P8 Cultural fungal mycobiome in non-cystic fibrosis bronchiectasis

Scadding, AJ; Pashley, Catherine H.; Monteiro, W; Bhatt, H; Wardlaw, A J

doi:10.1136/thorax-2018-212555.166

Cited by 1 publication

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“… 92 The participants with a positive sputum fungal culture had significantly more symptoms of cough, breathlessness, sputum production and sputum purulence compared to those with negative fungal cultures. 93 Using potato dextrose agar containing chloramphenicol (16 µg/mL), gentamicin (4 µg/mL) and fluconazole (5 µg/mL) (PGCF) as a culture medium, the most commonly cultured fungi were the Aspergillus species, of which A. fumigatus was the most commonly cultured. Penicillium species were the next prevalent, with a range of other fungi identified as single isolates ( Table 2 ).…”

Section: The Airway Mycobiotamentioning

confidence: 99%

New Perspectives in the Diagnosis and Management of Allergic Fungal Airway Disease

Wardlaw¹,

Rick²,

Özyiğit³

et al. 2021

JAA

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Allergy to airway-colonising, thermotolerant, filamentous fungi represents a distinct eosinophilic endotype of often severe lung disease. This endotype, which particularly affects adult asthma, but also complicates other airway diseases and sometimes occurs de novo, has a heterogeneous presentation ranging from severe eosinophilic asthma to lobar collapse. Its hallmark is lung damage, characterised by fixed airflow obstruction (FAO), bronchiectasis and lung fibrosis. It has a number of monikers including severe asthma with fungal sensitisation (SAFS) and allergic bronchopulmonary aspergillosis/mycosis (ABPA/ M), but these exclusive terms constitute only sub-sets of the condition. In order to capture the full extent of the syndrome we prefer the inclusive term allergic fungal airway disease (AFAD), the criteria for which are IgE sensitisation to relevant fungi in association with airway disease. The primary fungus involved is Aspergillus fumigatus, but a number of other thermotolerant species from several genera have been implicated. The unifying mechanism involves germination of inhaled fungal spores in the lung in the context of IgE sensitisation, leading to a persistent and vigorous eosinophilic inflammatory response in association with release of fungal proteases. Most allergenic fungi, including Alternaria and Cladosporium species, are not thermotolerant and cannot germinate in the airways so only act as aeroallergens and do not cause AFAD. Studies of the airway mycobiome have shown that A. fumigatus colonises the normal as much as the asthmatic airway, suggesting it is the tendency to become IgE-sensitised that is the critical triggering factor for AFAD rather than colonisation per se. Treatment is aimed at preventing exacerbations with glucocorticoids and increasingly by the use of anti-T2 biological therapies. Anti-fungal therapy has a limited place in management, but is an effective treatment for fungal bronchitis which complicates AFAD in about 10% of cases.

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Section: The Airway Mycobiotamentioning

confidence: 99%