Schwarz Carsten, Vandeputte Patrick, Rougeron Amandine, Giraud Sandrine, Dugé de Bernonville Thomas, Duvaux Ludovic, Gastebois Amandine, Alastruey-Izquierdo Ana, Martín-Gomez Maria Teresa, Mazuelos Estrella Martin, Sole Amparo, Cano Josep, Pemán Javier, Quindos Guillermo, Botterel Françoise, Bougnoux Marie-Elisabeth, Chen Sharon, Delhaès Laurence, Favennec Loïc, Ranque Stéphane, Sedlacek Ludwig, Steinmann Joerg, Vazquez Jose, Williams Craig, Meyer Wieland, Le Gal Solène, Nevez Gilles, Fleury Maxime, Papon Nicolas, Symoens Françoise, Bouchara Jean-Philippe
Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center Berlin/Charité -Universitätsmedizin Berlin, Berlin, Germany.
Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France.
Med Mycol. 2018 Apr 1;56(suppl_1):42-59. doi: 10.1093/mmy/myx106.
Cystic fibrosis (CF) is the major genetic inherited disease in Caucasian populations. The respiratory tract of CF patients displays a sticky viscous mucus, which allows for the entrapment of airborne bacteria and fungal spores and provides a suitable environment for growth of microorganisms, including numerous yeast and filamentous fungal species. As a consequence, respiratory infections are the major cause of morbidity and mortality in this clinical context. Although bacteria remain the most common agents of these infections, fungal respiratory infections have emerged as an important cause of disease. Therefore, the International Society for Human and Animal Mycology (ISHAM) has launched a working group on Fungal respiratory infections in Cystic Fibrosis (Fri-CF) in October 2006, which was subsequently approved by the European Confederation of Medical Mycology (ECMM). Meetings of this working group, comprising both clinicians and mycologists involved in the follow-up of CF patients, as well as basic scientists interested in the fungal species involved, provided the opportunity to initiate collaborative works aimed to improve our knowledge on these infections to assist clinicians in patient management. The current review highlights the outcomes of some of these collaborative works in clinical surveillance, pathogenesis and treatment, giving special emphasis to standardization of culture procedures, improvement of species identification methods including the development of nonculture-based diagnostic methods, microbiome studies and identification of new biological markers, and the description of genotyping studies aiming to differentiate transient carriage and chronic colonization of the airways. The review also reports on the breakthrough in sequencing the genomes of the main Scedosporium species as basis for a better understanding of the pathogenic mechanisms of these fungi, and discusses treatment options of infections caused by multidrug resistant microorganisms, such as Scedosporium and Lomentospora species and members of the Rasamsonia argillacea species complex.
囊性纤维化（CF）是白种人群中主要的遗传性疾病。CF患者的呼吸道会产生黏稠的黏液，这使得空气中的细菌和真菌孢子容易被困住，并为包括许多酵母和丝状真菌物种在内的微生物生长提供了适宜的环境。因此，呼吸道感染是这种临床情况下发病和死亡的主要原因。尽管细菌仍然是这些感染最常见的病原体，但真菌性呼吸道感染已成为一个重要的致病原因。因此，国际人类和动物真菌学会（ISHAM）于2006年10月发起了一个关于囊性纤维化患者真菌性呼吸道感染（Fri-CF）的工作组，该工作组随后得到了欧洲医学真菌学联合会（ECMM）的批准。该工作组的会议由参与CF患者随访的临床医生和真菌学家以及对相关真菌物种感兴趣的基础科学家共同组成，为开展合作研究提供了机会，旨在增进我们对这些感染的了解，以协助临床医生进行患者管理。本综述重点介绍了其中一些在临床监测、发病机制和治疗方面的合作研究成果，特别强调了培养程序的标准化、物种鉴定方法的改进，包括基于非培养的诊断方法的开发、微生物组研究和新生物标志物的鉴定，以及旨在区分气道短暂携带和慢性定植的基因分型研究的描述。该综述还报告了主要拟青霉属物种基因组测序方面的突破，以此作为更好地理解这些真菌致病机制的基础，并讨论了由多重耐药微生物引起的感染的治疗选择，如拟青霉属和卷枝霉属物种以及泥生拉氏菌物种复合体的成员。
