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Curran AK, Hava DL. Allergic Diseases Caused by Aspergillus Species in Patients with Cystic Fibrosis. Antibiotics (Basel) 2021; 10:antibiotics10040357. [PMID: 33800658 PMCID: PMC8067098 DOI: 10.3390/antibiotics10040357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/12/2021] [Accepted: 03/24/2021] [Indexed: 01/04/2023] Open
Abstract
Aspergillus spp. are spore forming molds; a subset of which are clinically relevant to humans and can cause significant morbidity and mortality. A. fumigatus causes chronic infection in patients with chronic lung disease such as asthma, chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF). In patients with CF, A. fumigatus infection can lead to allergic disease, such as allergic bronchopulmonary aspergillosis (ABPA) which is associated with high rates of hospitalizations for acute exacerbations and lower lung function. ABPA results from TH2 immune response to Aspergillus antigens produced during hyphal growth, marked by high levels of IgE and eosinophil activation. Clinically, patients with ABPA experience difficulty breathing; exacerbations of disease and are at high risk for bronchiectasis and lung fibrosis. Oral corticosteroids are used to manage aspects of the inflammatory response and antifungal agents are used to reduce fungal burden and lower the exposure to fungal antigens. As the appreciation for the severity of fungal infections has grown, new therapies have emerged that aim to improve treatment and outcomes for patients with CF.
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Affiliation(s)
| | - David L. Hava
- Synlogic Inc., 301 Binney Street, Cambridge, MA 02142, USA
- Correspondence:
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2
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Breuer O, Schultz A, Turkovic L, de Klerk N, Keil AD, Brennan S, Harrison J, Robertson C, Robinson PJ, Sly PD, Ranganathan S, Stick SM, Caudri D. Reply to Turnbull et al. and to Hulme et al.. Am J Respir Crit Care Med 2020; 201:750-752. [PMID: 31769999 PMCID: PMC7068835 DOI: 10.1164/rccm.201911-2213le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Oded Breuer
- Telethon Kids InstitutePerth, Australia.,Perth Children's HospitalPerth, Australia.,Hadassah-Hebrew University Medical CenterJerusalem, Israel
| | - Andre Schultz
- Perth Children's HospitalPerth, Australia.,University of Western AustraliaPerth, Australia
| | | | | | - Anthony D Keil
- Perth Children's HospitalPerth, Australia.,PathWest Laboratory Medicine WAPerth, Australia
| | | | - Joanne Harrison
- University of MelbourneMelbourne, Australia.,Murdoch Children's Research InstituteParkville, Australia.,Royal Children's HospitalParkville, Australia
| | - Colin Robertson
- University of MelbourneMelbourne, Australia.,Murdoch Children's Research InstituteParkville, Australia.,Royal Children's HospitalParkville, Australia
| | - Philip J Robinson
- University of MelbourneMelbourne, Australia.,Murdoch Children's Research InstituteParkville, Australia.,Royal Children's HospitalParkville, Australia
| | - Peter D Sly
- The University of QueenslandBrisbane, Australiaand
| | - Sarath Ranganathan
- University of MelbourneMelbourne, Australia.,Murdoch Children's Research InstituteParkville, Australia.,Royal Children's HospitalParkville, Australia
| | - Stephen M Stick
- Perth Children's HospitalPerth, Australia.,University of Western AustraliaPerth, Australia
| | - Daan Caudri
- Telethon Kids InstitutePerth, Australia.,Perth Children's HospitalPerth, Australia.,Erasmus University Medical CenterRotterdam, the Netherlands
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3
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Breuer O, Schultz A, Garratt LW, Turkovic L, Rosenow T, Murray CP, Karpievitch YV, Akesson L, Dalton S, Sly PD, Ranganathan S, Stick SM, Caudri D. Aspergillus Infections and Progression of Structural Lung Disease in Children with Cystic Fibrosis. Am J Respir Crit Care Med 2020; 201:688-696. [DOI: 10.1164/rccm.201908-1585oc] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Oded Breuer
- Telethon Kids Institute and
- Department of Pediatrics, Pediatric Pulmonary Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Respiratory and Sleep Medicine and
| | - Andre Schultz
- Telethon Kids Institute and
- Division of Child Health, Faculty of Medicine and Dentistry, University of Western Australia, Perth, Western Australia, Australia
- Department of Respiratory and Sleep Medicine and
| | | | | | - Tim Rosenow
- Telethon Kids Institute and
- Division of Child Health, Faculty of Medicine and Dentistry, University of Western Australia, Perth, Western Australia, Australia
| | - Conor P. Murray
- Department of Diagnostic Imaging, Perth Children’s Hospital, Perth, Western Australia, Australia
| | | | - Lauren Akesson
- Telethon Kids Institute and
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Samuel Dalton
- Department of Respiratory Medicine, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Peter D. Sly
- Children’s Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Sarath Ranganathan
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory Medicine, Royal Children’s Hospital, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia; and
| | - Stephen M. Stick
- Telethon Kids Institute and
- Division of Child Health, Faculty of Medicine and Dentistry, University of Western Australia, Perth, Western Australia, Australia
- Department of Respiratory and Sleep Medicine and
| | - Daan Caudri
- Telethon Kids Institute and
- Department of Respiratory and Sleep Medicine and
- Department of Pediatrics/Respiratory Medicine, Erasmus Medical Center–Sophia, Rotterdam, the Netherlands
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4
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Breuer O, Schultz A, Turkovic L, de Klerk N, Keil AD, Brennan S, Harrison J, Robertson C, Robinson PJ, Sly PD, Ranganathan S, Stick SM, Caudri D. Changing Prevalence of Lower Airway Infections in Young Children with Cystic Fibrosis. Am J Respir Crit Care Med 2020; 200:590-599. [PMID: 30811949 DOI: 10.1164/rccm.201810-1919oc] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Rationale: Historical studies suggest that airway infection in cystic fibrosis initiates with Staphylococcus aureus and Haemophilus influenzae, with later emergence of Pseudomonas aeruginosa. Aspergillus species are regarded as relatively infrequent, late-occurring infections.Objectives: To assess the prevalence and change in prevalence of early lower airway infections in a modern cohort of children with cystic fibrosis.Methods: All infants diagnosed with cystic fibrosis after newborn screening participating in the Australian Respiratory Early Surveillance Team for Cystic Fibrosis (AREST CF) cohort study between 2000 and 2018 were included. Participants prospectively underwent BAL at 3-6 months, 1 year, and annually up to 6 years of age. Lower airway infection prevalence was described. Changes in prevalence patterns were assessed longitudinally using generalized estimating equations controlling for age and repeated visits.Measurements and Main Results: A total of 380 infants underwent 1,759 BALs. The overall prevalence and median age of first acquisition of the most common infections were as follows: S. aureus, 11%, 2.5 years; P. aeruginosa, 8%, 2.4 years; Aspergillus species, 11%, 3.2 years; and H. influenzae, 9%, 3.1 years. During the study, a significant decrease in prevalence of P. aeruginosa (P < 0.001) and S. aureus (P < 0.001) was observed with a significant change toward more aggressive treatment. Prevalence of Aspergillus infections did not significantly change (P = 0.669).Conclusions: Aspergillus species and P. aeruginosa are commonly present in the lower airways from infancy. The decrease in prevalence of P. aeruginosa and S. aureus since 2000, coinciding with a more aggressive therapeutic approach, has resulted in Aspergillus becoming the most commonly isolated pathogen in young children. Further research is warranted to understand the implication of these findings.
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Affiliation(s)
- Oded Breuer
- Telethon Kids Respiratory Research Centre, Telethon Kids Institute, and.,Perth Children's Hospital, Perth, Australia
| | - Andre Schultz
- Telethon Kids Respiratory Research Centre, Telethon Kids Institute, and.,Division of Paediatric and Child Health, Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Perth Children's Hospital, Perth, Australia
| | - Lidija Turkovic
- Telethon Kids Respiratory Research Centre, Telethon Kids Institute, and
| | - Nicholas de Klerk
- Telethon Kids Respiratory Research Centre, Telethon Kids Institute, and
| | - Anthony D Keil
- Perth Children's Hospital, Perth, Australia.,Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
| | - Siobhain Brennan
- Telethon Kids Respiratory Research Centre, Telethon Kids Institute, and
| | - Joanne Harrison
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Australia
| | - Colin Robertson
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Australia
| | - Philip J Robinson
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Australia
| | - Peter D Sly
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, Australia; and
| | - Sarath Ranganathan
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Australia
| | - Stephen M Stick
- Telethon Kids Respiratory Research Centre, Telethon Kids Institute, and.,Division of Paediatric and Child Health, Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Perth Children's Hospital, Perth, Australia
| | - Daan Caudri
- Telethon Kids Respiratory Research Centre, Telethon Kids Institute, and.,Perth Children's Hospital, Perth, Australia.,Department of Pediatrics/Respiratory Medicine, Erasmus MC, Rotterdam, the Netherlands
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6
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Ranganathan SC. Attenuation of exacerbation. J Cyst Fibros 2018; 17:692-693. [PMID: 30314936 DOI: 10.1016/j.jcf.2018.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Sarath C Ranganathan
- Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Australia.
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