A 16-year retrospective study on fungal prevalence and diversity in patients with cystic fibrosis: Candida dubliniensis was associated with a decline in lung function. (July 2020)

• Record Type: Journal Article
• Authors: Al Shakirchi, Mahasin; Klingspor, Lena; Bergman, Peter; Hjelte, Lena; de Monestrol, Isabelle
• Is Part Of: International journal of infectious diseases. Volume 96(2020)
• Page Start: 663
• Page End: 670
• Publication Date: 2020-07
• Subjects: Cystic fibrosis -- Molds -- Yeasts -- Candida albicans -- Candida dubliniensis -- Aspergillus fumigatus; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2020.05.063
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Fungal prevalence and diversity in the cystic fibrosis (CF) airways increased over time. Candida dubliniensis in the CF airways was associated with a decline in lung function. Persistent Candida albicans over time was associated with a decline in lung function. Persistent Aspergillus fumigatus over time was associated with a decline in lung function. In CF, co-detection of yeast and bacteria had a negative impact on lung function. Abstract: Objectives: To study the prevalence of fungal species in cystic fibrosis (CF) patients over a 16 years period. To examine the impact of Candida albicans ( C. albicans ), Candida dubliniensis ( C. dubliniensis ) and Aspergillus fumigatus ( A. fumigatus ) on lung function. Methods: Observational single-center cohort study (2000–2015) including 133 CF patients (ages 6–66 years). Linear mixed models with autoregressive covariance matrix were used. Results: The most common fungus was C. albicans (prevalence 62%) followed by A. fumigatus (22%) and C. dubliniensis (11%). In the initial year of detection, there was no impact of C. albicans, C. dubliniensis or A. fumigatus on lung function. However, one and two years after detection of C. dubliniensis a reduction in percent predicted forced expiratory volume in the first second (ppFEV1) was observed of 3.8% ( p = 0.022) and 4.1% ( p = 0.017), respectively, compared with CF patients without these findings. Furthermore, patients with positive cultures for any of these fungal species for three consecutive years exhibited a decline in lung function: C. dubliniensis, 7.6% reduction in ppFEV1 ( p = 0.001); A. fumigatus, 4.9% ( p = 0.007); C. albicans, 2.6% ( p = 0.014). The results were adjusted for age, CFTR genotype, chronic and intermittent P. aeruginosa colonization, and numbers of intravenous antibiotic treatments per year. Persistence of C. dubliniensis for three consecutive years was positively correlated to age and erythrocyte sedimentation rate (ESR) (both p = 0.001). Conclusions: Cystic fibrosis patients who were cultured positive for C. dubliniensis, C. albicans or A. fumigatus in sputum exhibited a decline in ppFEV1 over time. The effect was most pronounced for C. dubliniensis .