Abstract
BackgroundThe prevalence of fungal disease in cystic fibrosis (CF) and non-CF bronchiectasis is increasing and the clinical spectrum is widening. Poor sensitivity and a lack of standard diagnostic criteria renders interpretation of culture results challenging. In order to develop effective management strategies, a more accurate and comprehensive understanding of the airways fungal microbiome is required. The study aimed to use DNA sequences from sputum to assess the load and diversity of fungi in adults with CF and non-CF bronchiectasis. MethodsNext generation sequencing of the ITS2 region was used to examine fungal community composition (n = 176) by disease and underlying clinical subgroups including allergic bronchopulmonary aspergillosis, chronic necrotizing pulmonary aspergillosis, non-tuberculous mycobacteria, and fungal bronchitis. Patients with no known active fungal disease were included as disease controls. ResultsITS2 sequencing greatly increased the detection of fungi from sputum. In patients with CF fungal diversity was lower, while burden was higher than those with non-CF bronchiectasis. The most common operational taxonomic unit (OTU) in patients with CF was Candida parapsilosis (20.4%), whereas in non-CF bronchiectasis sputum Candida albicans (21.8%) was most common. CF patients with overt fungal bronchitis were dominated by Aspergillus spp., Exophiala spp., Candida parapsilosis or Scedosporium spp. ConclusionThis study provides a framework to more accurately characterize the extended spectrum of fungal airways diseases in adult suppurative lung diseases.
Highlights
Cystic fibrosis (CF) and non-CF bronchiectasis are chronic suppurative lung diseases characterised by permanent bronchial dilatation, variable mucociliary clearance and recurrent infections [1,2]
operational taxonomic unit (OTU) belonging to the Candida genus were the most prevalent and abundant across both diseases (Fig. 2)
Candida OTUs were significantly less abundant in those with Fungal bronchitis (FB) compared to No active fungal disease (NAFD) (P < 0.001) and Non-tuberculous mycobacteria (NTM) (P < 0.001) (Fig. 2)
Summary
Cystic fibrosis (CF) and non-CF bronchiectasis are chronic suppurative lung diseases characterised by permanent bronchial dilatation, variable mucociliary clearance and recurrent infections [1,2]. Several studies have recognised that the presence of fungi in airway secretions are associated with accelerated clinical decline [8,9,10]. In adults with CF, Candida, Aspergillus and non-Aspergillus filamentous fungi have all been associated with worse disease and significantly impaired lung function [10,11,12,13]. The rising prevalence and variety of fungi in the sputum of CF patients and their association with severe disease suggest that fungi may directly contribute to airway inflammation, lung function decline and exacerbation rates [8,12]. The prevalence of fungal disease in cystic fibrosis (CF) and non-CF bronchiectasis is increasing and the clinical spectrum is widening. The study aimed to use DNA sequences from sputum to assess the load and diversity of fungi in adults with CF and non-CF bronchiectasis
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