What is the importance of classifying Aspergillus disease in cystic fibrosis patients?

Abstract

Aspergillus species are commonly isolated from lower respiratory tract samples of patients with cystic fibrosis (CF) and markers of immunological sensation to Aspergillus are frequently encountered in this group of patients; however, the contribution of Aspergillus to CF lung disease outside of the typical complications of ABPA and aspergilloma formation remains largely unclear. Patients with CF show discretely different responses to Aspergillus, though the underlying reasons for this variation are unknown. Recent work has begun to allow us to categorize patient responses to Aspergillus based upon molecular markers of infection and immune sensitization. Aspergillus sensitization and/or airway infection is associated with worse FEV1, in CF and other patients (asthma, chronic obstructive pulmonary disease, bronchiectasis). Classification of different clinical phenotypes of Aspergillus will enable future studies to determine the natural history of different manifestations of Aspergillus disease and evaluate the effects of intervention with antifungal therapy.

Keywords::

• allergic bronchopulmonary aspergillosis
• Aspergillus bronchitis
• cystic fibrosis Aspergillus
• galactomannan
• IgE
• IgG
• PCR
• triazoles

Financial & competing interests disclosure

DW Denning holds founder shares in F2G Ltd and has received grant support from the National Institute of Allergy and Infectious Diseases, The National Institute of Health Research, the European Union and AstraZeneca. DW Denning acts as a consultant to Trinity group, T2, Biosystems, GSK. DW Denning has acted as a consultant to Pfizer, Schering Plough (now Merck), Astellas and Gilead. DW Denning has also been paid for talks on behalf of Astellas, GSK, Gilead and Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.