Impact of airway Exophiala spp. on children with cystic fibrosis

Mills, Rowena; Rautemaa‐Richardson, Riina; Wilkinson, Stuart; Patel, Latifa; Maitra, Anirban; Horsley, Alex

doi:10.1016/j.jcf.2021.03.012

Cited by 5 publications

(5 citation statements)

References 35 publications

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“…candidal infection) whilst on IV antibiotics. However, the findings are consistent with previous studies that suggest that E. dermatitidis is not associated with worse clinical outcomes [9,16].…”

Section: Discussionsupporting

confidence: 92%

“…Routine targeting of E. dermatitidis with antifungals for acute exacerbations may therefore cause harm and is unlikely to be of benefit. In keeping with other studies, we found no significant difference in baseline BMI and lung function between the two groups, and no difference between groups in the change in lung function or BMI over 12 months [9,16]. As Singh et al describe, CF airways may be more susceptible to fungi because of an impaired immune response to fungal pathogens, although organisms such as E. dermatitidis may be more of a 'microbiological bystander' rather than causing sensitization or infection [17].…”

Section: Discussionsupporting

confidence: 88%

“…As Singh et al describe, CF airways may be more susceptible to fungi because of an impaired immune response to fungal pathogens, although organisms such as E. dermatitidis may be more of a ‘microbiological bystander’ rather than causing sensitization or infection [17]. This may also explain our findings that patients with E. dermatitidis were more likely to be prescribed a long-term antifungal medication for ABPA, as well as previous findings that isolation of E. dermatitidis is associated with aspergillus colonization [4, 9, 16].…”

Section: Discussionsupporting

confidence: 71%

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Isolation of Exophiala dermatitidis is not associated with worse clinical outcomes during acute pulmonary exacerbations in cystic fibrosis

Tewkesbury

Looi

Barry

et al. 2022

Journal of Medical Microbiology

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Introduction. The black yeast Exophiala dermatitidis has been isolated in respiratory samples from people with cystic fibrosis (CF). However, adequate detection may require longer incubation periods than the current UK national standard for CF respiratory samples. Furthermore, it is unclear whether isolation of E. dermatitidis is associated with poorer clinical outcomes in CF. Hypothesis/gap statement. E. dermatitidis does not cause clinically significant lung disease in CF adults. Aim. To evaluate differences in clinical outcomes over a 12 month period and during acute pulmonary exacerbations between CF adults with and without untreated E. dermatitidis. Methodology. Incubation times for respiratory samples on Sabouraud dextrose agar with chloramphenicol (SABC) plates at a large regional adult CF centre were extended from 2 to 7 days over a 1 month period. The number of patients from whom E. dermatitidis was isolated, and the length of incubation time prior to isolation, were recorded. Outcomes of treatment of exacerbations with intravenous antibiotics but in the absence of concomitant antifungal therapy were compared between those with and without E. dermatitidis, as were changes in lung function and body mass index (BMI) over a 12 month period. Results. Extended incubation unmasked the presence of E. dermatitidis in 22 of 132 patients; all isolations occurred after >48 h of incubation. Patients who isolated E. dermatitidis had lower rates of Pseudomonas aeruginosa isolation (P=0.02) and higher rates of non-tuberculous mycobacteria isolation (P=0.03), and were more likely to be prescribed a long-term antifungal medication (P=0.03), but had no differences in age, sex, baseline lung function or body mass index (BMI). There were no differences in response to treatment of acute exacerbations between patients with and without E. dermatitidis, or in change in forced expiratory volume in 1 s (FEV1), BMI and number of exacerbations over 12 months of follow-up. Conclusion. E. dermatitidis is not associated with worse clinical outcomes in CF. Given potential side effects and drug interactions, routine targeting of E. dermatitidis with antifungals during acute exacerbations is not advised.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 71%

See 1 more Smart Citation

Isolation of Exophiala dermatitidis is not associated with worse clinical outcomes during acute pulmonary exacerbations in cystic fibrosis

Tewkesbury

Looi

Barry

et al. 2022

Journal of Medical Microbiology

View full text Add to dashboard Cite

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“…This study reviews patients with an uncommon condition who are isolating a rare pathogen from their respiratory tract and, as such, the numbers in each group are lower in this single centre compared with other published works [8]. However, this study reviews historic lung function over a far longer timeframe than previously studied, which may account for the elucidation of a modest decline difference [8,9]. Despite the smaller numbers, the patients were well matched in each group; beyond the relationship with A. fumigatus, the only significant difference between the groups was age.…”

Section: Discussionmentioning

confidence: 93%

“…The rate of lung function decline, determined by comparison of FEV1% values over time, is perhaps an even more relevant and better predictor of clinical deterioration [7]. Prior studies have suggested that E. dermatitidis does not contribute to lung function decline, but patient numbers were limited and the length of follow up was short [8,9]. The primary objective of our study was to assess if the presence of E. dermatitidis in respiratory cultures impacts the trajectory of lung function decline of CF patients, which would help better inform the decision whether to initiate treatment targeting E. dermatitidis in future patients.…”

Section: Introductionmentioning

confidence: 99%

The Presence of Exophiala dermatitidis in the Respiratory Tract of Cystic Fibrosis Patients Accelerates Lung Function Decline: A Retrospective Review of Lung Function

Ayling-Smith

Speight

Dhillon

et al. 2022

JoF

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Exophiala dermatitidis is increasingly isolated from cystic fibrosis (CF) respiratory samples. The decision to treat is hampered by limited evidence demonstrating the clinical significance of isolating E. dermatitidis. The objective was to assess the impact of E. dermatitidis isolation on the lung function of CF patients. The rate of lung function decline in the local CF population was calculated using historic lung function data. A control population who had never had E. dermatitidis cultured from the respiratory tract was compared with the E. dermatitidis group, calculating their rate of lung function decline before and after the first isolation of the organism. A total of 1840 lung function measurements were reviewed between the 31 E. dermatitidis group patients and 62 control patients. Their demographics were similar. The control group declined at a rate of −0.824 FEV1%/year. The rate of decline in the E. dermatitidis group prior to infection was −0.337 FEV1%/year (p = 0.2). However, post infection with E. dermatitidis, there was a significant increase in the rate of decline in lung function (−1.824 FEV1%/year, p < 0.01). The results suggest E. dermatitidis has a temporal relationship with accelerated rate of lung function decline. It is not clear if this is a cause or effect, but this accelerated rate of decline indicates a need for further investigation.

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2023

Larone's Medically Important Fungi

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Impact of airway Exophiala spp. on children with cystic fibrosis

Cited by 5 publications

References 35 publications

Isolation of Exophiala dermatitidis is not associated with worse clinical outcomes during acute pulmonary exacerbations in cystic fibrosis

Isolation of Exophiala dermatitidis is not associated with worse clinical outcomes during acute pulmonary exacerbations in cystic fibrosis

The Presence of Exophiala dermatitidis in the Respiratory Tract of Cystic Fibrosis Patients Accelerates Lung Function Decline: A Retrospective Review of Lung Function

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