Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, NSW, Australia.
Med Mycol. 2010 Nov;48 Suppl 1:S37-44. doi: 10.3109/13693786.2010.500627.
Risk factors for the association of Scedosporium in cases of cystic fibrosis (CF) and its clinical implications are poorly understood. Clinical, lung function and laboratory data of adult CF patients in Sydney (April 2008-March 2009) were prospectively analysed for such risk factors. Expectorated sputa were cultured for bacteria and examined for fungi using standard mycological and Scedosporium-selective media, and by an internal transcribed spacer region-targeted multiplex PCR assay. Scedosporium spp. (n = 4 each of Scedosporium prolificans, Scedosporium aurantiacum and Pseudallescheria boydii/ Scedosporium apiospermum complex [non-S. aurantiacum]) were recovered from 12 of 69 (17.4%) patients. Samples of 11 of the patients yielded isolates on Scedosporium- selective media (vs. 6 [8.7%] by non-selective culture) and one additional patient was noted by PCR. Of these patients, 83.3% were co-colonized with other moulds, most frequently Aspergillus fumigatus. Colonization was not associated with best FEV₁/predicted, corticosteroid or antifungal therapies. By univariate analysis, patients with Scedosporium colonization were significantly less likely to be colonized with mucoid Pseudomonas aeruginosa (P = 0.025), while prior therapy with antistaphylococcal penicillins was a risk factor for colonization (P = 0.045). Bacterial colonization and antimicrobial exposure likely influence Scedosporium colonization, which is optimally detected with selective media. Studies are required to confirm independent risk factors for Scedosporium colonization and to determine its impact on lung disease.
囊性纤维化（CF）患者中鞘孢菌属相关的风险因素及其临床意义尚不清楚。本研究前瞻性分析了 2008 年 4 月至 2009 年 3 月悉尼的成年 CF 患者的临床、肺功能和实验室数据，以寻找这些风险因素。通过标准的真菌学和鞘孢菌选择性培养基以及内部转录间隔区靶向多重 PCR 检测，对患者的痰液进行细菌培养和真菌检查。从 69 例患者（17.4%）中分别分离出 4 株 prolificans 种、4 株 aurantiacum 种和 pseudallescheria boydii/ Scedosporium apiospermum 复合体（非 aurantiacum 种）的鞘孢菌属。与非选择性培养（6 例，8.7%）相比，11 例患者的样本在鞘孢菌选择性培养基上分离出了菌株（11 例，15.9%），通过 PCR 检测到 1 例额外的患者。在这些患者中，83.3%与其他霉菌（最常见的是烟曲霉）共同定植，定植与最佳 FEV₁/预计值、皮质类固醇或抗真菌治疗无关。单因素分析显示，有鞘孢菌定植的患者更不可能被黏液性铜绿假单胞菌定植（P = 0.025），而使用抗葡萄球菌青霉素治疗是定植的危险因素（P = 0.045）。细菌定植和抗菌药物暴露可能影响鞘孢菌定植，使用选择性培养基可以最佳地检测到定植。需要进行研究以确认鞘孢菌定植的独立风险因素及其对肺部疾病的影响。
