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Naseem R, Howe N, Williams CJ, Pretorius S, Green K. What diagnostic tests are available for respiratory infections or pulmonary exacerbations in cystic fibrosis: A scoping literature review. Respir Investig 2024; 62:817-831. [PMID: 39024929 DOI: 10.1016/j.resinv.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/02/2024] [Accepted: 07/06/2024] [Indexed: 07/20/2024]
Abstract
A scoping review methodological framework formed the basis of this review. A search of two electronic databases captured relevant literature published from 2013. 1184 articles were screened, 200 of which met inclusion criteria. Included studies were categorised as tests for either respiratory infections OR pulmonary exacerbations. Data were extracted to ascertain test type, sample type, and indication of use for each test type. For infection, culture is the most common testing method, particularly for bacterial infections, whereas PCR is utilised more for the diagnosis of viral infections. Spirometry tests, indicating lung function, facilitate respiratory infection diagnoses. There is no clear definition of what an exacerbation is in persons with CF. A clinical checklist with risk criteria can determine if a patient is experiencing an exacerbation event, however the diagnosis is clinician-led and will vary between individuals. Fuchs criteria are one of the most frequently used tests to assess signs and symptoms of exacerbation in persons with CF. This scoping review highlights the development of home monitoring tests to facilitate earlier and easier diagnoses, and the identification of novel biomarkers for indication of infections/exacerbations as areas of current research and development. Research is particularly prevalent regarding exhaled breath condensate and volatile organic compounds as an alternative sampling/biomarker respectively for infection diagnosis. Whilst there are a wide range of tests available for diagnosing respiratory infections and/or exacerbations, these are typically used clinically in combination to ensure a rapid, accurate diagnosis which will ultimately benefit both the patient and clinician.
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Affiliation(s)
- Raasti Naseem
- NIHR Newcastle HealthTech Research Centre in Diagnostic and Technology Evaluation, Fourth floor William Leech Building, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - Nicola Howe
- NIHR Newcastle HealthTech Research Centre in Diagnostic and Technology Evaluation, Fourth floor William Leech Building, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom.
| | - Cameron J Williams
- NIHR Newcastle HealthTech Research Centre in Diagnostic and Technology Evaluation, Fourth floor William Leech Building, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - Sara Pretorius
- NIHR Newcastle HealthTech Research Centre in Diagnostic and Technology Evaluation, Fourth floor William Leech Building, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - Kile Green
- NIHR Newcastle HealthTech Research Centre in Diagnostic and Technology Evaluation, Fourth floor William Leech Building, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
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Pontes L, Perini Leme Giordano AL, Reichert-Lima F, Gualtieri Beraquet CA, Leite Pigolli G, Arai T, Ribeiro JD, Gonçalves AC, Watanabe A, Goldman GH, Moretti ML, Zaninelli Schreiber A. Insights into Aspergillus fumigatus Colonization in Cystic Fibrosis and Cross-Transmission between Patients and Hospital Environments. J Fungi (Basel) 2024; 10:461. [PMID: 39057346 PMCID: PMC11277961 DOI: 10.3390/jof10070461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Approximately 60% of individuals with cystic fibrosis (CF) are affected by Aspergillus fumigatus infection. This condition is correlated with a decline in lung function and is identified as an independent risk factor contributing to hospital admissions among CF patients. This study investigates the dynamic interplay of A. fumigatus within the context of CF patients, tracing its evolution over time, with a specific emphasis on colonization dynamics. METHODS An analysis was conducted on 83 sequential A. fumigatus isolates derived from sputum samples of six patients receiving care at a renowned CF hospital in Brazil. Employing microsatellite genotyping techniques, alongside an investigation into cyp51A gene mutations, this research sheds light on the genetic variations, colonization, and resistance of A. fumigatus within the CF respiratory environment. RESULTS Our research findings indicate that CF patients can harbor A. fumigatus strains from the same clonal complexes for prolonged periods. Additionally, we identified that clinical isolates have the potential to spread among patients in the same healthcare facility, evidencing hospital contamination. Two patients who underwent long-term Itraconazole treatment did not show phenotypic resistance. However, one of these patients exhibited mutations in the cyp51A gene, indicating the need to monitor resistance to azoles in these patients colonized for long periods by A. fumigatus. We also observed co-colonization or co-infection involving multiple genotypes in all patients over time. CONCLUSION This comprehensive examination offers valuable insights into the pathogenesis of A. fumigatus infections in CF patients, potentially shaping future therapeutic strategies and management approaches. This enhanced understanding contributes to our knowledge of A. fumigatus impact on disease progression in individuals with cystic fibrosis. Additionally, the study provides evidence of cross-contamination among patients undergoing treatment at the same hospital.
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Affiliation(s)
- Laís Pontes
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Ana Luisa Perini Leme Giordano
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Franqueline Reichert-Lima
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Caio Augusto Gualtieri Beraquet
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Guilherme Leite Pigolli
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Teppei Arai
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba 260-0856, Japan; (T.A.); (A.W.)
| | - José Dirceu Ribeiro
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Aline Cristina Gonçalves
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Akira Watanabe
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba 260-0856, Japan; (T.A.); (A.W.)
| | - Gustavo Henrique Goldman
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto 14040-903, Brazil;
| | - Maria Luiza Moretti
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Angélica Zaninelli Schreiber
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
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Martínez Redondo M, Carpio Segura C, Zamarrón De Lucas E, Álvarez-Sala Walther R, Prados Sánchez C. Should atelectasis be considered a pulmonary complication and indicator of poor prognosis in cystic fibrosis? J Int Med Res 2024; 52:3000605241233520. [PMID: 38546237 PMCID: PMC10981250 DOI: 10.1177/03000605241233520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/29/2024] [Indexed: 04/01/2024] Open
Abstract
OBJECTIVE This study examined whether bronchoscopy leads to clinicoradiological improvement in cystic fibrosis (CF) and the predictive factors. The study also investigated whether pulmonary atelectasis is a poor prognostic factor in CF. METHODS This multicenter, case-control, observational, retrospective study included two groups of patients with CF: a case group (patients with persistent atelectasis who were followed-up at least for 2 years) and a control group (patients without atelectasis matched 1:1 by sex and age [±3 years]). We recorded demographic data, lung function test results, pulmonary complications, comorbidities, treatments (including bronchoscopies, surgery and transplantation), and deaths. RESULTS Each group included 55 patients (case group: 20 men, mean age 25.4 ± 10.4 years; control group: 20 men, mean age 26.1 ± 11.4 years). Bronchoscopy did not lead to clinicoradiological improvement. Allergic bronchopulmonary aspergillosis (ABPA) was more frequent in the case group. Patients in the case group more frequently used inhaled steroids, their pre-atelectasis lung function was statistically worse, and they had more exacerbations during follow-up. CONCLUSION Moderate-to-severe pulmonary disease and ABPA can favor atelectasis. Pulmonary atelectasis can be a poor prognostic factor in CF because it increases exacerbations. Despite our results, we recommend enhancing treatment, including bronchoscopy, to prevent persistent atelectasis.
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Affiliation(s)
- María Martínez Redondo
- Respiratory Department, CIBERES, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital-Autónoma University of Madrid, Madrid, Spain
| | - Carlos Carpio Segura
- Respiratory Department, CIBERES, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital-Autónoma University of Madrid, Madrid, Spain
| | - Ester Zamarrón De Lucas
- Respiratory Department, CIBERES, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital-Autónoma University of Madrid, Madrid, Spain
| | - Rodolfo Álvarez-Sala Walther
- Respiratory Department, CIBERES, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital-Autónoma University of Madrid, Madrid, Spain
| | - Concepción Prados Sánchez
- Respiratory Department, CIBERES, Hospital La Paz Institute for Health Research-IdiPAZ, La Paz University Hospital-Autónoma University of Madrid, Madrid, Spain
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Poore TS, Zemanick ET. Infection, Allergy, and Inflammation: The Role of Aspergillus fumigatus in Cystic Fibrosis. Microorganisms 2023; 11:2013. [PMID: 37630573 PMCID: PMC10458351 DOI: 10.3390/microorganisms11082013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
Aspergillus fumigatus (Af) is a mold frequently detected in airway samples from people with cystic fibrosis (pwCF). Abnormal airway mucus may allow Af to germinate, resulting in airway infection or an allergic response. While Af is known to increase morbidity in pwCF, individual responses and the degree of impact on lung disease vary. Improved approaches to diagnosis, treatment, and prevention of Af, particularly the persistent Af infection, are needed. This update highlights our current understanding of Af pathophysiology in the CF airway, the effects of Af on pwCF, and areas of research needed to improve clinical outcomes.
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Affiliation(s)
- T. Spencer Poore
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35223, USA
- UAB Gregory Fleming James Cystic Fibrosis Research Center, Birmingham, AL 35223, USA
| | - Edith T. Zemanick
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
- Breathing Institute, Children’s Hospital Colorado, Aurora, CO 80045, USA
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Exposure of Aspergillus fumigatus to Klebsiella pneumoniae Culture Filtrate Inhibits Growth and Stimulates Gliotoxin Production. J Fungi (Basel) 2023; 9:jof9020222. [PMID: 36836336 PMCID: PMC9961802 DOI: 10.3390/jof9020222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Aspergillus fumigatus is an opportunistic fungal pathogen capable of inducing chronic and acute infection in susceptible patients. A. fumigatus interacts with numerous bacteria that compose the microbiota of the lung, including Pseudomonas aeruginosa and Klebsiella pneumoniae, both of which are common isolates from cystic fibrosis sputum. Exposure of A. fumigatus to K. pneumoniae culture filtrate reduced fungal growth and increased gliotoxin production. Qualitative proteomic analysis of the K. pneumoniae culture filtrate identified proteins associated with metal sequestering, enzymatic degradation and redox activity, which may impact fungal growth and development. Quantitative proteomic analysis of A. fumigatus following exposure to K. pneumoniae culture filtrate (25% v/v) for 24 h revealed a reduced abundance of 1,3-beta-glucanosyltransferase (-3.97 fold), methyl sterol monooxygenase erg25B (-2.9 fold) and calcium/calmodulin-dependent protein kinase (-4.2 fold) involved in fungal development, and increased abundance of glutathione S-transferase GliG (+6.17 fold), non-ribosomal peptide synthase GliP (+3.67 fold), O-methyltransferase GliM (+3.5 fold), gamma-glutamyl acyltransferase GliK (+2.89 fold) and thioredoxin reductase GliT (+2.33 fold) involved in gliotoxin production. These results reveal that exposure of A. fumigatus to K. pneumoniae in vivo could exacerbate infection and negatively impact patient prognosis.
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Ding Y, Chen S, Gao P, Shi S, Wu B. Allergic bronchopulmonary aspergillosis in a child. Pediatr Int 2022; 64:e15318. [PMID: 36198392 DOI: 10.1111/ped.15318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/21/2022] [Accepted: 07/26/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Ying Ding
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Shanjia Chen
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Pei Gao
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Shuang Shi
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Beirong Wu
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
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Abstract
In the past three decades, fungal respiratory colonization and fungal respiratory infections increasingly raised concern in cystic fibrosis (CF). Reasons for this are a better knowledge of the pathogenicity of fungi, whereby detection is sought in more and more CF centers, but also improvement of detection methods. However, differences in fungal detection rates within and between geographical regions exist and indicate the need for standardization of mycological examination of respiratory secretions. The still existing lack of standardization also complicates the assessment of fungal pathogenicity, relevance of fungal detection and risk factors for fungal infections. Nevertheless, numerous studies have now been conducted on differences in detection methods, epidemiology, risk factors, pathogenicity and therapy of fungal diseases in CF. Meanwhile, some research groups now have classified fungal disease entities in CF and developed diagnostic criteria as well as therapeutic guidelines.The following review presents an overview on fungal species relevant in CF. Cultural detection methods with their respective success rates as well as susceptibility testing will be presented, and the problem of increasing azole resistance in Aspergillus fumigatus will be highlighted. Next, current data and conflicting evidence on the epidemiology and risk factors for fungal diseases in patients with CF will be discussed. Finally, an overview of fungal disease entities in CF with their current definitions, diagnostic criteria and therapeutic options will be presented.
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