the University of Cologne in 2012, where he also completed his residency. He is board certified internal medicine, hematology, oncology and intensive care and emergency medicine and infectious diseases. He is a fellow of the European Confederation of Medical Mycology (ECMM).
His clinical and scientific interests are focused on epidemiology, diagnosis, prophylaxis and treatment of invasive fungal infections in immunocompromised and critical care patients.
He is editorial board member for Mycoses and reviewer for numerous medical scientific journals.

News ECMM Excellence Centre 1
Philipp Koehler^{1, 2}

¹ Department I of Internal Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne
² Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Joseph-Stelzmann-Str. 26, 50931 Cologne

Invasive fungal infections are emergencies. They are difficult to diagnose and the treatment is complicated. The number of specialists who deal with these rare infections is very limited.

Around 50 fungal families of several thousand fungi cause disease in patients. The single pathogen is rare, but when infection occurs, the patient’s life depends on rapid diagnosis and treatment initiation.

The European Confederation of Medical Mycology (ECMM), the umbrella organization of 28 national mycology societies, awards European Centers of Excellence so that specialists for invasive fungal infections may be found more easily and a network Excellence Centers is created throughout the world. In Germany, the Cologne Excellence Center was opened with a symposium at Cologne University Hospital in October 2017 and was re-certified in mid-September 2021.

Here we will give information of the past, current and future activities of the ECMM Excellence Center at University Hospital of Cologne, Cologne Germany.

Biography
PhD in Health Sciences by the University of Cologne (Cologne, Germany) is a postdoctoral researcher and project manager. Currently, he is a member of the Coordination Office of the VACCELERATE Consortium, a pan European clinical research network for the coordination and conduction of COVID-19 vaccine trials (www.vaccelerate.eu), managing the EUVAP – European Vaccine Trial Accelerator Platform (www.euvap.eu), so as the VACCELERATE Volunteer Registry (www.vaccelerate.eu/volunteer-registry). In parallel, he also coordinates the EPICOVIDEHA survey – Epidemiology of COVID-19 infection in patients with haematological malignancies: A European Haematology Association Survey (www.ehaweb.org/covid-19/epicovideha-survey/). Additionally, he is in charge of the research series “The current state of laboratory mycology in…”, an online survey where institutions from different geographical regions are being asked about their diagnostic and treatment capacities for invasive fungal infections. He has a special interest in registries and questionnaires, database management, invasive fungal infections and infectious diseases in general.

Abstract
Objectives:
Early identification and clinical treatment of invasive fungal diseases require access to the right instruments. The goal of this work is to summarise Europe’s diagnostic capabilities for invasive fungal infections in order to better understand the situation and the most critical issues that need to be addressed.

Materials & Methods:
Institutions in Europe self-assessed their invasive fungal infection control capabilities. They were contacted through email and requested to take part.

Results:
For diagnosis and management, 383 (99%) of the 388 participating institutions from 45 countries had access to cultures, 375 (97%) to microscopy, 363 (94%) to antigen-detection assays, 329 (85%) to molecular testing (mainly PCR), and 324 (84%) to antibody tests. With the exception of microscopy, there were significant disparities in availability to methods among nations based on their GDP. With country-based differences, at least one triazole was accessible in 363 (94%) of the institutions, one echinocandin in 346 (89%), and liposomal amphotericin B in 301 (78%). There were also differences in access to therapeutic medication monitoring.

Conclusions:
Despite the fact that Europe is well prepared to handle invasive fungal infections, certain institutions lack access to specific diagnostic equipment and antifungal medications, despite the fact that the majority are deemed necessary by WHO. These constraints must be addressed in order to ensure that all patients receive the greatest diagnostic and treatment care.

Biography
Rita Oladele, MBBS, FMCPath (Nig), PhD (Manc), FRCPath (UK), FECMM

An ECMM fellow with over 15 years’ experience as a clinical microbiologist involved daily with the diagnosis and management of infectious diseases in the hospital. An Associate Professor at the University of Lagos, Nigeria. The GAFFI ambassador for Nigeria. Have established collaborative network with clinicians and researchers in PEPFAR sponsored HIV reference laboratories and clinics, involved with the diagnosis and management of over 100000 HIV infected patients in Nigeria. 1 conducted a 14 Centers training on diagnosis and management of cryptococcal meningitis in 2018; over 850 health care workers were trained. The impact of the training contributed to the Federal Ministry of Health constituting a national task team for advanced HIV disease, of which I am a member. Recently concluded a 10-site survey of histoplasmosis in Nigeria and proceeded to build capacity in 10 HIV disease high burden sites in Nigeria. Was a member of the WHO advisory group on priority fungal pathogens. Published over 90 peers reviewed articles with 4638 citations with an H-index of 22 and i10-index of 37.
Summary of the impact of my work includes:
– Member of the AHD-TWG that conducted a phased implementation of AHD package of care in Nigeria, starting with 28 high burden sites, which has now been scaled up to 2000 sites in Nigeria.
– Single handedly driven education on suspicion and diagnosis in the at-risk groups in Nigeria, by hosting forums for training multidisciplinary clinicians and scientists. This cumulated in establishing a Medical Mycology Society in Nigeria, with a membership strength of 84.
– Founded with guidance from ISHAM, the Pan African Mycology working group of which I am the co-chair. The group has successfully established a network of scientists and clinicians in over 14 African countries and is hosting her 1st scientific meeting this May 2023
– Co-authored 3, Clinical international global oneHealth, Guidelines – Mucormycosis (2020), Aspergillosis in covid-19 (2021) and the world’s first for chronic pulmonary aspergillosis (for LMICs, 2018); Essential Diagnostics for LMICs (GAFFI, 2018)
– Trained over 850 health care workers in Nigeria on diagnosis and management of cryptococcal meningitis.
– Trained over 300 health care workers on the diagnosis and management of disseminated histoplasmosis in the Advanced HIV disease population
– Completed the first prospective multi-centre survey (10 sites) on histoplasmosis amongst AHD patients in Africa.

Fungal disease surveillance; the impact of capacity building
Rita Oladele
Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos University Teaching Hospital, Lagos Nigeria.

Background: Invasive fungal diseases are a neglected group of diseases, despite being life-threatening with rising morbidity and mortality in many countries including Nigeria.

Objective: To determine the effectiveness of a clinician training intervention on invasive fungal diseases in consultants and residents in tertiary hospitals in Nigeria.

Methods: This was a pre-experimental research design (one-group pretest-posttest research design) which involved 162 clinicians in 6 federal tertiary hospitals in Lagos. Six Training modules were developed and peer reviewed by international experts from renowned organizations such as ECMM, GAFFI and ISHAM and utilized to administer the training. Respondents were also given a developed pretest and posttest, before and after each module to voluntarily provide responses. Descriptive statistics was used to summarize variables and paired t test was used to test for significant differences in means. A p value of < 0.05 was taken to be statistically significant.

Results:  A total of 149 clinicians were involved in one or more pretest-posttest exercises. The mean performance scores of the participants was improved significantly after training on invasive aspergillosis (pretest = 12.6 ± 2.6, posttest = 15.8 ± 2.1 ;p < 0.001), chronic pulmonary aspergillosis (pretest = 15.4 ± 2.2, posttest = 17.4 ± 1.6 ;p < 0.001), invasive candidiasis (pretest = 14.7 ± 2.1, posttest = 18.2 ± 1.1 ;p < 0.001), pneumocystis pneumonia (pretest = 13.3 ± 2.3, Post-test = 16.3 ± 1.8 ;p < 0.001), mucormycosis (pretest = 13.2 ± 2.2, posttest = 17.1 ± 1.7 ;p < 0.001) and histoplasmosis (pretest = 13.0 ± 2.4, posttest = 14.9 ± 1.7 ;p = 0.002).

Conclusion: Clinicians’ knowledge of invasive fungal diseases should not be left to assumption but training targeted at building capacity for diagnosis and management should be engaged to enhance patient treatment outcomes.

Biography
Professor Sharon Chen is the Director, Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, which incorporates the Clinical Mycology Reference Laboratory. She is also a Senior Staff Specialist in Infectious Diseases and Head of Clinical Mycology. Her ongoing contributions to mycology stem from a PhD (2000) in molecular epidemiology and basic mycology on characterization of cryptococcal phospholipase and virulence which she has built on since.

An active member and past co-chair of the Australia and New Zealand Mycoses Interest Group (ANZMIG), she has been on the steering committee for the inaugural and present guidelines for antifungal drug use. She has collaborated with the European Confederation of Medical Mycology and ISHAM on guidelines for managing rare yeast infections, mucormycosis, candidiasis, and COVID-associated aspergillosis. She is a member/past Secretary of the Board, Mycoses Study Group Education and Research Consortium and member of its Scientific Committee.
Her interests are in novel diagnostics, drug resistance and epidemiology of fungal diseases. She is an investigator on several antifungal drug trials evaluating their efficacy, safety, and including use of various dosing regimens of new antifungals within existing, and novel, drug classes. She is the present Editor-in-Chief of Medical Mycology, the societal journal of ISHAM.

Biography
Professor of infectious diseases at UFCSPA, Southern Brazil
Fellow of the ECMM

Biography
Livio Pagano is currently Associate Professor of Hematology at the Università Cattolica del Sacro Cuore and works at Fondazione Policlinico Universitario A. Gemelli-IRCCS Rome.
Director of Division of “Geriatric Hematology and Rare Hemopathies”.
Member of national and international academic societies in the field of hematological and infectious diseases such as GIMEMA (Chairman Infectious Working Party), ASH, EHA (Executive Board of Infectious Disease Group), SIE, EORTC-IDG (Chairman 2018-2020), FIMUA (President for 2007-2015), SEIFEM (Chairman 2004-2018). Peer-review of numerous international journals.
Author of over 400 original articles published in journals with an impact factor and a Citation Index (Scopus) of 66.
The main areas of interest are the diagnosis and treatment of hematological malignancies (with particular attention to “rare” forms), epidemiology and treatment of secondary leukemias, and the management of infectious complications in the neutropenic patient

Biography
Thomas J. Walsh, MD, PhD (hon), FIDSA, FAAM, FECMM, serves as Founding Director of the Center for Innovative Therapeutics and Diagnostics, the Henry Schueler Foundation Scholar in Mucormycosis, Adjunct Professor of Pathology of Johns Hopkins University School of Medicine, and Adjunct Professor of Medicine, Microbiology and Immunology of the University of Maryland School of Medicine, as well as Visiting Professor in Infectious Diseases and Medical Mycology, Aristotle University School of Medicine, and Visiting Professor, National and Kapodistrian University of Athens School of Medicine. Following graduation from Johns Hopkins University School of Medicine, and completing 10 years of post-doctoral training, leading to board certification in Medicine, Infectious Diseases, and Oncology, Dr. Walsh became the Chief of the Immunocompromised Host Section in the Pediatric Oncology Branch at the National Cancer Institute, where he founded a translational and clinical research program dedicated to the pharmacotherapeutics, immunopharmacology, and molecular detection of invasive fungal diseases in immunocompromised pediatric and adult patients. He was then recruited to serve as Professor of Medicine, Pediatrics, Microbiology & Immunology and the Founding Director of the first Weill Cornell/New York Presbyterian Hospital Transplantation-Oncology Infectious Diseases Program. As the author of more than 1,100 publications and investigator for more than 100 clinical studies, he and his colleagues have laid translational research foundations for major advances in diagnosis, host defenses, treatment, and prevention of invasive mycoses in immunocompromised pediatric and adult patients. Dr. Walsh has mentored more than 200 physicians, and scientists, and taught Medical Mycology, Pharmacology, and Immunology to more than medical 8,000 medical students. Finally, he has devoted his life to caring for pediatric and adult patients with severe life-threatening fungal diseases worldwide (www.missionfromtheheart.org).

Pre-Emptive, Empirical, and Prophylactic Management of Invasive Fungal Diseases in Neutropenic Patients and Hematopoietic Cell Transplantation Recipients

Invasive fungal diseases (IFDs) are important causes of morbidity and mortality in pediatric and adult patients with hematological malignancies.  Early diagnosis of IFDs is difficult and a delay in treatment while pursuing a diagnosis may result in progressive infection with potentially fatal outcome.  The interventions for early treatment and prevention of IFDs in patients with hematological malignancies have been developed through well designed and rigorously implemented randomized clinical trials.  Empirical, pre-emptive, and prophylactic antifungal strategies have significantly reduced the incidence and improved the outcome of IFDs in these vulnerable patient populations. However, understanding these different strategies is essential to optimizing individual patient care and establishing standard institutional protocols. The objective for empirical therapy is to initiate early antifungal treatment with a broad spectrum agent (liposomal amphotericin B, mould-active triazole, or echinocandin) for possible invasive fungal disease and to provide prophylaxis in high risk febrile patients.  Pre-emptive antifungal therapy is usually administered as a mould-active triazole to target probable invasive aspergillosis based upon computerized tomographic imaging and galactomannan or PCR biomarkers on the background of fluconazole prophylaxis against invasive candidiasis. Antifungal prophylaxis is initiated with mould-active triazoles before the onset of neutropenia and continued until recovery from neutropenia in acute leukemia and continued through post engraftment immunosuppression in hematopoietic cell transplant recipients. Studies of prophylaxis with echinocandins in neutropenic pediatric patients with acute leukemia and adult patients with hematopoietic cell transplantation also have demonstrated activity in prevention of IFDs. The decision to use a specific strategy or an antifungal agent depends upon patient risk factors for IFDs, net state of immunosuppression, underlying neoplastic condition, drug-drug interactions, end-organ toxicity, epidemiology of hospital and community associated mycoses, patterns of local antifungal resistance, and availability of diagnostic modalities.  These strategies collectively have contributed to significantly  improved outcome as well as reduction of severe morbidity and mortality in pediatric and adult patients with hematological malignancies.

Biography
Robert Krause, MD, DTMP, is Head of the Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Austria. He further leads the Infectious Diseases Consultation service located at the University Hospital Graz. Clinical mycology in one of his main research interests and he established the fungal research group at his institution. He served as the President of the Austrian Society of Antimicrobial Chemotherapy and is Executive Board member of the Austrian Society of Infectious Diseases and Tropical Medicine.

Biography

Birgit Willinger
Medical University of Vienna, Austria

Associate professor, Head of the Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, head of the Austrian reference laboratory for yeasts and moulds.
Current president of the German Speaking Mycology Society and past president of the Austrian Society of Hygiene, Microbiology and Preventive Medicine (2018 – 2022), the Austrian Society of Medical Mycology (2006 -2012) as well as the head of the section “Antimycotic Therapy” of the Paul-Ehrlich-Gesellschaft (PEG), Germany.
Birgit Willinger received her MD from the University of Vienna and was then trained at the Hygiene-Institute of the Medical University of Vienna. She became fascinated by medical mycology when she visited a summer course at Duke University, Durham, NC, USA. This was followed by several fellowships at different mycology units in Germany. She then established the diagnostic work up at the Division of Clinical Microbiology of the former Department of Hygiene and Medical Microbiology, Medical University of Vienna.
The focus of her research is based on epidemiology, diagnosis of fungal infections as well as antifungal susceptibility testing.

Abstract

The Division of Clinical Microbiology is part of the Department of Laboratory Medicine at the General Hospital of Vienna, which is a tertiary care hospital and closely connected to the Medical University of Vienna. The division is primarily involved in the diagnosis of infectious diseases having a focus on bacterial and fungal infections. It provides a routine diagnostic service not only to the General Hospital but also to other hospitals and any physician when special expertise is needed. The division’s consultants also offer consultation service for all questions regarding diagnosis of fungal infections. In terms of Medial Mycology, the main goal is to offer timely, most distinguished diagnostics to allow rapid and reliable detection of fungi and to perform antifungal susceptibility testing whenever it is necessary.

Understanding the burden of fungal disease new molecular platforms, in the form of advanced nucleic acid amplification systems, nuclear magnetic resonance systems, proteomic platforms, including matrix assisted laser desorption time of flight spectroscopy are offered to accelerate laboratory detection and afford earlier targeted antifungal therapy. Up-to-date immunologic assays for antigen detection are important add-ons for a reliable diagnosis and early treatment and are also in regular use. Teaching of undergraduate,and graduate students as well as postgraduate education are well established and studies for a better and more rapid diagnosis of fungal diseases have been and will be continuously performed.

We stand committed to fill open gaps being not only a reliable partner in collaborative studies but also to dedicate our research to enhance the field of Medical Mycology.

Biography
Johannes Wagener is Associate Professor / Consultant in Clinical Microbiology at Trinity College Dublin, the University of Dublin, Ireland. He is also a Consultant Microbiologist at St. James’s Hospital, Dublin, and at the Health Service Executive (HSE) Public Health Laboratory in Dublin.
He received his medical degree and completed his specialist training in medical microbiology, virology and infectious disease epidemiology at the University of Munich, Germany. Before establishing his research group in Ireland, he headed research groups at the University of Munich and the University of Würzburg in Germany. His research interests include applied clinical microbiology and basic medical mycology with a special focus on antifungal agents, fungal cell biology, biomarkers of fungal infections and host-pathogen interaction.

Short biography
Joerg Steinmann, MD, is Professor of Microbiology and Hygiene at the Paracelsus Medical University, Nuremberg, Germany and the Director of the Institute of Clinical Hygiene, Medical Microbiology and Infectiology at the Hospital Nürnberg.
He received his medical degree (2005) from the Justus-Liebig University Giessen. In 2007 he moved to the University Hospital Essen, became in 2012 a specialist for Medical Microbiology, Virology and Epidemiology of Infectious Diseases and habilitated in 2014.
His research interests are laboratory diagnosis of fungal infections including molecular based methods, antifungal susceptibility testing, resistance mechanisms against antifungals and fungal biofilms.
Joerg Steinmann is a reviewer for several scientific journals and Editorial Board member of Reviews in Medical Microbiology. He is involved in the ISHAM working groups Fungal Respiratory Infections in Cystic Fibrosis, Pseudallescheria/Scedosporium and Aspergillus Resistance.

Biography

Katrien Lagrou is Head of the Microbiology Laboratory at the University Hospitals of Leuven (UZ Leuven), board member of UZ Leuven, Chair of the Department of Microbiology, Immunology and Transplantation at the KU Leuven and coordinates the Belgian National Reference Center for Mycosis. She is full professor at the Faculty of Medicine of the University of Leuven (KU Leuven), Leuven, Belgium. Professor Lagrou obtained her Master’s degree in Pharmaceutical Sciences from the University of Leuven in 1992, and remained there to specialise in Laboratory Medicine between 1992 and 1997. During this period, she received a degree in Mycology from the Institute of Tropical Medicine in Antwerp, Belgium and completed her PhD in 2002.

Professor Lagrou’s main interest is the diagnosis and treatment of infections in severely immunocompromised patients, with a focus on invasive pulmonary aspergillosis. She is chair of the European Confederation of Medical Mycology (ECMM) Committee Academy and board member of the Belgian Society of Infectiology and Clinical Microbiology. Professor Lagrou published her research in more than 320 manuscripts in peer reviewed journals.

Biography
Sanja Pleško MD, PHD, Senior consultant in medical microbiology and Assistant Professor, School of Medicine, University of Zagreb.
Author of 2 chapter in medical textbooks and over 29 in extenso scientific publications.
Area of interest: mainly focused on invasive fungal infection, especially on the diagnostic of invasive fungal infections and antifungal susceptibility.
Currently, Head of Division for Mycology, University Hospital Centre Zagreb, Zagreb, Croatia.

Excellence center FECMM Croatia
          Department for Clinical and Molecular Microbiology, University Hospital Centre Zagreb in 2018 became ECMM Excellence Centre for Medical Mycology and from January 2019 and started with the support of Croatian Committee for Antibiotic Resistance, Croatian Academy of Medical Sciences the surveillance of the etiological agents of candidemia started with collecting Candida spp. isolates from blood cultures. All microbiological laboratories in Croatia were invited after isolation of Candida spp from blood culture to send the isolate to Division for Mycology, Department for Clinical and Molecular Microbiology, University Hospital Centre Zagreb, ECCM Excellence Centre and fulfil the form on the Excellence Centre website fungi.kbc-zagreb.hr. This form contains the data about the isolate, identification methods and methods used to determine isolate antifungal susceptibility as well as clinical data about the patient. In Division for Mycology every isolate was re-identified with MALDI-TOF MS (Bruker Microflex LT Biotyper) and then susceptibility testing was performed for every isolate using microdilution method according to CLSI guidelines.

From beginning of year 2019 until the end of year 2021 around 505 Candida spp. isolated from blood cultures were re-identified and tested for antifungal susceptibility. Until 2021 the most common isolate was C. albicans but in 2021 C. parapsilosis for the first time became most common species isolated from blood cultures in Croatia in 2021. Isolates of C. parapsilosis developed resistance to fluconazole in large number of isolates unfortunately; in 2019 resistance was 76,7%, in 2020 73,67%. And 2021. 80%. It is important to emphasize that in 2019 13, 46% of patients with fluconazole resistant C. parapsilosis were on fluconazole therapy 7 days before beginning of candidemia in year 2020 16,67% and in year 2021 13,75%.

Further surveillance and molecular studies such as genotyping collected fluconazole resistant isolates of C. parapsilosis is planned as well as researching new methods in controlling possible outbreaks with such isolates.

Biography
Dr. Thompson is Professor of Clinical Medicine at the University of California, Davis, School of Medicine with a joint appointment in the Departments of Medical Microbiology and Immunology, and Internal Medicine, Division of Infectious Diseases. Dr. Thompson specializes in the care of patients with invasive fungal infections and has research interest in clinical trials, fungal diagnostics, and host immunogenetics.

Biography
Dr. Thuy Le is an adult infectious disease physician and epidemiologist from Duke University School of Medicine. Her research focuses on development and testing of novel diagnostic and treatment strategies for HIV-associated invasive fungal infections.

Summary

Talaromycosis is an invasive fungal infection caused by the dimorphic fungus Talaromyces marneffei. In the endemic regions in South East Asia talaromycosis is a leading cause of HIV-associated fungal infection and AIDS death, and is increasingly diagnosed in travelers to the endemic regions and in other immunocompromised people. Approximately 18,000 cases and 5,000 deaths occur per annum. High mortality on therapy is a result of delays in current culture-based diagnosis which takes up to 28 days for isolation and has low sensitivity especially during the early stages of disease. Treatment options remain limited to just two drugs amphotericin B and itraconazole; both of which have severe limitations. This talk reviews the epidemiology of talaromycosis and gives an update on current and new diagnostic and treatment strategies for talaromycosis as well as strategies for primary and secondary prevention of disease.

Biography
Infectious Diseases and Tropical Medicine Specialist
Associate Professor, Public Health Department, Federal University of Paraná, Brazil

Biography
Ferry Hagen is a group leader at the Westerdijk Fungal Biodiversity Institute (WI-KNAW). After receiving his PhD from the Utrecht University with a thesis entitled ‘Cryptococcus gattii and Cryptococcus neoformans – Cosmopolitans on the move’, Hagen worked as (medical) molecular microbiologist at CWZ Canisius-Wilhelmina Hospital in Nijmegen. In 2017, he returned to the Westerdijk Institute where he is heading the research group Medical Mycology. Since 2022 he is professor ‘Fungal Functional Diversity’ at the University of Amsterdam.

Biography
Dr Kauser Jabeen is a clinical microbiologist working at the Aga Khan University, Karachi, Pakistan. She has a special interest in fungal infection and has done MSc in Medical Mycology from UCL, UK. She has more than 120 publications and several grants. She is the current country ambassador for GAFFI from Pakistan. She is one of the guideline coordinators of the ECMM/ISHAM global guidelines for Aspergillus.

Biography
Daniele Roberto Giacobbe, MD, PhD, is assistant professor of infectious diseases at the University of Genoa, Italy. He is also working as an infectious diseases specialist at San Martino Polyclinic Hospital in Genoa and is a member of the directive committee of the Italian Society of Anti-Infective Therapy (SITA). His main fields of research are severe infections due to difficult-to-treat gram-negative bacteria and invasive fungal diseases in the intensive care unit. He is author of more than 200 original articles or reviews in peer review journals, and has received the National Academic Qualification as Associate Professor in Infectious Diseases (Italian ASN). He serves as editor, editorial board member and/or referee for a number of international scientific journals. Past member of the executive committee of the Critically Ill Patients Study Group of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), he enjoys coordinating research projects and working in enthusiastic multicenter, multinational research groups.

Biography
John R. Perfect, MD is James B Duke Professor of Medicine, Professor of Molecular Genetics and Microbiology and Chief of Infectious Diseases at Duke University. His general research focus for four decades has been on cryptococcosis: pathogenesis and management. He also investigates other fungal infections through basic, translational and clinical trials with a worldwide net of collaborators. He interacts as a consultant for many pharmaceutical companies in the antifungal space and holds multiple NIH grants to support his research. He has published approximately 650 papers and 7 books. He is a Fellow in the Infectious Disease Society of American, American Society of Microbiology, American Association for the Advancement of Science, and Association of American Physicians. At Duke he has been honored as University Scholar/Teacher of the year, Research Mentoring Award, and Alumni Associations Distinguished Faculty Award. He is recipient of the Maxwell Littman Award from Medical Mycology Society of New York, the Rhoda Benham Award from the Medical Mycology Society of the Americas, Lucille Georg Award from ISHAM, and the IDSA Edward H. Kass Lecturer. He has directly mentored or trained over 70 graduate students, post-docs, ID fellows or Junior Faculty at Duke. Along with his basic science research portfolio, he also teaches students and attends to patients at the beside. He is Past-President of the Mycoses Study Group (MSG) based in USA and now President of the international Society of Human and Animal Mycology (ISHAM).

Cryptococcal Guidelines-2023
John R. Perfect, MD, Duke University Medical Center

The Cryptococcal Guidelines initiated by the European Congress of Medical Mycology has been completed.  This work has been a comprehensive review and collection of data which has produced a graded structure of recommendations similar to the 2010 Infectious Diseases Society of the America’s Cryptococcal Guidelines.   The primary risk groups have been divided into three:  HIV, Transplantation, non-HIV and non-transplant.  This has allowed some specific issues to be addressed within groups but continues to attempt to recommend insightful principles which can be used by clinicians. In many respects, these guidelines represent a mixture of prior experiences, insights from robust recent clinical trials and determination of clinical nuances for successful management combined to give important recommendations for both resource-available and resource-limited health care systems.  The AIDS epidemic created a host ideal for cryptococcal dissemination and subsequently, the incidence of disease rose substantially.  With ART the numbers of cases have dropped from their peak world-wide but amount of disease has seemed to stabilize and new risk populations have appeared.  The acute mortality of cryptococcal meningoencephalitis has improved but failures remain with deaths.  In the most recent clinical trials with best present regimens in resource-limited health care systems reports show an acute mortality of approximately 25% while retrospective studies in resource-available health care systems suggest that mortality rates may be substantially lower at around 10%.  In the process of carefully describing and producing management strategies, the guidelines were divided into the following sections to provide an inside look at the knowledge of management with its successes and failures.  At present, there are only 3 major antifungals to be used in management (polyenes- either conventical amphotericin B or a lipid product, flucytosine and fluconazole.  It is important to emphasize that there is now substantial clinical experience with this encapsulated basidiomycetous yeast  with over 75 years of successful management of these serious, life-threatening infections.  The Guidelines are divided into the following topics: (1) At risk populations, clinical presentations, and outcomes; (2) Yeasts causing cryptococcosis and diagnostic methods;(3) Screening, primary prophylaxis/ pre-emptive therapy; (4) Principles of treatment and navigating guidelines (HIV-associated, solid organ transplant recipients, non-AIDS, non-transplant individuals) for CNS, pulmonary, non-pulmonary, non-CNS disseminated disease; (5) A series of specific management issues were addressed: Raised intracranial pressure; Timing of antiretroviral use; Resistance to antifungals; Cryptococcal persistence, clinical and culture positive relapse; Immune-reconstitution inflammatory syndrome (C-IRIS); Cryptococcus gattii infections; Cryptococcomas; Non-neoformans and non-gattii strains of cryptococcus; Pregnancy; and Pediatrics.  This is a comprehensive discussion synthesized into tables that are practical for clinicians to utilize. The work has been accomplished with contributions and insights from over 40 medical mycology experts world-wide and documented with over 300 published reports.  It is comprehensive and world-wide in its reach and understandings as it attempts to provide context for resource-available and resource-limited health care environments.  It is hoped that this updated work provides clinicians with a standard for clinical practice today and a road map for Guidelines of tomorrow.