Mycology Reference Centre Manchester, ECMM Centre of Excellence for Medical Mycology and the Department of Infectious Diseases, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK; Paediatric Respiratory Department, Royal Manchester Children's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Department of General Paediatrics, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
Mycology Reference Centre Manchester, ECMM Centre of Excellence for Medical Mycology and the Department of Infectious Diseases, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK; Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
J Cyst Fibros. 2021 Jul;20(4):702-707. doi: 10.1016/j.jcf.2021.03.012. Epub 2021 Mar 26.
Isolation of Exophiala species from sputum samples has become increasingly reported in Cystic Fibrosis (CF). However, the clinical significance of Exophiala spp. with regards to the paediatric CF population is unknown.
A case control study was undertaken to compare CF children with and without chronic Exophiala spp. in their sputum samples. Demographic and clinical data were collected retrospectively for each case from the date of Exophiala isolation and for 12 months preceding isolation. Each case was compared to three age and year-matched controls. To determine the effect of Exophiala on clinical course, patients were then followed for 12 months post isolation.
In total, 27 of 244 eligible paediatric CF patients (11%) isolated Exophiala spp. on more than one occasion. There were no significant differences in the key clinical parameters: spirometry, mean number of intravenous (IV) antibiotic days and body mass index (BMI), between cases and controls (p = 0.91, p = 0.56 and p = 0.63 respectively). A higher proportion of cases isolated Candida spp. (67% vs 21%, p < 0.0001) and Aspergillus fumigatus (37% vs 26%, p = 0.37). There was no clinically significant difference in spirometry, mean number of IV antibiotic days and BMI in cases pre and post Exophiala spp. isolation. Posaconazole was the only drug used that successfully eradicated Exophiala.
Despite the frequent isolation of Exophiala spp. in this cohort, in most patients it is not associated with significant clinical deterioration. It does however seem to be associated with isolation of other fungi.
在囊性纤维化（CF）患者的痰样本中，越来越多地分离出外瓶霉属物种。然而，外瓶霉属物种与儿科 CF 人群的临床意义尚不清楚。
进行了一项病例对照研究，比较了痰标本中慢性外瓶霉属的 CF 儿童和无慢性外瓶霉属的 CF 儿童。从外瓶霉属分离的日期和分离前 12 个月，回顾性地收集每个病例的人口统计学和临床数据。每个病例与 3 个年龄和年份匹配的对照进行比较。为了确定外瓶霉属对临床病程的影响，患者在分离后 12 个月进行随访。
在总共 244 名符合条件的儿科 CF 患者中，有 27 名（11%）多次分离出外瓶霉属。病例和对照组之间在关键临床参数（肺活量、静脉内抗生素使用天数的平均值和体重指数（BMI））方面没有显著差异（p=0.91，p=0.56 和 p=0.63）。更多的病例分离出念珠菌属（67%比 21%，p<0.0001）和烟曲霉（37%比 26%，p=0.37）。在分离出外瓶霉属前后，病例的肺活量、静脉内抗生素使用天数的平均值和 BMI 均无临床显著差异。伏立康唑是唯一成功根除外瓶霉属的药物。
尽管在本队列中外瓶霉属的分离很常见，但在大多数患者中，它与明显的临床恶化无关。然而，它似乎与其他真菌的分离有关。
