blog

Today is Rare disease day, a day dedicated to raising global awareness about rare diseases and their impact on patients’ lives.

In recognition of this, we interviewed Anna Skiada, February’s featured Faculty Member of the Month, a consultant in infectious diseases who firmly believes that international collaboration is the only way to explore, and eventually conquer, rare fungal infections.  

Skiada was born in Athens, Greece, and graduated from the Aristotelion University School of Medicine, in Thessaloniki, before completing her residency in Internal Medicine in the National and Kapodistrian University of Athens.

After doing a PhD in Infectious Diseases, she has been working in Laiko Hospital, which is affiliated with National and Kapodistrian University of Athens, doing consultation and research in infectious diseases. She carries out research in a large University Hospital in Athens, Greece, mainly involved in clinical trials for new antibiotics and working against multi-drug resistant bacteria.

She coordinates the registry of the ECMM/ISHAM Working Group on Zygomycosis. The registry provides the opportunity to communicate with physicians from all around the world, exchanging information about the clinical presentation, diagnosis and treatment of this potentially lethal infection.

What triggered your interest in rare fungal infections?

Although I do have a general interest in rare fungal infections, my true love is mucormycosis – a serious but rare fungal infection caused by people coming in contact with fungal spores in the environment. When I was specialising in infectious diseases, I worked with Professor George Petrikkos, who was a pioneer in mycology, particularly focused on mucormycosis, in Greece.

Our lab was the national reference center and Prof. Petrikkos introduced me to the European Confederation for Medical Mycology, where we formed the Working Group for Zygomycosis. Later on, in 2008, the group became global, under the auspices of the International Society for Human and Animal Mycology (ISHAM). Cases of mucormycosis are collected globally and added to a registry to provide information and enhance collaboration.

Please tell us about one of the recent articles you recommended on F1000Prime, why you picked it, and how it fits into the current research landscape?

I recently recommended an interesting article that provided important information about the epidemiology of a new infection. Lockhart et al. looked at the multidrug resistant yeast, Candida auris, a rare Candida species that has emerged in recent years and seems to pose a serious threat to hospitalised patients.

They showed, with the use of whole-genome sequencing, that C. auris most probably emerged almost simultaneously in several locations all over the world, rather than a single source. They also report clinical characteristics of this infection as well as antifungal susceptibility patterns.

What recent advances have been seen in diagnostics and therapies to treat rare and emerging fungi?

The clinical presentation of infections due to rare and emerging fungi is non-specific. This means that the clinicians must have a high index of suspicion, posing diagnostic questions to the microbiologists.  Conventional diagnostic methods, such as cultures and histopathology, are still essential, but rapid and more specific molecular techniques to detect and identify infecting pathogens are being developed. These will hopefully lead to early targeted treatment.

As an example, there have been attempts for directed molecular-based diagnosis of mucormycosis from blood and serum with promising clinical data (Millon et al, Clin Microbiol Infect. 2016; Ino et al, Intern Med. 2017). In these studies, molecular tests on serum resulted in earlier diagnosis when compared to culture, and overall confirmed culture-proven cases.

What, in your opinion, should be the main focus of future research on rare fungal infectious agents?

There is a lack of new antifungal drugs and it seems that in order to achieve a better outcome of invasive fungal infections we must find ways to make the diagnosis as early as possible.

Furthermore, the agents of rare fungal infections have various susceptibility patterns. Optimising molecular-based techniques, along with expanding reference libraries and the possibility for direct detection of resistance mechanisms, are eagerly awaited in the near future.