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Aspergillus Bronchitis in Patients with Cystic Fibrosis
Claudia Brandt1, Jobst Roehmel1, Volker Rickerts2
1Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Abstract:
Aspergillus fumigatus frequently colonizes the airways of patients with cystic fibrosis (CF) and may cause various severe infections, such as bronchitis. Serological data, sputum dependent markers and longitudinal data of treated cases of Aspergillus bronchitis were evaluated for further description of this infection. This study, which comprises three substudies, aimed to analyze epidemiological data of Aspergillus in CF and the entity of Aspergillus bronchitis. In a first step, data of the German Cystic Fibrosis Registry were used to evaluate the frequency of Aspergillus colonization in patients with CF (n = 2599). Then a retrospective analysis of 10 cases of Aspergillus bronchitis was performed to evaluate longitudinal data for lung function and clinical presentation parameters: sputum production, cough and physical capacity. Finally, a prospective cohort study (n = 22) was conducted to investigate serological markers for Aspergillus bronchitis: total serum IgE, specific serum IgE, specific serum IgG, as well as sputum galactomannan, real-time PCR detection of Aspergillus DNA in sputum and fungal cultures. Analysis of the German CF registry revealed an Aspergillus colonization rate of 32.5% among the 2599 patients. A retrospective data analysis of 10 treated cases revealed the clinical course of Aspergillus bronchitis, including repeated positive sputum culture findings for A. fumigatus, no antibiotic treatment response, total serum IgE levels <200 kU/l, no observation of new pulmonary infiltrates and appropriate antifungal treatment response. Antifungal treatment durations of 4 ± 1.6 (2-6) weeks significantly reduced cough (P = 0.0067), sputum production (P < 0.0001) and lung function measures (P = 0.0358) but not physical capacity (P = 0.0794). From this retrospective study, a prevalence of 1.6% was calculated. In addition, two cases of Aspergillus bronchitis were identified in the prospective cohort study according to immunological, molecular and microbiological parameters. A prevalence of 9% was assessed. Aspergillus bronchitis appears to occur in a minority of colonized CF patients. Antifungal treatment may reduce respiratory symptoms and restore lung function.
Insights
Aspergillus fumigatus colonization affects over 30% of cystic fibrosis patients. Antifungal treatment for Aspergillus bronchitis in CF patients can significantly reduce respiratory symptoms and improve lung function.
Area of Science:
- Medical Mycology
- Pulmonology
- Infectious Diseases
Background:
- Aspergillus fumigatus is a common airway colonizer in cystic fibrosis (CF) patients.
- This colonization can lead to severe respiratory infections, including bronchitis.
Purpose of the Study:
- To analyze the epidemiology of Aspergillus in CF patients.
- To describe the clinical characteristics and treatment outcomes of Aspergillus bronchitis in CF.
- To investigate diagnostic markers for Aspergillus bronchitis.
Main Methods:
- Analysis of the German Cystic Fibrosis Registry (n=2599) for colonization rates.
- Retrospective analysis of 10 treated cases of Aspergillus bronchitis.
- Prospective cohort study (n=22) evaluating serological, molecular, and microbiological markers.
Main Results:
- Aspergillus colonization rate in CF patients is 32.5%.
- Retrospective analysis showed antifungal treatment improved cough, sputum production, and lung function.
- Prevalence of Aspergillus bronchitis was estimated at 1.6% (retrospective) and 9% (prospective).
Conclusions:
- Aspergillus bronchitis occurs in a subset of colonized CF patients.
- Antifungal therapy is effective in alleviating symptoms and improving lung function in CF patients with Aspergillus bronchitis.
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