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Aspergillosis and atopy in cystic fibrosis
Abstract:
Forty-six patients with cystic fibrosis (CF) were studied for colonization and sensitization by Aspergillus organisms. The fungus was cultured from 21 of 37 (57%) patients who produced sputum. The non-CF sputum isolation rate was 6.5%. Sputum hyphae were seen in 95% of patients with positive cultures. Sputum eosinophilia accompanied colonization by Aspergillus. Aspergillus precipitins were found in 37% of CF patients; positive immediate skin tests were found in 39%. "Atopy" defined by skin test criteria was found in 46%. All of these findings were more common in patients with more severe disease (p less than 0.05). CF patients had predominant mold sensitivity in contrast to predominant pollen sensitivity in a control group of asthmatic subjects. Serum IgE concentrations were increased in 22% of CF patients. CF patients who had increased serum concentrations of IgE were more likely to have a family history of atopy. Wheezing was more common in those who were atopic, especially the group with predominant mold sensitivity who had more severe disease. Four patients fulfilled the diagnostic criteria for allergic bronchopulmonary aspergillosis (ABPA) during the time of study and follow-up. A fifth patient had ABPA diagnosed before the study. The incidence of ABPA during a 2-yr period in our CF population was 11%.
Insights
Cystic fibrosis (CF) patients frequently show Aspergillus colonization and sensitization, particularly those with severe disease. This Aspergillus sensitivity is linked to allergic bronchopulmonary aspergillosis (ABPA) and wheezing in CF patients.
Area of Science:
- Pulmonary Medicine
- Clinical Immunology
- Microbiology
Background:
- Cystic fibrosis (CF) is a genetic disorder affecting multiple organs, primarily the lungs.
- Aspergillus colonization and sensitization are increasingly recognized complications in CF patients.
- Understanding the prevalence and impact of Aspergillus in CF is crucial for patient management.
Purpose of the Study:
- To investigate the prevalence of Aspergillus colonization and sensitization in cystic fibrosis patients.
- To correlate Aspergillus findings with disease severity, atopy, and allergic bronchopulmonary aspergillosis (ABPA).
- To compare mold sensitivity in CF patients with pollen sensitivity in asthmatic controls.
Main Methods:
- Sputum culture and microscopy for Aspergillus in 46 CF patients.
- Serological tests for Aspergillus precipitins and skin prick tests for sensitization.
- Assessment of atopy, serum IgE levels, and disease severity.
- Clinical evaluation for allergic bronchopulmonary aspergillosis (ABPA).
Main Results:
- Aspergillus was cultured from 57% of CF patients producing sputum, significantly higher than non-CF controls.
- Aspergillus colonization was associated with sputum eosinophilia and more severe CF disease.
- 37% of CF patients had Aspergillus precipitins, and 39% had positive skin tests.
- 46% of CF patients were atopic, with predominant mold sensitivity.
- The incidence of ABPA in the CF population was 11% over a 2-year period.
Conclusions:
- Aspergillus colonization and sensitization are common in cystic fibrosis patients, especially those with severe disease.
- These findings are associated with increased risk of atopy, allergic bronchopulmonary aspergillosis (ABPA), and wheezing.
- Targeted screening for Aspergillus sensitization and ABPA is warranted in CF patients, particularly those with severe lung disease.