Fungal respiratory infections in cystic fibrosis: a growing problem

Abstract

tions increases as the life expectancy of patients improves. But in contrast to bacterial respiratory infections, relatively little progress has been made with regards to fungal respiratory infections. Aspergillus fumigatus is by far the most common causative agent with a reported prevalence rate varying from 5.9% to 58.3%, but a wide range of fungi may colonize the respiratory tract of CF patients. For example, other Aspergillus species like Aspergillus terreus , as well as Scedosporium spp. and Exophiala dermatitidis are increasingly described in the CF context, but their prevalence is certainly underestimated. Additionally, whether the colonization of the airways by fungi/micromycetes constitutes a clinically relevant problem is still a matter of debate. However, recent studies have clearly indicated an increase in their prevalence rate, and a relationship with increased numbers of hospital admissions. Moreover, due to their thermotolerance and to their propensity to disseminate in immunocompromised hosts, prior colonization of the airways by fi lamentous fungi constitutes a serious risk factor for invasive infections in cases of lung transplantation. The latter remains the ultimate treatment of CF patients. Numerous questions are created by fungal colonization of the airways, and basic research on the ecology of the fungi, their biochemistry, and their pathogenic mechanisms should be promoted in order to defi ne prophylactic measures or to develop more effi cient antifungal drugs. To address these questions, the International Society for Human and Animal Mycology (ISHAM) launched in October 2006, a working group on “Fungal Respiratory Infections in Cystic Fibrosis”, whose fi rst formal meeting was held in Angers, France, on June 7-8, 2009. Altogether 65 clinicians, mycologists or scientists from 14 different countries participated to this meeting, as well as numerous PhD students to guarantee dynamic discussions. Thirtyeight presentations were provided by attendees, covering a wide variety of topics, including (a) “clinical surveillance All authors are members of the ISHAM working group on Fungal Respiratory Infections in Cystic Fibrosis. Correspondence: Jean-Philippe Bouchara, Groupe d’Etude des Interactions Hote-Pathogene, UPRES-EA 3142, Laboratoire de ParasitologieMycologie, CHU, 4 rue Larrey, 49933 Angers cedex 9, France. Tel: 33 (0)2 41 35 34 72; Fax: 33 (0)2 41 35 36 16; E-mail: jean-philippe. bouchara@univ-angers.fr Fungal respiratory infections in cystic fi brosis: a growing problem