title: Tracheobronchial mycosis in a retrospective case-series study of five status asthmaticus patients.
abstract: 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.
authors.affiliation: Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
authors.forename: Garbo
authors.initials: G
authors.lastname: Mak
authors.forename: Paul C
authors.initials: PC
authors.lastname: Porter
authors.forename: Venkata
authors.initials: V
authors.lastname: Bandi
authors.forename: Farrah
authors.initials: F
authors.lastname: Kheradmand
authors.forename: David B
authors.initials: DB
authors.lastname: Corry
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D001991:Bronchitis / Q000150:complications / Q000276:immunology / Q000382:microbiology*; D002177:Candidiasis / Q000150:complications / Q000276:immunology; D004195:Disease Models, Animal; D005260:Female; D006801:Humans; D008297:Male; D051379:Mice; D008810:Mice, Inbred C57BL; D009182:Mycosis Fungoides / Q000150:complications / Q000276:immunology*; D012189:Retrospective Studies; D013224:Status Asthmaticus / Q000150:complications / Q000276:immunology / Q000382:microbiology*; D014136:Tracheitis / Q000150:complications / Q000276:immunology / Q000382:microbiology*