Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
Clin Immunol. 2013 Feb;146(2):77-83. doi: 10.1016/j.clim.2012.11.005. Epub 2012 Nov 27.
The etiology of status asthmaticus (SA), a complication of severe asthma, is unknown. Fungal exposure, as measured by fungal atopy, is a major risk factor for developing asthma, but the relationship of fungi in SA per se has not previously been reported. In this five patient retrospective case series study, lower respiratory tract cultures were performed on bronchoalveolar lavage or tracheal aspirate fluid, comparing standard clinical laboratory cultures with a specialized technique in which respiratory mucus was removed prior to culture. We show that mucolytic treatment allows an increased detection of fungal growth, especially yeast, from the lower airways of all SA patients. We also demonstrate that inhalation of the yeast Candida albicans readily induces asthma-like disease in mice. Our observations suggest that SA may represent a fungal infectious process, and support additional prospective studies utilizing anti-fungal therapy to supplement conventional therapy, broad-spectrum antibiotics and high-dose glucocorticoids, which can promote fungal overgrowth.
哮喘持续状态（SA）是一种严重哮喘的并发症，其病因尚不清楚。真菌暴露（通过真菌过敏来衡量）是发生哮喘的一个主要危险因素，但真菌在 SA 中的作用尚未见报道。在这项回顾性的五例患者病例系列研究中，对支气管肺泡灌洗液或气管抽吸液进行了下呼吸道培养，将标准临床实验室培养与一种专门技术进行了比较，即在培养前清除呼吸道黏液。我们发现黏液溶解治疗可增加 SA 患者下呼吸道中真菌生长的检出率，尤其是酵母。我们还证明，吸入白色念珠菌酵母可使小鼠容易发生哮喘样疾病。我们的观察结果表明，SA 可能代表一种真菌感染过程，并支持进一步的前瞻性研究，利用抗真菌治疗来补充常规治疗、广谱抗生素和大剂量糖皮质激素，因为这些治疗可能会促进真菌过度生长。
