Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
Department of Microbiology, Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
Mycopathologia. 2018 Feb;183(1):45-59. doi: 10.1007/s11046-017-0143-7. Epub 2017 May 17.
Bronchiectasis is a chronic irreversible airway abnormality associated with infectious agents that either cause or superinfect the airways. While the role of bacteria is well studied, much remains to be determined about fungi in both cystic fibrosis- and non-cystic fibrosis-related bronchiectasis. The airway is constantly exposed to inhaled ambient moulds of which Aspergillus represent the most ubiquitous. In a normal healthy host, this situation is of little consequence. The presence of anatomical or immunological abnormalities such as those in bronchiectasis leads to a range of fungal-related pathologies from asymptomatic airway colonization to fungal sensitization, allergic bronchopulmonary aspergillosis or chronic pulmonary aspergillosis. These entities are difficult to recognize, diagnose and treat due in part to a lack of validated biomarkers. Our true understanding of the complex relationships that regulate fungal-host interactions is still in its infancy and, several questions remain. This includes if fungal epidemiology in bronchiectasis is uniform across countries, and to what extent immunopathological mechanisms-related to fungal airway infections-occurs in different disease states. Specific triggers to allergic or infectious responses to Aspergillus require further exploration. How transition occurs between allergic and invasive phenotypes and their respective biomarkers is also important. Whether anti-fungal treatment is warranted in all cases and what the optimal management strategy is, particularly when treatment should commence and its expected duration remains unclear. Further research is clearly necessary and should be prioritized to better understand the clinical effects and impact of Aspergillus in the setting of bronchiectasis.
支气管扩张症是一种与感染因子相关的慢性不可逆气道异常，这些感染因子可导致或继发气道感染。虽然细菌的作用已得到充分研究，但真菌在囊性纤维化和非囊性纤维化相关支气管扩张症中的作用仍有许多待确定。气道不断暴露于吸入性环境霉菌中，其中曲霉菌最为普遍。在正常健康宿主中，这种情况没有什么影响。解剖学或免疫学异常的存在，如支气管扩张症，会导致一系列与真菌相关的病理变化，从无症状的气道定植到真菌致敏、变应性支气管肺曲霉病或慢性肺曲霉病。由于缺乏经过验证的生物标志物，这些实体难以识别、诊断和治疗。我们对调节真菌-宿主相互作用的复杂关系的真正理解仍处于起步阶段，仍有几个问题需要解决。这包括支气管扩张症中真菌的流行病学在各国是否一致，以及与真菌气道感染相关的免疫病理机制在不同疾病状态下的程度。需要进一步探索曲霉菌过敏或感染反应的特定触发因素。从过敏表型到侵袭表型的转变及其各自的生物标志物如何发生也很重要。是否所有情况下都需要抗真菌治疗，以及最佳管理策略是什么，特别是何时开始治疗及其预期持续时间仍不清楚。显然需要进一步研究，并应优先考虑，以更好地了解支气管扩张症中曲霉菌的临床影响。
