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Fungal Pathogens in CF Airways: Leave or Treat?
A Singh1, A Ralhan1, C Schwarz2
1Department of Pediatrics, Pediatric Infectiology, Immunology and Cystic Fibrosis, Children's Hospital, University of Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany.
Abstract:
Chronic airway infection plays an essential role in the progress of cystic fibrosis (CF) lung disease. In the past decades, mainly bacterial pathogens, such as Pseudomonas aeruginosa, have been the focus of researchers and clinicians. However, fungi are frequently detected in CF airways and there is an increasing body of evidence that fungal pathogens might play a role in CF lung disease. Several studies have shown an association of fungi, particularly Aspergillus fumigatus and Candida albicans, with the course of lung disease in CF patients. Mechanistically, in vitro and in vivo studies suggest that an impaired immune response to fungal pathogens in CF airways renders them more susceptible to fungi. However, it remains elusive whether fungi are actively involved in CF lung disease pathologies or whether they rather reflect a dysregulated airway colonization and act as microbial bystanders. A key issue for dissecting the role of fungi in CF lung disease is the distinction of dynamic fungal-host interaction entities, namely colonization, sensitization or infection. This review summarizes key findings on pathophysiological mechanisms and the clinical impact of fungi in CF lung disease.
Insights
Fungi like Aspergillus fumigatus are increasingly found in cystic fibrosis (CF) airways. This review explores their role in CF lung disease, distinguishing infection from colonization.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Microbiology
Background:
- Chronic airway infections are central to cystic fibrosis (CF) lung disease progression.
- Bacterial pathogens like Pseudomonas aeruginosa have historically dominated research, but fungal presence is common.
- Emerging evidence suggests fungi, including Aspergillus fumigatus and Candida albicans, may influence CF lung disease.
Purpose of the Study:
- To review the pathophysiological mechanisms and clinical impact of fungal presence in CF airways.
- To differentiate between fungal colonization, sensitization, and infection in the context of CF lung disease.
- To summarize current understanding of fungal-host interactions in CF.
Main Methods:
- Literature review of in vitro and in vivo studies.
- Analysis of clinical data associating fungal presence with CF lung disease course.
- Discussion of immune response mechanisms in CF airways towards fungi.
Main Results:
- Fungi are frequently detected in CF airways, with Aspergillus fumigatus and Candida albicans being common.
- Impaired immune responses in CF patients may increase susceptibility to fungal pathogens.
- The precise role of fungi—whether active participants or bystanders—in CF lung disease pathology remains under investigation.
Conclusions:
- Fungi represent a significant, yet not fully understood, factor in cystic fibrosis lung disease.
- Distinguishing fungal colonization from active infection is crucial for understanding their impact.
- Further research is needed to elucidate the mechanisms and clinical significance of fungal-host interactions in CF.
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