Aspergillus fumigatus colonization in cystic fibrosis: implications for lung function?

Abstract

Aspergillus fumigatus is commonly found in the respiratory secretions of patients with cystic fibrosis (CF). Although allergic bronchopulmonary aspergillosis (ABPA) is associated with deterioration of lung function, the effects of A. fumigatus colonization on lung function in the absence of ABPA are not clear. This study was performed in 259 adults and children with CF, without ABPA. A. fumigatus colonization was defined as positivity of >50% of respiratory cultures in a given year. A cross-sectional analysis was performed to study clinical characteristics associated with A. fumigatus colonization. A retrospective cohort analysis was performed to study the effect of A. fumigatus colonization on lung function observed between 2002 and 2007. Longitudinal data were analysed with a linear mixed model. Sixty-one of 259 patients were at least intermittently colonized with A. fumigatus. An association was found between A. fumigatus colonization and increased age and use of inhaled antibiotics. In the longitudinal analysis, 163 patients were grouped according to duration of colonization. After adjustment for confounders, there was no significant difference in lung function between patients colonized for 0 or 1 year and patients with 2-3 or more than 3 years of colonization (p 0.40 and p 0.64) throughout the study. There was no significant difference in lung function decline between groups. Although colonization with A. fumigatus is more commonly found in patients with more severe lung disease and increased treatment burden, it is not independently associated with lower lung function or more severe lung function decline over a 5-year period.

Evaluation of the Aspergillus Western Blot IgG Kit for Diagnosis of Chronic Aspergillosis

“…The primary interest of including colonized patients in this evaluation is that they are typically those in whom Aspergillus serology is performed. In contrast to effect in CF patients (21,(23)(24)(25), little is known concerning the impact of Aspergillus colonization in non-CF patients. Despite the relatively small sample size, we observed a striking difference in Asp-WB sensitivity, with 100% and 42% in CF and non-CF patients, respectively.…”

Evaluation of a Recombinant Antigen-Based Enzyme Immunoassay for the Diagnosis of Noninvasive Aspergillosis

“…In addition, Aspergillus may also colonize bronchial airways of patients with altered mucociliary clearance, such as cystic fibrosis patients or heavy smokers. This colonization does not seem to impact negatively the respiratory function of these patients while it may be the primum movens of other clinical forms, notably allergic bronchopulmonary aspergillosis (4,12).…”

Aspergillus Species and Other Molds in Respiratory Samples from Patients with Cystic Fibrosis: a Laboratory-Based Study with Focus on Aspergillus fumigatus Azole Resistance

“…Invasive aspergillosis in the absence of lung transplantation is rare among CF patients (33). Finally, Aspergillus may colonize the lungs without causing apparent clinical disease, and the effects on lung function are not clear (2,22). Genotyping studies of A. fumigatus isolates indicate that patients may be simultaneous or sequentially colonized with several different strains but eventually a single strain becomes dominant (15,20,51).…”