Fungal infections and treatment in cystic fibrosis.
OBJECTIVE
This review summarizes some of the important recent findings concerning fungal airway infections in patients with cystic fibrosis (CF). For many years, both researchers and clinicians have focused on the problems in CF caused by chronic bacterial airway infection with organisms such as Haemophilus, Staphylococcus and Pseudomonas. However, until recently, the lack of sensitive culture techniques to isolate fungi in sputum, bronchoalveolar lavage fluid and other respiratory tract samples has limited the recognition of fungal species and their possible role in CF airway infections.


RESULTS
Recent studies using fungal-selective culture media and molecular techniques have shown a plethora of different fungal species in the sputum expectorated from CF patients. Cross-sectional studies have shown associations between Aspergillus and Candida in the sputum and worse lung function. The presence of allergic bronchopulmonary aspergillosis is likely to be a negative prognostic factor, but whether simple fungal colonization itself indicates future problems is not clear. Current research is now examining these epidemiological associations to try to determine the clinical implications. This will help determine whether fungal colonization/infection is associated with worse outcome in CF patients.


CONCLUSIONS
At present, there is no conclusive evidence that fungal organisms cause respiratory decline. Recent studies of antifungal therapy in CF patients have reported differing results, so further investigations in this area are needed.
aCystic Fibrosis Unit, Ludwig Engel Centre for Respiratory Research, Westmead Millennium Institute bCentre for Infectious Diseases and Microbiology Laboratory, ICPMR - Pathology West cMolecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead Millennium Institute dSydney Medical School, University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia.
Peter G
PG
Middleton
Sharon C-A
SC
Chen
Wieland
W
Meyer
D000908:Antibodies, Fungal / Q000302:isolation & purification*; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy / Q000382:microbiology* / Q000503:physiopathology; D001230:Aspergillus / Q000276:immunology / Q000302:isolation & purification; D001232:Aspergillus fumigatus / Q000302:isolation & purification; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D002175:Candida / Q000276:immunology / Q000302:isolation & purification; D002177:Candidiasis / Q000188:drug therapy / Q000382:microbiology* / Q000503:physiopathology; D003550:Cystic Fibrosis / Q000188:drug therapy / Q000382:microbiology* / Q000503:physiopathology; D004271:DNA, Fungal; D005260:Female; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D011743:Pyrimidines / Q000627:therapeutic use; D021681:Scedosporium / Q000276:immunology / Q000302:isolation & purification; D013183:Sputum / Q000382:microbiology*; D014230:Triazoles / Q000627:therapeutic use; D014797:Vital Capacity; D065819:Voriconazole
D000908:Antibodies, Fungal; D000935:Antifungal Agents; D004271:DNA, Fungal; D011743:Pyrimidines; D014230:Triazoles; D017964:Itraconazole; D065819:Voriconazole