title: Chronic Aspergillus fumigatus colonization of the pediatric cystic fibrosis airway is common and may be associated with a more rapid decline in lung function.
abstract: Filamentous fungi are commonly isolated from the respiratory tract of CF patients, but their clinical significance is uncertain and the reported incidence variable. We report on the degree of Aspergillus fumigatus airway colonization in a tertiary pediatric CF cohort, evaluate the sensitivity of routine clinical sampling at detecting A. fumigatus, and compare lung function of A. fumigatus-colonized and non-colonized children.We carried out an 8-year retrospective cohort analysis using local databases, examining 1024 respiratory microbiological specimens from 45 children. Nineteen (42%) had a positive A. fumigatus culture at least once during the 8-year period, with 10 (22%) children persistently colonized. Overall, 29% of 48 bronchoalveolar lavage (BAL) samples tested positive for A. fumigatus, compared with 14% of 976 sputum samples. Of 33 children for whom lung function data were available during the study period, seven were classed as having severe lung disease, of whom four (57%) were persistently colonized with A. fumigatus.We conclude that chronic A. fumigatus colonization of the CF airway is common, and may be associated with worse lung function. In our practice, BAL appears superior at detecting lower airway A. fumigatus compared to sputum samples.
authors.affiliation: University Hospitals of Leicester NHS Trust, Department of Clinical Microbiology, Infirmary Square, Leicester, UK.
authors.forename: Rosalind V
authors.initials: RV
authors.lastname: Saunders
authors.affiliation: University Hospitals of Leicester NHS Trust, Department of Clinical Microbiology, Infirmary Square, Leicester, UK.
authors.forename: Deborah E
authors.initials: DE
authors.lastname: Modha
authors.affiliation: Children's Hospital, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Claydon
authors.affiliation: University of Leicester, Dept. of Infection, Immunity and Inflammation, University Road, Leicester, UK Children's Hospital, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, UK Institute for Lung Health, NIHR Leicester Respiratory Biomedical Research Unit, Leicester, UK eag15@le.ac.uk.
authors.forename: Erol A
authors.initials: EA
authors.lastname: Gaillard
mesh_terms: D000293:Adolescent; D001228:Aspergillosis / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D001232:Aspergillus fumigatus / Q000302:isolation & purification*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000150:complications* / Q000473:pathology*; D005260:Female; D006801:Humans; D008168:Lung / Q000382:microbiology* / Q000473:pathology*; D008297:Male; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D062606:Tertiary Care Centers
keywords: Bronchoalveolar lavage; Children; Filamentous fungi; Sputum