Prospective multicenter German study on pulmonary colonization with Scedosporium /Lomentospora species in cystic fibrosis: Epidemiology and new association factors

Abstract

BackgroundAn increasing rate of respiratory colonization and infection in cystic fibrosis (CF) is caused by fungi of the Scedosporium apiospermum species complex or Lomentospora prolificans (Sac-Lp). These fungi rank second among the filamentous fungi colonizing the CF airways, after Aspergillus fumigatus. However, the epidemiology, clinical relevance and risk of pulmonary colonization with Sac-Lp are rarely understood in CF. The objective of the present prospective multicenter study was to study pathogen distribution and determine association factors of pulmonary Sac-Lp colonization in patients with CF.Material and methodsClinical, microbiological and laboratory data of 161 patients aged 6–59 years with CF in Germany were analyzed for Sac-Lp distribution and association factors. The free statistical software R was utilized to investigate adjusted logistic regression models for association factors.ResultsOf the 161 patients included in the study, 74 (56%) were male. The median age of the study cohort was 23 years (interquartile range 13–32 years). 58 patients of the total cohort (36%) were < 18 years old. Adjusted multivariate regression analysis revealed that Sac-Lp colonization was associated with younger age (OR 0.8684, 95%CI: 0.7955–0.9480, p<0.005) and less colonization with H. influenzae (OR 0.0118, 95%CI: 0.0009–0.1585, p<0.001). In addition, Sac-Lp-colonized patients had more often allergic bronchopulmonary aspergillosis (ABPA) (OR 14.6663, 95%CI: 2.1873–98.3403, p<0.01) and have been colonized more often with the mucoid phenotype of Pseudomonas aeruginosa (OR 9.8941, 95%CI: 1.0518–93.0705, p<0.05).ConclusionNewly found association of ABPA and Pseudomonas revealed new probable risk factors for Sac-Lp colonization. Allergy might play a role in inducing immunologic host reactions which lead to a less effective response to species of Sac-Lp.

Inhaled antibiotic use is associated with Scedosporium/Lomentospora species isolation in cystic fibrosis

“…The average age of first isolation of Scedosporium spp in CF has been described as approximately 14.5 years . In contrast, younger age was associated with Scedosporium/Lomentospora colonization in a German CF cohort . The detection of fungi in older individuals may be due sampling bias, given less reliable microbiological data in younger children unable to expectorate sputum.…”

“…Scedosporium species (spp) is the second most common mold seen in the CF lung after Aspergillus spp . Scedosporium apiospermum complex (includes S. apiospermum sensu stricto, S. boydii , and S. auranticum ) and Lomentospora prolificans (formerly known as Scedosporium prolificans ) have been identified in CF hosts . Despite this, little is known about the characteristics associated with isolation of Scedosporium spp from CF sputum.…”

Scedosporium apiospermum complex in cystic fibrosis; should we treat?

“…Several studies have defined fungal chronic colonisation as the presence of fungus in >50% of cultures or the presence of two or more positive cultures in a given year . Especially for S. apiospermum complex, data are still limited and ambiguous . Taken into account the already published literature about chronic colonisation in CF patients as well as the significance of the positive cultures and a possible underestimation of fungus isolation due to inadequate sputum samples, we defined the chronic colonisation as the presence of two or more positive cultures in a given year.…”

Lomentospora prolificans fungemia in hematopoietic stem cell transplant patients: First report in South America and literature review

“…In immunocompetent hosts, localized infections (skin, eye, ear, and osteoarticular) have been described, generally following surgery or trauma . L. prolificans can also colonize the respiratory tract of cystic fibrosis patients and may negatively influence the outcome of lung transplantation . In immunocompromised individuals, L. prolificans is considered the most common agent of disseminated phaeohyphomycosis, which is associated with high mortality despite antifungal therapy .…”

“…3 L. prolificans can also colonize the respiratory tract of cystic fibrosis patients and may negatively influence the outcome of lung transplantation. 4 In immunocompromised individuals, L. prolificans is considered the most common agent of disseminated phaeohyphomycosis, which is associated with high mortality despite antifungal therapy. 2,5,6 Although L. prolificans is considered an emerging pathogen, it seems to be restricted to some countries in Europe (Spain, France, and Germany), Australia, and some Southern states of United States of America.…”