Microbial yield from physiotherapy assisted sputum production in respiratory outpatients

Langridge, Philip; Sheehan, Reyenna; Denning, David W.

doi:10.1186/s12890-016-0188-2

Cited by 17 publications

(10 citation statements)

References 26 publications

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“…We did not systematically collect bacterial culture data, primarily because it is likely to be very incomplete. We have assembled information of the bacteria cultured from our patients [29], and 19 (5%) out of 364 patients attending our service (50% with CPA) grew Pseudomonas aeruginosa, and slightly fewer grew other rapidly growing bacteria. No attempt was made to analyse any impact on survival of these bacterial infections.…”

Section: Resultsmentioning

confidence: 99%

Predictors of mortality in chronic pulmonary aspergillosis

et al. 2016

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Chronic pulmonary aspergillosis (CPA) is a chronic progressive infection that destroys lung tissue in non-immunocompromised patients. Contemporary series suggest 50-85% 5-year mortality, with few prognostic factors identified.A cohort of 387 CPA patients referred to the UK's National Aspergillosis Centre from 1992 to June 2012 was studied until June 2015. The impact of objective and subjective variables including age, sex, previous pulmonary conditions, dyspnoea score, quality of life, serum albumin and C-reactive protein and radiological appearances were assessed using Kaplan-Meier curves, log rank tests and Cox proportional hazards modelling. In samples of patients, retrospective review of time from likely onset of CPA to referral and cause of death were also investigated.Survival was 86%, 62% and 47% at 1, 5 and 10 years, respectively. Increased mortality was associated with nontuberculous mycobacterial infection (hazard ratio 2.07, 95% CI 1.22-3.52; p<0.001) and chronic obstructive pulmonary disease (1.57, 1.05-2.36; p=0.029) as well as higher age (1.053, 1.03-1.07 per year; p<0.001), lower albumin (0.92, 0.87-0.96 per g·L), lower activity (1.021, 1.01-1.03 per point increase in St George's Respiratory Questionnaire activity domain; p<0.001) and having one, and especially, bilateral aspergillomas (p<0.001).Several factors impact on mortality of CPA, and can be evaluated as tools to assess CPA prognosis.

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Section: Resultsmentioning

confidence: 99%

Predictors of mortality in chronic pulmonary aspergillosis

et al. 2016

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“…Conventional cultures of bronchoalveolar lavage (BAL) fluid and other respiratory samples are negative in the majority (up to 90%) of aspergillosis patients [88]. Thus, determination of resistance in culture-negative patients is difficult.…”

Section: Detection Of Azole Resistance In Patients With Negative Cultmentioning

confidence: 99%

Clinical implications of globally emerging azole resistance in Aspergillus fumigatus

Meis

Chowdhary

Rhodes

et al. 2016

Phil. Trans. R. Soc. B

268

252

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One contribution of 18 to a discussion meeting issue 'Tackling emerging fungal threats to animal health, food security and ecosystem resilience'. Aspergillus fungi are the cause of an array of diseases affecting humans, animals and plants. The triazole antifungal agents itraconazole, voriconazole, isavuconazole and posaconazole are treatment options against diseases caused by Aspergillus. However, resistance to azoles has recently emerged as a new therapeutic challenge in six continents. Although de novo azole resistance occurs occasionally in patients during azole therapy, the main burden is the aquisition of resistance through the environment. In this setting, the evolution of resistance is attributed to the widespread use of azole-based fungicides. Although ubiquitously distributed, A. fumigatus is not a phytopathogen. However, agricultural fungicides deployed against plant pathogenic moulds such as Fusarium, Mycospaerella and A. flavus also show activity against A. fumigatus in the environment and exposure of non-target fungi is inevitable. Further, similarity in molecule structure between azole fungicides and antifungal drugs results in cross-resistance of A. fumigatus to medical azoles. Clinical studies have shown that twothirds of patients with azole-resistant infections had no previous history of azole therapy and high mortality rates between 50% and 100% are reported in azole-resistant invasive aspergillosis. The resistance phenotype is associated with key mutations in the cyp51A gene, including TR 34 /L98H, TR 53 and TR 46 /Y121F/T289A resistance mechanisms. Early detection of resistance is of paramount importance and if demonstrated, either with susceptibility testing or through molecular analysis, azole monotherapy should be avoided. Liposomal amphotericin B or a combination of voriconazole and an echinocandin are recomended for azole-resistant aspergillosis.This article is part of the themed issue 'Tackling emerging fungal threats to animal health, food security and ecosystem resilience'.

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“…However, not uncommonly obtaining a sputum sample can be difficult. Physiotherapy assistance and induced sputum assist yield [ 23 ]. A referral to a bronchoscopist for bronchoalveolar lavage would be the next step.…”

Section: Diagnosismentioning

confidence: 99%

The Management of Chronic Pulmonary Aspergillosis: The UK National Aspergillosis Centre Approach

Maghrabi

Denning

2017

Curr Fungal Infect Rep

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Purpose of ReviewChronic pulmonary aspergillosis (CPA) is a serious long-term fungal disease of the lung with a worldwide prevalence. Treatment of CPA is not straightforward given the often-multiple associated co-morbidities, complex clinical picture, drug interactions, toxicities and intolerances.Recent FindingsFirst line treatment is oral itraconazole or voriconazole. In the event of intolerance or toxicity, patients may be swapped from itraconazole to voriconazole or vice versa. In the event of resistance or further intolerance, third line treatment with posaconazole could be initiated. In those with pan-azole resistance, short-term courses of intravenous liposomal amphotericin B or micafungin are fourth line therapy, keeping in mind the nephrotoxic effects of amphotericin B.SummaryThe available evidence for current treatments in CPA is limited and based mostly on retrospective cohort studies. There is a real need to raise awareness of this devastating disease to enable early treatment as well as prospective drug trials and studies to identify potential patient factors that correlate with progression, severity and overall outcomes in order to target future therapies.

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Microbial yield from physiotherapy assisted sputum production in respiratory outpatients

Cited by 17 publications

References 26 publications

Predictors of mortality in chronic pulmonary aspergillosis

Predictors of mortality in chronic pulmonary aspergillosis

Clinical implications of globally emerging azole resistance in Aspergillus fumigatus

The Management of Chronic Pulmonary Aspergillosis: The UK National Aspergillosis Centre Approach

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