A Peculiar Case of Pneumonia due to Mycoplasma pneumoniae in a Child with Cystic Fibrosis and Sensibilization to Aspergillus fumigatus

Aspergillus fumigatus escape mechanisms from its harsh survival environments

Aspergillus fumigatus is a ubiquitous pathogenic mold and causes several diseases, including mycotoxicosis, allergic reactions, and systemic diseases (invasive aspergillosis), with high mortality rates. In its ecological niche, the fungus has evolved and mastered many reply strategies to resist and survive against negative threats, including harsh environmental stress and deficiency of essential nutrients from natural environments, immunity responses and drug treatments in host, and competition from symbiotic microorganisms. Hence, treating A. fumigatus infection is a growing challenge. In this review, we summarized A. fumigatus reply strategies and escape mechanisms and clarified the main competitive or symbiotic relationships between A. fumigatus, viruses, bacteria, or fungi in host microecology. Additionally, we discussed the contemporary drug repertoire used to treat A. fumigatus and the latest evidence of potential resistance mechanisms. This review provides valuable knowledge which will stimulate further investigations and clinical applications for treating and preventing A. fumigatus infections. KEY POINTS: • Harsh living environment was a great challenge for A. fumigatus survival. • A. fumigatus has evolved multiple strategies to escape host immune responses. • A. fumigatus withstands antifungal drugs via intrinsic escape mechanisms.

The effects of the atomization inhalation of budesonide, salbutamol, and ipratropium bromide on the T-lymphocyte subset and inflammatory cytokine levels in children with asthmatic pneumonia

OBJECTIVE

This study aimed to explore the effects of the atomization inhalation of budesonide (BUD), salbutamol (SAL), and ipratropium bromide (IB) on the T-lymphocyte subset and inflammatory cytokine levels in children with asthmatic pneumonia (AP).

METHODS

A total of 118 children with AP admitted to our hospital were selected as the study cohort and randomly divided into two groups. The study group, included 67 patients who were treated with the atomization inhalation of BUD, SAL, and IB. The control group, included 51 patients who were treated with the atomization inhalation of BUD. The two groups were compared in terms of their symptom disappearance times, the therapeutic effects, inflammatory cytokine changes, their pulmonary function indices [C-reactive protein (CRP), respiratory frequency, forced vital capacity (FVC), one-second forced expiratory volume (FEV1), blood oxygen saturation (SpO2)], and their T-lymphocyte subset levels before and after the treatment, and the incidences of adverse reactions after the treatment.

RESULTS

The symptom disappearance times in the study group were shorter than they were in the control group (P<0.05), and the overall response rate (ORR) was significantly higher in the study group (P<0.05). The IL-5, IL-6, and IL-10 levels were all lower in the study group (P<0.05), but the interferon-γ levels were higher in this group (P<0.05). The CRP level was lower in the study group (P<0.05), but the FVC, FEV1, and SpO2 levels were higher in this group (P<0.05). After the treatment, the CD3⁺, CD4⁺ and CD4⁺/CD8⁺ levels were all higher in the study group (P<0.05), but the CD8⁺ level was lower in this group (P<0.05). The incidence of adverse reactions in the study group was lower than it was in the control group (P=0.014).

CONCLUSION

The atomization inhalation of BUD, SAL, and IB is markedly effective in treating children with AP, and it can improve their immune function and reduce their inflammatory cytokines levels.

Allergic Bronchopulmonary Aspergillosis in Children with Cystic Fibrosis: An Update on the Newest Diagnostic Tools and Therapeutic Approaches

Cystic fibrosis (CF), the most common autosomal-recessive genetic disease in the Caucasian population, is characterized by frequent respiratory infections and progressive lung disease. Fungal species are commonly found in patients with CF, and among them, Aspergillus fumigatus is the most frequently isolated. While bacteria, particularly Pseudomonas aeruginosa, have a well-established negative effect on CF lung disease, the impact of fungal infections remains unclear. In patients with CF, inhalation of Aspergillus conidia can cause allergic bronchopulmonary aspergillosis (ABPA), a Th2-mediated lung disease that can contribute to disease progression. Clinical features, diagnostic criteria and treatment of ABPA are still a matter of debate. Given the consequences of a late ABPA diagnosis or the risk of ABPA overdiagnosis, it is imperative that the diagnostic criteria guidelines are reviewed and standardized. Along with traditional criteria, radiological features are emerging as tools for further classification as well as novel immunological tests. Corticosteroids, itraconazole and voriconazole continue to be the bedrock of ABPA therapy, but other molecules, such as posaconazole, vitamin D, recombinant INF-γ and Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulators, have been showing positive results. However, few studies have been conducted recruiting CF patients, and more research is needed to improve the prevention and the classification of clinical manifestations as well as to personalize treatment. Early recognition and early treatment of fungal infections may be fundamental to prevent progression of CF disease. The aim of this narrative review is to give an update on ABPA in children with CF.