Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom.
Paediatric Respiratory Department, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
Front Cell Infect Microbiol. 2021 Jan 22;10:605241. doi: 10.3389/fcimb.2020.605241. eCollection 2020.
The relationship between fungal culture (FC) positivity and airway inflammation in CF is largely unknown. Identifying the clinical significance of filamentous fungi in CF using both clinical parameters and biomarkers may change our antimicrobial therapeutic strategies.
To investigate the clinical characteristics and airway biomarker profile in relation to the detection of filamentous fungi in respiratory samples obtained from CF patients.
A prospective cohort study over 24 months, including children and adults with CF. Participants provided sputum and/or bronchoalveolar lavage samples, which underwent processing for bacterial and fungal culture, leukocyte differential cell count and biomarker analysis for neutrophil elastase (NE), interleukin-8 (IL-8), galactomannan and tumor necrosis factor receptor type 2 (TNF-R2). We performed FC using neat sputum plugs, an approach shown to be more sensitive compared to routine laboratory testing.
Sixty-one patients provided 76 respiratory samples (72 sputum and 4 BAL). Median age was 17 years (range 6 months-59 years). FC positivity was noted in 49% of the cohort. FC positivity was greater during pulmonary exacerbation compared to the stable state (67 versus 50%). Participants aged 5-30 years had a lower FEV1 within the FC positive group. A significant association between FC positivity and non-tuberculosis mycobacterial (NTM) culture was observed on non-parametric testing (p = 0.022) and regression analysis (p = 0.007). Exposure to indoor mold was a predictor for FC positivity (p = 0.047). There was a trend towards increased lung clearance index (LCI), bronchiectasis and intravenous antibiotic use in the FC positive group. There was no significant difference in biomarkers between FC positive and negative patients.
is the commonest filamentous fungi cultured from CF airways. We found no difference in the airway biomarker profile between FC positive and negative patients. The role of galactomannan and TNFR2 as fungal specific biomarkers in CF remains uncertain. FC positivity is associated with a lower FEV in younger patients, a lower LCI, NTM positivity, bronchiectasis, and intravenous antibiotic exposure. Larger trials are needed to determine the role of galactomannan and TNF-R2 as potential fungal biomarkers in CF.
真菌培养（FC）阳性与 CF 气道炎症之间的关系在很大程度上尚不清楚。使用临床参数和生物标志物来确定 CF 中丝状真菌的临床意义可能会改变我们的抗菌治疗策略。
研究与 CF 患者呼吸道样本中丝状真菌检测相关的临床特征和气道生物标志物谱。
一项为期 24 个月的前瞻性队列研究，纳入儿童和成人 CF 患者。参与者提供痰和/或支气管肺泡灌洗液样本，进行细菌和真菌培养、白细胞分类计数以及中性粒细胞弹性蛋白酶（NE）、白细胞介素-8（IL-8）、半乳甘露聚糖和肿瘤坏死因子受体 2（TNF-R2）的生物标志物分析。我们使用未经稀释的痰栓进行 FC，与常规实验室检测相比，这种方法更敏感。
61 名患者提供了 76 份呼吸道样本（72 份痰和 4 份 BAL）。中位年龄为 17 岁（范围 6 个月至 59 岁）。队列中有 49%的患者 FC 阳性。与稳定状态相比，在肺部恶化时 FC 阳性的比例更高（67%比 50%）。5-30 岁的患者在 FC 阳性组中的 FEV1 较低。非参数检验（p = 0.022）和回归分析（p = 0.007）显示，FC 阳性与非结核分枝杆菌（NTM）培养之间存在显著关联。室内霉菌暴露是 FC 阳性的预测因素（p = 0.047）。FC 阳性组的肺清除指数（LCI）、支气管扩张和静脉内抗生素使用均有增加的趋势。FC 阳性和阴性患者的生物标志物无显著差异。
是 CF 气道中最常见的丝状真菌。我们发现 FC 阳性和阴性患者的气道生物标志物谱没有差异。半乳甘露聚糖和 TNF-R2 作为 CF 中真菌特异性生物标志物的作用仍不确定。FC 阳性与年轻患者的 FEV 较低、LCI 较低、NTM 阳性、支气管扩张和静脉内抗生素暴露有关。需要更大规模的试验来确定半乳甘露聚糖和 TNF-R2 作为 CF 中潜在真菌生物标志物的作用。
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