Abstract
Although the spectrum of fungal pathology has been studied extensively in immunosuppressed patients, little is known about the epidemiology, risk factors, and management of fungal infections in chronic pulmonary diseases like bronchiectasis. In bronchiectasis patients, deteriorated mucociliary clearance—generally due to prior colonization by bacterial pathogens—and thick mucosity propitiate, the persistence of fungal spores in the respiratory tract. The most prevalent fungi in these patients are Candida albicans and Aspergillus fumigatus; these are almost always isolated with bacterial pathogens like Haemophillus influenzae and Pseudomonas aeruginosa, making very difficult to define their clinical significance. Analysis of the mycobiome enables us to detect a greater diversity of microorganisms than with conventional cultures. The results have shown a reduced fungal diversity in most chronic respiratory diseases, and that this finding correlates with poorer lung function. Increased knowledge of both the mycobiome and the complex interactions between the fungal, viral, and bacterial microbiota, including mycobacteria, will further our understanding of the mycobiome’s relationship with the pathogeny of bronchiectasis and the development of innovative therapies to combat it.
Highlights
Bronchiectasis is defined as chronic inflammatory bronchial disease with irreversible dilation of the bronchial lumen, and it can occur for a number of reasons
Aspergillus fumigatus is isolated from respiratory secretions of patients with cystic fibrosis (CF) in between 9% and 57% of samples, and the rate is somewhat higher in the case of C. albicans
allergic bronchopulmonary aspergillosis (ABPA) is associated, in both CF and bronchiectasis, with a greater prevalence of airway infection by other pathogenic microorganisms, such as non-tuberculous mycobacteria (NTM) [56,57], it is not known whether this association is due to defects in the cystic fibrosis transmembrane conductance regulator that could occur in patients with bronchiectasis, or whether this explanation is only applicable to CF patients [70]
Summary
Bronchiectasis is defined as chronic inflammatory bronchial disease with irreversible dilation of the bronchial lumen, and it can occur for a number of reasons. There are no published data about the real prevalence of co-colonization of fungi and bacteria, in most cases, fungi are isolated with pathogens, such as Haemophillus influenzae or Pseudomonas aeruginosa, making difficult to determine their pathogenic significance They are associated with a persistent inflammatory response in the airways that can be measured accurately, in those patients with more marked respiratory deterioration. The traditional diagnostic methods (microscopic tests, biochemical analysis, and cultures in selective media) are still used, in many instances they have been superseded by new molecular techniques, such as metagenomic analysis, as well as by the application of mass spectrometry (Matrix-Assisted Laser Desorption/Ionization Time-of-Flight—MALDI TOF) technique [4] These breakthroughs have made it possible to identify new fungal pathogens, more studies are needed to determine their clinical significance. We are still lacking in uniform diagnostic criteria for some of these fungal diseases [6]
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