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Abstract
PURPOSE OF REVIEW This review summarizes some of the important recent findings concerning fungal airway infections in patients with cystic fibrosis (CF). For many years, both researchers and clinicians have focused on the problems in CF caused by chronic bacterial airway infection with organisms such as Haemophilus, Staphylococcus and Pseudomonas. However, until recently, the lack of sensitive culture techniques to isolate fungi in sputum, bronchoalveolar lavage fluid and other respiratory tract samples has limited the recognition of fungal species and their possible role in CF airway infections. RECENT FINDINGS Recent studies using fungal-selective culture media and molecular techniques have shown a plethora of different fungal species in the sputum expectorated from CF patients. Cross-sectional studies have shown associations between Aspergillus and Candida in the sputum and worse lung function. The presence of allergic bronchopulmonary aspergillosis is likely to be a negative prognostic factor, but whether simple fungal colonization itself indicates future problems is not clear. Current research is now examining these epidemiological associations to try to determine the clinical implications. This will help determine whether fungal colonization/infection is associated with worse outcome in CF patients. SUMMARY At present, there is no conclusive evidence that fungal organisms cause respiratory decline. Recent studies of antifungal therapy in CF patients have reported differing results, so further investigations in this area are needed.
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Rougeron A, Schuliar G, Leto J, Sitterlé E, Landry D, Bougnoux ME, Kobi A, Bouchara JP, Giraud S. Human-impacted areas of France are environmental reservoirs of thePseudallescheria boydii/Scedosporium apiospermumspecies complex. Environ Microbiol 2014; 17:1039-48. [DOI: 10.1111/1462-2920.12472] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/20/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Amandine Rougeron
- L'UNAM Université; Université d'Angers; Groupe d'Etude des Interactions Hôte-Pathogène; EA 3142 Angers France
- Laboratoire de Parasitologie-Mycologie; Centre Hospitalier Universitaire; Angers France
| | - Gaëlle Schuliar
- L'UNAM Université; Université d'Angers; Groupe d'Etude des Interactions Hôte-Pathogène; EA 3142 Angers France
| | | | - Emilie Sitterlé
- Service de Microbiologie; Hôpital Necker-Enfants Malades; Assistance Publique-Hôpitaux de Paris; Université Paris Descartes; Paris France
| | - David Landry
- Laboratoire LETG-Angers LEESA; Université d'Angers; Angers France
| | - Marie-Elisabeth Bougnoux
- Service de Microbiologie; Hôpital Necker-Enfants Malades; Assistance Publique-Hôpitaux de Paris; Université Paris Descartes; Paris France
| | - Abdessamad Kobi
- Laboratoire en sûreté de fonctionnement qualité et organisation; L'UNAM Université; Université d'Angers; EA 3142 Angers France
| | - Jean-Philippe Bouchara
- L'UNAM Université; Université d'Angers; Groupe d'Etude des Interactions Hôte-Pathogène; EA 3142 Angers France
- Laboratoire de Parasitologie-Mycologie; Centre Hospitalier Universitaire; Angers France
| | - Sandrine Giraud
- L'UNAM Université; Université d'Angers; Groupe d'Etude des Interactions Hôte-Pathogène; EA 3142 Angers France
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53
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Lopes SP, Azevedo NF, Pereira MO. Microbiome in cystic fibrosis: Shaping polymicrobial interactions for advances in antibiotic therapy. Crit Rev Microbiol 2014; 41:353-65. [PMID: 24645634 DOI: 10.3109/1040841x.2013.847898] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Recent molecular methodologies have demonstrated a complex microbial ecosystem in cystic fibrosis (CF) airways, with a wide array of uncommon microorganisms co-existing with the traditional pathogens. Although there are lines of evidence supporting the contribution of some of those emergent species for lung disease chronicity, clinical significance remains uncertain for most cases. A possible contribution for disease is likely to be related with the dynamic interactions established between microorganisms within the microbial community and with the host. If this is the case, management of CF will only be successful upon suitable and exhaustive modulation of such mixed ecological processes, which will also be useful to predict the effects of new therapeutic interventions.
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Affiliation(s)
- Susana P Lopes
- IBB-CEB, Institute for Biotechnology and Bioengineering, Centre of Biological Engineering, University of Minho, Campus de Gualtar , Braga , Portugal and
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54
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Impact of Scedosporium apiospermum complex seroprevalence in patients with cystic fibrosis. J Cyst Fibros 2014; 13:667-73. [PMID: 24530191 DOI: 10.1016/j.jcf.2014.01.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/20/2014] [Accepted: 01/27/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Species of the Scedosporium apiospermum complex (S. a complex) are emerging fungi responsible for chronic airway colonization in cystic fibrosis (CF) patients. Recent studies performed on Aspergillus fumigatus suggest that the colonization of the airways by filamentous fungi may contribute to the progressive deterioration of lung function. METHODS We studied S. a complex seroprevalence, as a marker of close contact between patient and the fungi, in a large monocentric cohort of CF patients attended in a reference centre in Lyon, France. RESULTS Serum samples from 373 CF patients were analysed. Antibodies against S. a complex were detected in 35 patients (9.4%). In multivariate analysis, S. a complex seropositivity was only associated with seropositivity to A. fumigatus. CONCLUSIONS This study does not suggest an association between sensitization against S. a complex and poorer lung function in CF. Prospective studies are needed to evaluate the impact of both seropositivity and S. a complex colonization on the course of CF.
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55
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State-of-the-Art Procedures and Quality Management in Diagnostic Medical Mycology. CURRENT FUNGAL INFECTION REPORTS 2013. [DOI: 10.1007/s12281-013-0145-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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56
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Impact of multidrug-resistant organisms on patients considered for lung transplantation. Infect Dis Clin North Am 2013; 27:343-58. [PMID: 23714344 DOI: 10.1016/j.idc.2013.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Infections with multidrug-resistant organisms are a growing problem in lung transplant recipients. Carriage of drug-resistant bacteria and fungi before transplantation is an important risk factor for such infections. In that regard Pseudomonas aeruginosa and species of Burkholderia, Acinetobacter, non-tuberculous mycobacteria and Scedosporium are particularly important. An understanding of the impact of these organisms is essential to the evaluation of lung transplant candidates. The microbiology, epidemiology, clinical manifestations, and approach to these pathogens before transplant are reviewed in this article.
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57
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Tissue Diagnosis of Invasive Fungal Infections: Current Limitations and the Emerging Use of Molecular Techniques. CURRENT FUNGAL INFECTION REPORTS 2012. [DOI: 10.1007/s12281-012-0098-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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58
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Güngör O, Tamay Z, Güler N, Erturan Z. Frequency of fungi in respiratory samples from Turkish cystic fibrosis patients. Mycoses 2012; 56:123-9. [PMID: 22747891 DOI: 10.1111/j.1439-0507.2012.02221.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
An increased isolation of fungi from the respiratory tract of patients with cystic fibrosis (CF) has been reported. The prevalence of different fungi in CF patients from Turkey is not known. Our aim was to determine the frequency of fungi in the respiratory tract of Turkish CF patients. We investigated a total of 184 samples from 48 patients. Samples were inoculated on Medium B+ and CHROMagar Candida. Candida albicans was the predominant yeast isolated [30 patients (62.5%)], followed by C. parapsilosis [6 (12.5%)] and C. dubliniensis 5 (10.4%). Aspergillus fumigatus was the most common filamentous fungus [5 (10.4%)] and non-fumigatus Aspergillus species were isolated from four (8.3%) patients. Staphylococcus aureus was the most frequently detected bacterium in C. albicans positive samples (53.57%). A. fumigatus and Pseudomonas aeruginosa or S. aureus were detected together in 75% of A. fumigatus positive samples each. No statistically significant relationship was detected between growth of yeast and moulds and age, gender, the use of inhaled corticosteroids or tobramycin. No significant correlation was found between the isolation of C. albicans, A. fumigatus and P. aeruginosa, Stenotrophomonas maltophilia or S. aureus, and the isolation of C. albicans and Haemophilus influenzae. Other factors which may be responsible for the increased isolation of fungi in CF need to be investigated.
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Affiliation(s)
- Ozge Güngör
- Department of Microbiology and Clinical Microbiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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59
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Lackner M, Rezusta A, Villuendas MC, Palacian MP, Meis JF, Klaassen CH. Infection and colonisation due to Scedosporium in Northern Spain. An in vitro antifungal susceptibility and molecular epidemiology study of 60 isolates. Mycoses 2012; 54 Suppl 3:12-21. [PMID: 21995658 DOI: 10.1111/j.1439-0507.2011.02110.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Since the latest taxonomical changes in the genus Scedosporium by Gilgado et al. in 2010, no species-specific studies on epidemiology and antifungal susceptibility patterns (AFSP) have so far been published. This study aimed to provide qualitative epidemiological data of Scedosporium spp. isolated from cystic fibrosis (CF) patients and immunocompromised patients from Northern Spain. Isolates were identified by using amplified fragment length polymorphism (AFLP), and species-specific AFSP were generated for all currently available antifungal compounds. AFLP was a useful tool for identification to species-level and for the discrimination of inter- and intra-patient isolates. Scedosporium prolificans represents the most prevalent species in the respiratory tract of CF patients and immunocompromised patients in Northern-Spain, followed by Pseudallescheria boydii, P. apiosperma, and P. ellipsoidea. CF patients were exclusively colonised with either P. boydii or S. prolificans. Patients were colonised over years exclusively with isolates affiliated to one species, but some patients were colonised with multiple strains with different AFSP. The sum of those co-colonising strains in one patient, may appear in vitro and in vivo as a multi-resistant S. prolificans isolate, as strains are morphologically identical and might therefore be regarded as only one strain. A majority of Scedosporium strains (with exception of S. prolificans) were found susceptible for voriconazole and micafungin.
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Affiliation(s)
- M Lackner
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
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60
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Lu Q, van den Ende AHGG, de Hoog GS, Li R, Accoceberry I, Durand-Joly I, Bouchara JP, Hernandez F, Delhaes L. Reverse line blot hybridisation screening of Pseudallescheria/Scedosporium species in patients with cystic fibrosis. Mycoses 2012; 54 Suppl 3:5-11. [PMID: 21995657 DOI: 10.1111/j.1439-0507.2011.02108.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The PCR-RLB (reverse line blot hybridisation) was applied as a molecular technique for the detection of members of Pseudallescheria and Scedosporium from sputum of patients with cystic fibrosis (CF). Fifty-nine sputum samples were collected from 52 CF patients, which were analysed by culture and PCR-RLB. Conventional and semi-selective culture yielded five positive samples, but the PCR-RLB hybridisation assay permitted the detection of members of Pseudallescheria/Scedosporium in 32 out of 52 patients (61.5%). In total, PCR-RLB yielded 47 positives. Pseudallescheria apiosperma was detected in 20 samples, while Pseudallescheria boydii and Pseudallescheria aurantiacum were detected in 17 and eight samples, respectively. Six samples gave a positive reaction with two distinct species-specific probes and one sample with three probes. In conclusion, the PCR-RLB assay described in this study allows the detection of Scedosporium spp. in CF sputum samples and the identification of Pseudallescheria apiosperma, P. boydii, S. aurantiacum, Scedosporium prolificans and Pseudallescheria minutispora.
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Affiliation(s)
- Q Lu
- Department of Dermatology, Peking University First Hospital, and Research Center for Medical Mycology, Peking University, Beijing, China
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61
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de Hoog GS, Robert V, Lackner M, Vehreschild MJGT, Vehreschild JJ, Symoens F, Göttlich-Fligg E, Garcia-Hermoso D, Harun A, Meyer W, Chen SCA, Hamprecht A, Fischer G, Buzina W, Cornely OA, Guarro J, Cano J, Horré R. Making Moulds Meet Information retrieval as a basis for understanding Pseudallescheria and Scedosporium. Mycoses 2011; 54 Suppl 3:1-4. [DOI: 10.1111/j.1439-0507.2011.02122.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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62
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Hell M, Neureiter J, Wojna A, Presterl E, Willinger B, de Hoog GS, Lackner M. Post-traumatic Pseudallescheria apiosperma osteomyelitis: positive outcome of a young immunocompetent male patient due to surgical intervention and voriconazole therapy. Mycoses 2011; 54 Suppl 3:43-7. [DOI: 10.1111/j.1439-0507.2011.02106.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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63
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Le Bourgeois M, Sermet I, Bailly-Botuha C, Delacourt C, de Blic J. [Fungal infections in cystic fibrosis]. Arch Pediatr 2011; 18 Suppl 1:S15-21. [PMID: 21596282 DOI: 10.1016/s0929-693x(11)70936-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fungal colonization in cystic fibrosis patient is frequent and dominated by Aspergillus fumigatus (A. fumigatus). Mycological analysis on specific media showed other filamentous species Scedosporium, Geosmithia argillacea. Prospective studies are necessary to appreciate prevalence and pathogenicity in this pathology. A. fumigatus causes the most frequently allergic bronchopulmonary aspergillosis (ABPA). Invasive infection is exceptional in this context. An early diagnosis is important to avoid bronchial deterioration but is very difficult despite international consensus. New more specific biological markers are evaluated. Oral corticotherapy is the cornerstone of therapy but adverse effects are more frequent in cystic fibrosis. Antifungal therapy has a corticosteroid-sparing effect. New therapeutic strategies have to be evaluated.
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Affiliation(s)
- M Le Bourgeois
- Service de Pneumologie et Allergologie Pédiatriques, Hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France.
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64
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Harun A, Serena C, Gilgado F, Chen SCA, Meyer W. Scedosporium aurantiacum is as virulent as S. prolificans, and shows strain-specific virulence differences, in a mouse model. Med Mycol 2011; 48 Suppl 1:S45-51. [PMID: 21067330 DOI: 10.3109/13693786.2010.517224] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Several Scedosporium species are clinically important emerging pathogens. Scedosporium prolificans is reported to be the most virulent of the species, while the recently described species Scedosporium aurantiacum, which accounts for a substantial proportion of Australian clinical isolates is capable of causing a range of serious infections. In addition, environmental surveys have revealed a high prevalence of S. aurantiacum in the urban Sydney region. This study was conducted to assess the virulence of selected S. aurantiacum strains recovered from patients who are colonized or have invasive disease, as well as those from environmental sources, in comparison with S. prolificans. PCR fingerprinting with the primer M13 revealed high genetic variation among the S. aurantiacum strains. We evaluated the virulence of eight S. aurantiacum and two S. prolificans strains in a murine model using an infectious dose of 2 × 10⁵ conidia. S. aurantiacum was noted to be as virulent as S. prolificans, causing death in 60-100% of mice (P > 0.05). There were significant strain-specific virulence differences (P < 0.005), indicating a possible link between genotype and virulence in S. aurantiacum.
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Affiliation(s)
- Azian Harun
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead Millennium Institute, The University of Sydney, Australia
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65
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Development and validation of a multiplex PCR for detection of Scedosporium spp. in respiratory tract specimens from patients with cystic fibrosis. J Clin Microbiol 2011; 49:1508-12. [PMID: 21325557 DOI: 10.1128/jcm.01810-10] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The emergence of Scedosporium infections in diverse groups of individuals, which are often treatment refractory, warrants timely and accurate laboratory diagnosis. Species- or group-specific primers based on internal transcribed spacer (ITS) sequence polymorphisms were designed for Scedosporium aurantiacum, Scedosporium dehoogii, Scedosporium prolificans, Pseudallescheria boydii species complex (former clade 5)/Pseudallescheria apiosperma (formerly classified as S. apiospermum sensu lato) and Pseudallescheria minutispora. Primers for S. aurantiacum, S. prolificans, and P. boydii species complex/P. apiosperma were incorporated into a multiplex PCR assay for the detection and identification of the three major clinically important Scedosporium species and validated using sputum specimens collected from patients seen at a major Australian cystic fibrosis clinic. The multiplex PCR assay showed 100% specificity in identifying the three major clinically relevant Scedosporium species from pure culture. When evaluated using DNA extracts from sputa, sensitivity and specificity of the multiplex PCR assay were 62.1% and 97.2%, respectively. This highly species-specific multiplex PCR assay offers a rapid and simple method of detection of the most clinically important Scedosporium species in respiratory tract specimens.
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66
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Elad D. Infections caused by fungi of the Scedosporium/Pseudallescheria complex in veterinary species. Vet J 2011; 187:33-41. [DOI: 10.1016/j.tvjl.2010.05.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 05/17/2010] [Accepted: 05/23/2010] [Indexed: 11/28/2022]
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67
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Hauser AR, Jain M, Bar-Meir M, McColley SA. Clinical significance of microbial infection and adaptation in cystic fibrosis. Clin Microbiol Rev 2011; 24:29-70. [PMID: 21233507 PMCID: PMC3021203 DOI: 10.1128/cmr.00036-10] [Citation(s) in RCA: 287] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A select group of microorganisms inhabit the airways of individuals with cystic fibrosis. Once established within the pulmonary environment in these patients, many of these microbes adapt by altering aspects of their structure and physiology. Some of these microbes and adaptations are associated with more rapid deterioration in lung function and overall clinical status, whereas others appear to have little effect. Here we review current evidence supporting or refuting a role for the different microbes and their adaptations in contributing to poor clinical outcomes in cystic fibrosis.
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Affiliation(s)
- Alan R Hauser
- Department of Microbiology/Immunology, Northwestern University, 303 E. Chicago Ave., Searle 6-495, Chicago, IL 60611, USA.
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68
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Müller FMC, Seidler M. Characteristics of pathogenic fungi and antifungal therapy in cystic fibrosis. Expert Rev Anti Infect Ther 2010; 8:957-64. [PMID: 20695750 DOI: 10.1586/eri.10.72] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A defective mucociliary clearance facilitates colonization with bacteria and fungal spores in cystic fibrosis patients. Yeasts and molds are cultured from the cystic fibrosis respiratory tract and often their clinical relevance is unknown. Candida spp. are the most commonly isolated yeasts, whereas Aspergillus spp., Scedosporium apiospermum, as well as Exophiala dermatitidis in some countries, are the most frequent molds recovered from respiratory specimens. Molecular biotyping studies have revealed that some fungal genotypes are capable of chronically colonizing the airways. Persistent Aspergillus fumigatus infection is associated with an increased risk of pulmonary exacerbations requiring hospitalization. The prevalence of non-Aspergillus molds may be underestimated due to overgrowth of Pseudomonas and Aspergillus spp. on routine media. Allergic bronchopulmonary aspergillosis is usually treated by oral steroids and an antifungal azole drug. Interactions with the co-medication have to be considered. A small number of antifungal pharmacokinetic studies indicate a high inter-subject variability for itraconazole, voriconazole and posaconazole, and therefore therapeutic drug monitoring is recommended.
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Affiliation(s)
- Frank-Michael C Müller
- University Heidelberg, Department of Pediatrics III, Pediatric Pulmonology, Cystic Fibrosis Centre & Infectious Diseases, Im Neuenheimer Feld 430, D-69120 Heidelberg, Germany.
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69
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Blyth CC, Middleton PG, Harun A, Sorrell TC, Meyer W, Chen SCA. Clinical associations and prevalence ofScedosporiumspp. in Australian cystic fibrosis patients: identification of novel risk factors? Med Mycol 2010; 48 Suppl 1:S37-44. [DOI: 10.3109/13693786.2010.500627] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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70
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Disseminated Scedosporium/Pseudallescheria infection after double-lung transplantation in patients with cystic fibrosis. J Clin Microbiol 2010; 48:1978-82. [PMID: 20220160 DOI: 10.1128/jcm.01840-09] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a case of disseminated Scedosporium/Pseudallescheria infection due to Pseudallescheria boydii sensu stricto after lung transplantation in a patient with cystic fibrosis. Dissemination occurred under voriconazole. Despite surgery and combination therapy with voriconazole, caspofungin, and terbinafine, the patient died 8 months after transplantation. Previously reported cases are reviewed.
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