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Pakistan-US Science and Technology Cooperation Program                                                            
Phase 4 (2009 Deadline)

Prevalence, Species Distribution, and Trends in Resistance of Fungi Responsible for Invasive Mycoses in Pakistan

Mary E. Brandt, U.S. Centers for Disease Control and Prevention
Afia Zafar, Aga Khan University
Pakistani Funding (Department of State): $256,088
U.S. Funding (Department of State): $40,250
Project Dates on U.S. Side: November 15, 2010 - November 14, 2013 (Extended through September 30, 2014)
           
Project Overview
 
The rapid escalation of invasive fungal infections and their high mortality is an increasing global issue, as the introduction of aggressive medical treatments such as bone marrow transplants and chemotherapy along with the increased prevalence of immunosuppressive diseases including HIV have contributed to a rise in invasive fungal infections across the globe. However, to date there is little epidemiological data available on such infections and trends in Pakistan. With increasing numbers of HIV-infected individuals and post-transplant patients in Pakistan, fungal infections will pose significant healthcare challenge, and baseline information on prevalent fungal infections is essential in developing plans to manage such infections in the country. The goal of this project is to improve the diagnosis and management of fungal infections in the Pakistani population by building lab infrastructure and technical expertise in fungal diagnostics and epidemiology. The research team at Aga Khan University (AKU) will develop linkages with oncologists, orthopedic surgeons and other specialists to explore the frequency of various fungal species in immunocompromized and immunocompetent individuals. The Mycotic Diseases Branch of the Centers for Disease Control will provide support for training, molecular typing, and expert advice. The project should result in the development of baseline epidemiological data on prevalent fungi causing invasive diseases in the local community and contribute towards the formulation of local guidelines for treatment. In addition, this activity will also provide opportunities for training in detection and identification of medically important fungi to a large number of laboratory workers across the country, upgrading Pakistan’s mycology capabilities at the national level. 
 
Quarterly Update
 
 CDC-AKU Diagnosis of Fungal Infections Workshop, 2013
Training workshop “Diagnosis of Fungal Infections in Clinical Laboratory” at Sheikh Zayed Hospital in Lahore, Feb 22, 2013
Over the past year, the project team saved 269 invasive fungal isolates for further workup in order to determine the spectrum of fungal pathogens associated with invasive fungal diseases in Pakistan. Dr. Kausar Jabeen, an MSc student in Medical Mycology from University College London, completed her bench work for molecular identification of molds under the supervision of Dr. Mary Brandt, CDC. Lab results continue to determine the frequency of occurrence and antifungal resistance among specific species of Candida associated with invasive disease through susceptibility test. On the basis of recent data and published studies (see publication list), a seminar is planned in late 2013 for medical microbiologists and infectious disease physicians to develop policies and guidelines for infection control and rational antifungal use. By conducting workshops throughout Pakistan, the PIs reported overall improvement in the standard of mycology diagnostic proficiency in clinical laboratories across Pakistan reflected by an increase in appropriate reporting and inclusion of fungal susceptibility testing in many laboratories. A simplified manual was prepared and distributed to all workshop participants, including technologists, laboratory doctors, and postgraduate residents. This grant also facilitated the MSc (Masters’ in Science in Medical Mycology degree) training of one of the co-investigators in the U.K. and higher level training of two postgraduates at CDC, Atlanta. As a result of multiple training activities and inclusion of both culture and non-culture based diagnostic methods, awareness of fungal infections among Pakistani clinicians has improved.
 
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