Co-colonisation with Aspergillus fumigatus and Pseudomonas aeruginosa is associated with poorer health in cystic fibrosis patients: an Irish registry analysis (original) (raw)
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Changing Epidemiology of the Respiratory Bacteriology of Patients With Cystic Fibrosis
Chest, 2016
BACKGROUND: Monitoring potential changes in the epidemiology of cystic fibrosis (CF) pathogens furthers our understanding of the potential impact of interventions. METHODS: We performed a retrospective analysis using data reported to the Cystic Fibrosis Foundation Patient Registry (CFFPR) from 2006 to 2012 to determine the annual percent changes in the prevalence and incidence of selected CF pathogens. Pathogens included Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus aureus (MSSA), methicillinresistant S aureus (MRSA), Haemophilus influenzae, Burkholderia cepacia complex, Stenotrophomonas maltophilia, and Achromobacter xylosoxidans. Changes in nontuberculous mycobacteria (NTM) prevalence were assessed from 2010 to 2012, when the CFFPR collected NTM species. RESULTS: In 2012, the pathogens of highest prevalence and incidence were MSSA and P aeruginosa, followed by MRSA. The prevalence of A xylosoxidans and B cepacia complex were relatively low. From 2006 to 2012, the annual percent change in overall (as well as in most age strata) prevalence and incidence significantly decreased for P aeruginosa and B cepacia complex, but significantly increased for MRSA. From 2010 to 2012, the annual percent change in overall prevalence of NTM and Mycobaterium avium complex increased. CONCLUSIONS: The epidemiology of CF pathogens continues to change. The causes of these observations are most likely multifactorial and include improvements in clinical care and infection prevention and control. Data from this study will be useful to evaluate the impact of new therapies on CF microbiology.
Recent Approach in Microbial Pathogen Complications in Patients with Cystic Fibrosis
Clarivate, 2020
Cystic fibrosis (CF) is a multisystem genetic disease caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Microbial infection is the defined characteristics of cystic fibrosis airway disease. This infection is caused by bacteria, fungi, and viruses which increase complications leading to patient death. Additionally, bacterial pathogens including Haemophilus influenza, Staphylococcus aureus, Pseudomonas aeruginosa, nontuberculous mycobacterium (NTM) species, and MRSA are attributed to pulmonary infections. Subsequently, fungal pathogens such as Candida sp. and filamentous fungi such as Aspergillus fumigatus can also lead to pulmonary infections. On the other hand, Pseudomonas aeruginosa is the most common bacterial pathogen leading to complications in CF distal airways disease. Also, Aspergillus fumigatus can lead to aspergillus lung diseases including allergic bronchopulmonary aspergillosis and aspergilloma formation. Control of pathogenic microorganisms associated with cystic fibrosis may prevent pulmonary complications and has the potential to improve the prognosis of this life-limiting disease.
Thorax, 1998
Background-Colonisation with Pseudomonas aeruginosa (PA) is a striking feature of lung involvement in cystic fibrosis. To identify the clinical consequences of the diVerent steps of colonisation with PA under a defined therapeutic regime (no prophylactic antibiotic treatment as long as patients had no severe pulmonary disease), their influence on pulmonary function and on therapeutic intensity was examined. Methods-Forty patients with cystic fibrosis were followed from first detection of PA (PA1), chronic PA colonisation (PAc), first mucoid PA detection (PAm), to chronic mucoid PA colonisation (PAcm). Percentage predicted forced expiratory volume in one second (FEV 1 ), the number of intravenous antibiotic treatment courses, and the percentage of patients on inhaled antibiotics were followed retrospectively and longitudinally in relation to the diVerent steps of PA colonisation. The annual changes in FEV 1 and therapeutic intensity in the two years preceding each step were compared with the two years following each step. Changes in FEV 1 were related to therapeutic intensity. Results-The mean (SD) annual changes in FEV 1 (% predicted) worsened significantly only with the transition to the mucoid stages (PAm: 4.6 (13.2) versus -4.3 (8.1); PAcm: 7.3 (12.0) versus -4.8 (7.4)) with a mean diVerence (95% CI) between before and after the transition of 8.9 (2.6 to 15.2) for PAm and 12.1 (6.4 to 17.6) for PAcm. With non-mucoid PA stages the therapeutic intensity increased in the year of transition and with mucoid PA stages it increased in the years following transition. Therapeutic intensity was unrelated to changes in FEV 1 . Conclusion-With the treatment regime used an accelerated decrease in FEV 1 was successfully prevented in the non-mucoid stages but not in the mucoid stages of PA colonisation. (Thorax 1998;53:732-737)
Scandinavian Journal of Infectious Diseases, 2012
Background: Cystic fi brosis (CF) patients presenting with persistent carriage of, or sensitization to, Aspergillus fumigatus are often treated with antifungal therapies because the presence of the fungus is commonly thought to impede lung function, even in the absence of allergic bronchopulmonary aspergillosis (ABPA). The aim of this study was to assess Aspergillusrelated status modulating the forced expiratory volume in 1 s (FEV 1 ) of CF patients. Methods: From 1995 to 2007, 251 patients were evaluated. Demographic data, cystic fi brosis transmembrane conductance regulator gene (CFTR) mutations, body mass index, and FEV 1 were recorded. The presence of A. fumigatus and Pseudomonas aeruginosa in sputum and the levels of A. fumigatus precipitin, total IgE (t-IgE), and specifi c anti-A. fumigatus IgE (Af-IgE) were determined. Patients were divided into 3 groups: (1) ABPA: A. fumigatus precipitin Ն3 lines, Af-IgE Ͼ 0.35 IU/ml, and t-IgE Ն500 IU/ml; (2) sensitization: Af-IgE Ͼ 0.35 IU/ml but t-IgE Ͻ 500 IU/ml; and (3) persistent carriage: Af-IgE Յ 0.35 IU/ml with either an A. fumigatus persistent positive culture or an A. fumigatus precipitin Ն3 lines, provided this serological fi nding had been found associated with at least 1 A. fumigatus-positive culture. The remaining patients represented the control group. A multivariate analysis was carried out with FEV 1 as the outcome variable. Results: ABPA, sensitization, and persistent carriage were signifi cantly associated with a larger decline in FEV 1 compared with the control group, with odds ratios of 15.9, 14.9, and 10.7, respectively. This association was independent of other associated factors (P. aeruginosa transient detection, age, being underweight, and low FEV 1 at baseline). Conclusions: In addition to ABPA, sensitization and persistent carriage appear to have an impact on pulmonary function in CF patients.
The Effects of Aspergillus fumigatus Colonization on Lung Function in Patients with Cystic Fibrosis
Journal of Fungi
Aspergillus fumigatus is commonly isolated from CF airways. However, the impact on CF lung progression is not completely understood. In this study, using a 16-year retrospective observational cohort study (2000–2015) that included 132 patients, we determined the annual lung function, measured as percent predicted forced expiratory volume in the first second (ppFEV1), decline before and after the first colonization with A. fumigatus. Further, in the same individual, the ratios of lung function when patients were colonized with A. fumigatus and when they were not were calculated. The impact of eradication, with antifungal treatment or spontaneously, was assessed. The annual ppFEV1 was significantly lower after the first colonization with A. fumigatus. Furthermore, within the same individual, colonization with A. fumigatus for two and three years in a row was associated with 4.3% and 7.9% lower ppFEV1, respectively, compared to when not colonized. Finally, patients who eradicated A. fu...
Bacteriology of sputum in cystic fibrosis – 2 years of systematic monitoring
Journal of Cystic Fibrosis, 2008
Introduction: This study focuses on the prevalence of pathogens colonising the respiratory tract of adult CF patients at our specialist centre between 1985 and 2005. During this time, the care and treatment of patients with CF has continued to evolve. Therefore, we hypothesised that sputum microbiology would have changed and new pathogens may have emerged. Method: A retrospective analysis using data from the Royal Brompton Hospital CF database was performed. Results: There were no significant changes in the proportion of patients colonised with Pseudomonas aeruginosa or Staphylococcus aureus between 1985 and 2005 (77 to 82%, p = 0.159; and 54% to 47%, p = 0.108 respectively). The prevalence of Haemophilus influenzae (48 to 6%; p 0.001) and Aspergillus species (18 to 9%; p = 0.002) decreased. Stenotrophomonas maltophilia and Methicillin-resistant Staphylococcus aureus significantly increased (1 to 4%, p = 0.02; and 1 to 6%, p = 0.002, respectively). Burkholderia cepacia significantly decreased (9% (1990) to 4% (2005), p = 0.041). The mean FEV 1 and body mass index increased (47 to 53% predicted, p = 0.0075; and 19 to 22, p < 0.001, respectively). Conclusion: There has been relatively little change in the proportion of patients with P. aeruginosa colonisation since 1985 and importantly, there has been a decline in the prevalence of B. cepacia, H. influenzae and Aspergillus sp. The health status of the patients has improved which, in part, may be due to the intensive antibiotic strategy which, so far has not resulted in clinically significant emergence of new pathogens.
Respiratory Care, 2008
BACKGROUND: Patients with cystic fibrosis (CF) can become colonized by aspergillus, which can act as an allergen and cause allergic bronchopulmonary aspergillosis (ABPA). OBJECTIVE: To determine the rate of aspergillus colonization and ABPA in a population of Irish patients with CF. METHODS: In 50 consecutive patients with CF who presented with exacerbations, we looked for the presence of aspergillus in their sputum and signs and symptoms of ABPA. RESULTS: Fifteen patients (30%) grew aspergillus species in their sputum cultures. Six patients (12%) had ABPA. Matched for age, sex, genotype, and microbiology, there was no significant difference in forced expiratory volume in the first second (percent predicted, FEV 1 %) in subjects with aspergilluspositive sputum compared to those not colonized with aspergillus. Subjects with ABPA experienced sharp short-term deterioration in lung function (mean 6.7% predicted FEV 1 ), which returned to baseline following at least 4 weeks of treatment. CONCLUSIONS: The prevalence of ABPA was 12%. Aspergillus-positive sputum of itself was not a poor prognostic sign in terms of lung function over the 5-year study course. ABPA produces short-term reversible declines in lung function and responds to treatment. The frequency of aspergillus isolates did not correlate with the occurrence of ABPA. A low threshold for the diagnosis of ABPA should be maintained in any patient with CF who does not improve with antibiotics.
Journal of Cystic Fibrosis, 2015
Background: Clinical and demographical knowledge on Spanish cystic fibrosis (CF) patients is incomplete as no national registry exists. CFmicrobiology has not been studied at national level. The results of the first Spanish multicenter study on CF microbiology are presented. Methods: 24 CF-Units for adult (n = 12) and pediatric (n = 12) patients from 17 hospitals provided sputa and clinical data from 15 consecutive patients. Cultures and susceptibility testing were performed. Colonization impact on pulmonary function was assessed. Results: 341 patients [mean (SD) age 21 (11) years, 180 ≥ 18 years, mean (SD) FEV 1 = 68 (25)%] were included. Pseudomonas aeruginosa was reported as chronic, intermittent or absent in 46%, 22% and 32% of patients, respectively. The annual prevalence was 62%. Positive P. aeruginosa and methicillin-resistant Staphylococcus aureus cultures were significantly associated with lower FEV 1 (p b 0.001 and p = 0.003, respectively). Conclusions: The representative subset of the Spanish CF-population which has been clinically, demographically and microbiologically characterized will serve as a reference for future CF studies in Spain.