title: Aspergillus and cystic fibrosis: old disease - new classifications.
abstract: OBJECTIVE
  Aspergillus pulmonary infection has traditionally been recognized as a clinical spectrum of increasing pathogenicity, encompassing saprophytic airways colonization historically regarded of doubtful clinical significance, to allergic bronchopulmonary aspergillosis, chronic cavitatory and life-threatening invasive disease in the immunocompromised host. Whilst the latter two categories are rarely encountered in cystic fibrosis (CF), there is recognition of an extending spectrum of disease yet to be reflected in consensus management guidelines. The purpose of this review is to provide an up-to-date overview of this extending spectrum, with a focus on disease categories and their clinical significance.
  
  
  RESULTS
  Conflicting evidence regarding the clinical significance of Aspergillus colonization and sensitization in CF, alongside the emergence of a novel disease category 'Aspergillus bronchitis', has led to proposals for the reclassification of Aspergillus disease. In addition, lack of standardization and poor sensitivity of culture-dependent mycology techniques renders clinical and epidemiological interpretation of these isolates challenging.
  
  
  CONCLUSIONS
  The role of Aspergillus in the absence of established CF-allergic bronchopulmonary aspergillosis remains unclear. The following review discusses new approaches proposed to categorise the extended spectrum of CF Aspergillus disease, highlighting the need for enhanced microbiological investigation and serological monitoring of patients in light of evidence which differentiates colonization from categories of greater pathogenic potential.
authors.affiliation: aAdult Cystic Fibrosis Centre, Royal Brompton and Harefield NHS Foundation Trust, Royal Brompton Hospital bNational Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Imogen C
authors.initials: IC
authors.lastname: Felton
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Simmonds
mesh_terms: D000908:Antibodies, Fungal / Q000276:immunology*; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000175:diagnosis / Q000276:immunology* / Q000503:physiopathology; D001230:Aspergillus / Q000276:immunology / Q000472:pathogenicity*; D003550:Cystic Fibrosis / Q000150:complications / Q000276:immunology* / Q000503:physiopathology; D006801:Humans; D016867:Immunocompromised Host; D017410:Practice Guidelines as Topic
chemical_list: D000908:Antibodies, Fungal